PHOTOGRAPHY BY LAUREN JEZIORSKI, ZOE COMMUNICATIONS GROUP

The young boy entered Children’s Eye Care of Michigan shuffling in his snow boots. “Pick up your feet,” his mother ordered. The boy replied by marching loudly into one of the locations of the 50-year-old Great Lakes state practice, remembers ophthalmic tech Emily Remick, COT (See “The academic side,” p. 14).

“I just started laughing and from that moment on, that boy and I were buddies,” she says.

Building such rapport goes a long way in developing a trusting relationship with the patient. And according to several studies, such trust is essential for acquiring a comprehensive patient history, accurate test results, and patient compliance to prescribed management.^1,2

Ms. Remick is among 17 allied health staff members (10 techs and seven orthoptists) in addition to nine pediatric ophthalmologists who routinely must achieve patient rapport at the practice.

Here’s a look at how they’ve accomplished this.

“Reading” the patient

Every patient, regardless of ocular issue and age, has their own personality. Learning that personality type from the outset and adjusting one’s interaction with the patient accordingly is one way the Children’s Eye Care of Michigan team builds patient rapport, points out Ms. Remick.

“I’m reading the child from the time I pick them up from the waiting room,” she explains. “If they’re hiding their face or they’re gluing themselves to the waiting room chair, I immediately know that I’m going to have to tread carefully in getting the information needed for the doctor.”

Treading carefully to allay the child’s anxiety can include appearing quiet, calm, and patient, Ms. Remick notes.

“I remember this little girl who was very apprehensive with us after her cataract surgery,” remembers Ms. Remick. “I told her that it was OK to be upset and that we’d be gentle. Two years later, she hugs me now.”

Ms. Remick also offers a cautionary word: “None of the staff here say, ‘calm down’ because that’s going to make it worse.”

Christiana Hawk, another ophthalmic assistant at the practice, says she lets introverted patients know they don’t have to talk.

“I’ll say, ‘You can just point to the picture,’” she says. “Knowing that conversation isn’t going to be forced on them definitely helps those types of patients feel more comfortable.”

Ophthalmic technician Mary Cyccone, COT, adds that the techs question parents about their infant’s personality.

“All patients, regardless of age, want comfort,” stresses Lisa I. Bohra, MD, one of Children’s Eye Care of Michigan’s doctors. “With our adult strabismic patients, this often comes in the form of making small talk, such as discussing the weather.”

Clarifying the chief complaint

In recognizing the diagnosis isn’t the child, the Children’s Eye Care of Michigan staff members make a point of asking how, specifically, the condition is affecting the patient. It’s another step that helps create patient rapport, notes Mary DeYoung-Smith, CO, COMT, an orthoptist at the practice.

“We may ask, for example, ‘What makes you struggle the most? Is it when reading or playing with things up close, or do you have more issues when watching TV?’” she says. “We want patients to know that we see them as people who have real feelings and that we want to help if we can, so they appreciate this questioning.”

Using the “right” tools

The old adage “Know your audience” applies to private practice ophthalmology: When patients recognize that the practice knows who they are, the staff builds rapport, says Ms. Cyccone.

To help build this recognition, Children’s Eye Care of Michigan employs a variety of child-friendly vision assessment tools, including popular toys (e.g., Elsa from “Frozen”), pictures (e.g., Pokémon), animated stuffed animals (e.g., a monkey using cymbals), movie clips (e.g., “Monsters, Inc.”), games (matching to test VA), Lea Symbols, HOTV chart, the Randot stereo butterfly test, and stickers, among others. “If the child sees that a tech has something they like as well, such as a ‘Paw Patrol’ sticker, for instance, that creates a connection between the tech and that child, making the child more likely to cooperate,” Ms. Cyccone explains. “Additionally, the tools we use create patient engagement, which is needed to yield accurate data in those patients who don’t have the best attention spans.”

When infants and children are unable to keep their heads in place for slit lamp exams that use stationary equipment, staff members will conduct the exams using handheld or portable devices, such as portable slit lamps, Tono-Pens (Reichert), iCare tonometers (CenterVue), and battery-operated indirect ophthalmoscopes.

Providing explanations

The staff at Children’s Eye Care of Michigan says they explain the purpose of tests and what patients can expect because they want to create informed patients who know their feelings are being considered. It’s another way the practice fosters patient rapport, notes Ms. Hawk.

“When it comes to instilling the dilating drops, I find that explaining too much to the younger kids can worsen their fears,” she describes. “When getting ready to give the drops to the older kids, however, I explain that the drops are going to sting for a couple seconds, but if the child blinks right after, their eyes will feel better. Because I’m telling them what to expect, they’re less apprehensive.”

Dr. Bohra stresses that providing explanations is also important in acquiring patient compliance to the prescribed management. She uses amblyopia as an example.

“I explain to the parent and the child — if the child is old enough to understand — that the brain is starting to ignore the eye that has weaker vision and rely on the eye that has good vision,” she explains. “Then, I say that we can intervene up to a certain age by patching, which can strengthen vision in the weaker eye.”

Dr. Bohra adds that Children’s Eye Care of Michigan recently started a patching poster program. Once the patient fills up their poster with their patches, it is put on display in the practice, and the patient receives a small prize.

Patient rapport is paramount

In looking back on her visit with the marching boy, among other patients, Ms. Remick acknowledges that patient rapport is absolutely paramount in any ophthalmic practice.

“We need to win the patient over, so we can provide them with the best care,” she says. OP

REFERENCES

1. Goold SD. Trust, Distrust and Trustworthiness. J Gen Intern Med. 2002;17(1):79-81.
2. Bell J, Condren M. Communication Strategies for Empowering and Protecting Children. J Pediatr Pharmacol Ther. 2016;21(2):176-184.