Imagine you have a happy, compliant patient

Andrew Watkins

Andrew Watkins is a 1985 graduate of University of New South Wales. He has a full scope practice in Canberra City. The practice has a special interest in contact lenses with an emphasis on fitting keratoconics, corneal grafts and iatrogenic ectasias. He also travels regularly to provide primary eye care to developing countries and Australian indigenous communities.

Imagine you have a happy, compliant patient.  They have worn contact lenses for many years.  Very few complications.  They also have glasses that they are happy to wear, doing so at least one day per week and at the end of each day before they go to bed.  The corneas are normal – tear film, epithelium and endothelium look good.  There is a little bit of limbal injection but nothing clinically significant.  The upper lids are smooth.  The patient even reports, when asked, that their lenses are comfortable. 

So do we leave the happy, compliant patient as they are? If it ain’t broken don’t fix it, right?

Wrong.  We should not be lazy and take their success or compliance for granted.  Some of these patients are wearing lenses that may have hit the market in 1989 - nearly twenty years ago!  If we can give them another lens that allows them longer wear time and reduced long term effects on the eye we would be negligent to not at least explore that possibility with the patient.

We should also ask this question: why is this patient so compliant, doing everything as they should?  Compliance from a patient is generally because the patient has a fear that something could do wrong.  Or, while they report their lenses to be comfortable, at the end of the day they are actually keen to get them out because they physically start to feel the desire to take them out.

So, now we have materials, silicon-based, that let the eye breathe 4-5 times more than their old material.  We should offer these more breathable materials to individual patients and prescribe much more often to the population base as a whole.  I have done this many times in my practice.  The happy, compliant patient becomes even happier, because they can now wear their contacts even longer with less long term complication.  They will start to view you differently: instead of being simply a supplier of a commodity they respect you more as a clinician.  This is because you have become more proactive, but more importantly, because you have taken an interest in their eye health.  It is also the reality.

Other things start to happen as a result of this.  Patient loyalty is increased dramatically and referrals to your practice increase as a result. 

A young lawyer moved to my district a few years ago.  She is a high myope and wore -12.00 R and L without apparent symptoms for approximately ten years prior to seeing me.  She wore her lenses for relatively long periods and claimed to always put on her glasses a few hours before bed time.  Slit-lamp findings were nothing remarkable.  Her lids were smooth, corneas clear but with Grade 1+ limbal neovascularization.  The lenses she was wearing at the time had been in production since 1989.

I told her of some new materials that were available that let 4-5 times the amount of oxygen through, creating much better long term prospects for her.  I fitted her with an extended wear material but still just on a daily wear basis.  She took a pair of trial lenses from my practice that day and we arranged a review at two weeks.

At two weeks, the slit-lamp signs were no different.  The patient’s perception of contact lenses and contact lens practitioners was very different however.  While she thought she was happy enough before, the new lenses offered her much more comfort and longer wear time and she had confidence in me as a practitioner who was interested in her ocular health.  Her previous practitioner, in my opinion, had not served her appropriately as they kept her in a lens that was dong the job reasonably well but did not take advantage of new technology.

Since seeing her I am amazed at the number of lawyers and other staff that come in as new patients from her very large law firm.

If we fail to be innovative in our prescribing habits we risk many things.  Clinically, the patient is much more at risk of corneal hypoxia and its long term complications.  The practitioner is more vulnerable to legal complications if things go wrong with the old lenses.  Of course this is the case with new material lenses also, but I would prefer to argue that we tried these lenses in the best interests of the patient rather than arguing that a lens developed in 1989 is still the best without exploring other possibilities. 

The other risk with not upgrading your patients is purely a business risk.  You risk losing these patients forever if they perceive you as someone who keeps supplying the same old lenses without exploring new developments.

Patients referred to me were usually already seeing another practitioner but they obviously had a perception that perhaps it is time for a change.  We all lose patients occasionally, but I’d never want to lose them because they perceive me as someone not interested in making things better and not interested in their ocular health.

Don’t neglect your happy, compliant patients. It may be that their present lens is the best lens for them but often a more probing history taking will reveal some reservations about their present lenses. No matter how small their reservations, if we can solve their problem, your patient will always be grateful. Make happy patients happier.