The "Academic" Patient
The internet has been of great help to physicians as patients are now able to learn more about their diseases on their own. Additionally, they can find other patients with similar conditions or support groups easily. It can also be a hazard to physicians, as patients become spammed with advertisements for wonder drugs and procedures they should "ask their doctor about". Some patients are able to sift through the material to determine what seems educational versus promotional. Others not only evaluate all forms of information but search for as much as possible. These are the patients who enter the office with pages of printed research from the internet they want to discuss. They’ve determined, often before diagnosed with cataracts, that they would like an aspheric lens but want to know more about "dysphotopsias" in lens A versus B. These patients have acquired a large body of information on optics and intraocular lenses and should be handled carefully. Unfortunately, like much information on the internet, not everything is true.
To begin, I re-educate the patient as to what a cataract is and what we are doing in cataract surgery. I have found that cataract education software does an excellent job of providing a visual aid to explain everything to the patient, including risks of surgery. Regarding the intraocular lens choice, I let the patient know that all of the currently available lenses are fantastic, but there are very subtle differences between them. Oftentimes I will offer the patient to let me pick what I would believe to be the best lens for them. However, these patients often want to be involved in the lens choice process. For them, I will use the internet to my advantage; First, I will decipher which lenses they are currently considering. After listening to the patient’s needs, I will let them know which of their lenses the "top two" are for them. Then, I will refer them to the lens manufacturers’ websites. I will then ask them to e-mail me their choice of lens. Once I receive that e-mail, I will reply to the patient reinforcing which lens they have selected, what realistic expectations are for that lens, and what some shortcomings of that lens may be. This allows the patient to have realistic expectations, to feel that they have made the appropriate lens choice themselves, and provides an additional piece of informed consent for me which I include in the patient record.
Ultimately, these patients can be very demanding, essentially desiring a complete education in visual optics within a short office visit. However, by recommending the appropriate internet venues to acquire information and by using e-mail to answer questions, chair time can be shortened to that of an average patient visit.