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How to Reduce Resistance to Care

Posted by Ilena Di Toro | Posted on October 23, 2018

Repeat after me:
• If you are between the ages of 20 and 64, even if you don’t have any underlying health issues, you need to have an eye exam every two years.
• If you are age 65 or older, you need an eye exam every year.
• If you have diabetes or a history of glaucoma or cataracts, you need eye exams even more frequently.

Exams are needed to detect problems early. The trouble is that not everyone is amenable to getting regular eye care. Many say things like:
“I see fine. I don’t need to go to the eye doctor.”
“I bought these eyeglasses in the drug store and they work for me.”
“It’s just another way to get money out of me.”

So, what can you, as the doctor, do to reduce resistance? Here are some strategies:

Gender
Studies show that men are less likely to seek medical care. Not surprisingly, it has to do with the cult of machismo and not admitting to weakness, i.e. feeling sick or having failing eyesight. If male patients have wives or adult children, they will eventually and begrudgingly make their way into your office. Once they are in your office, you need to make your case. Talk about how regular eye exams will help maintain good eyesight, which in turn helps them to keep their independence, so they can continue driving and taking part in favorite activities. Help them understand that the consequences can be serious.

Watch your words
You may say to your patient: “Persons over the age of 45 are more likely to have presbyopia and will need corrective lenses.”

That same sentence in plain language: “Most people when they reach middle age will find it hard to read printed materials and they will need bifocal lenses.”

You worked hard to get your education, but using big words in front of patients without defining them won’t make you sound impressive. Rather, it confuses the patient. Using plain language is best way to improve compliance.

It also helps to educate the patient about eye anatomy, as it relates to the patient’s condition. Show the patient their retinal photo, an eye model, and/or YouTube videos. If the patient has glaucoma, explain how the eye drops help to prevent further vision loss. The idea is to empower the patient, not make him or her depressed or confused about their condition. Tell them that regular visits will help monitor changes in vision and increase the likelihood of improved outcomes.

Recommend other services
Sometimes, despite your best efforts and perfect annual exam attendance, your patient’s vision gets worse. If you can tell this is starting to happen, it is best to discuss other services, such as low vision services, that can benefit the patient. They will appreciate you taking the initiative. Mentioning a service like low vision early on allows the patient to learn more about these services without the stress of needing something immediately and being unprepared.

While not every resistant patient will respond to your efforts, the idea is to encourage patients to take small steps towards ownership of their health, especially their eye health. When the focus is on what patients can do for themselves, as opposed to the idea that things are being done to them, patients engage with you and they resist less.

Sources:
https://www.preventblindness.org/how-often-should-i-have-eye-exam

https://www.cdc.gov/features/healthyvision/index.htm

https://theconversation.com/men-more-reluctant-to-go-to-the-doctor-and-its-putting-them-at-risk-57420

http://reviewob.com/how-to-make-it-more-likely-patients-follow-your-treatment-plans/

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