Evdokia Sourla

Many factors can induce anxiety in patients before and during an eye examination. It is important to take into consideration that many patients did not have a previous ocular assessment and thus remain unfamiliar with the procedural aspects. Among these patients, some are in a lot of pain around or inside the eye or have an episode of sudden loss of vision or their disease progresses and they are gradually losing their vision. These patients are usually anxious and concerned about the pronouncements that the ophthalmologist would make regarding their ocular condition and visual acuity. Additional sources of anxiety may arise from pre-existing mental health issues, exacerbating patients’ stress in clinical and crowded settings. Moreover, language barriers impair effective communication between patients and their healthcare providers triggering their anxiety. They will feel the pressure to provide precise information while simultaneously worrying about their ability to understand the doctor’s instructions after the consultation.

Recognize the anxious patient

Sometimes a patient who experiences anxiety can be recognized by some physical signs. Some of them are high blood pressure, high respiratory rate, sweating and agitation.

At the beginning of the consultation, anxious patients may have many inquiries related to the examination process seeking detailed information about each step of it. During examination, they usually interrupt the procedure out of fear especially when the ophthalmologist handles an instrument near their eyes. For instance, when the ophthalmologist uses the lens to assess the fundus, these patients may withdraw their head from the slit lamb and inquire about the nature of the instrument and its potential effect on their eyes. After examination, anxious patients usually ask a lot of questions and repeat the same questions for a profound understanding of their condition.  On the other hand, some anxious patients would hesitate to ask questions and share their concerns because of their fear of hearing “bad news” or getting unfavorable updates about their condition or their vision status.

Issues of concern while dealing with an anxious patient

When patients are uncomfortable, they are more likely to share inaccurate or incomplete details regarding their medical history or their visual symptoms. Moreover, they often fail to follow the doctor’s instructions during the examination.

All the aforementioned limitations could have a negative impact on the doctor’s assessment which could eventually affect the management and treatment plan. Those patients usually pay less attention during the consultation, making them more susceptible to forgetting and misinterpreting the diagnosis, management and treatment plan.

How to approach anxious patients

1. Greet patients and guide them to the examination room.
2. Building rapport with patients is crucial, start by introducing yourself and your role. Try to keep eye contact and smile during the whole consultation.
3. While you are talking try to have your chair at the same eye level as the patient’s chair.
4. It is also important to ask the name that the patient would like to be addressed; family or first name. You can use this name during the consultation. This will make them feel more comfortable.
5. Before starting to take the medical history, explain to the patient what you are going to do in each step and the reason for each examination. For example, taking a medical history, perform an eye examination on the slit lamp and review their investigation results.
6. Sometimes it helps before starting to take the medical history to briefly talk about non-clinical topics like weather, and holidays. This will help to establish rapport and alleviate any initial tension.
7. Always pay attention when the patient is talking. Try to avoid long silence periods and try not to look at the computer screen checking the patient’s investigations or typing your notes while the patient is talking.
8. Start the conversation with open-ended questions. This approach will give patients a valuable opportunity to discuss their concerns about their vision. This will help you better understand how the patient’s vision probably affects their everyday life activities. Listen carefully without interrupting them while they are expressing their thoughts and try to address their concerns, which can be fully discussed at the end of the examination. For example, if the patient’s vision has been decreased and no abnormal finding through examination, advice for new spectacles can be given.
9. If the patient is shy or there is a language barrier between the patient and the doctor, close-ended questions might be more appropriate. This will help to obtain some useful information about the history. During the consultation, if the patient becomes more comfortable and not so anxious, you can start asking them some open-ended questions to get a more detailed medical history.
10. During the eye examination, it is very important to explain to the patient each step of the examination with simple and easy-to-understand terms. For example, I will use a lens that will not touch your eye to look at the back of your eye or I will put some drops to make your pupil larger to be able to see the back of your eye.
11. Patients always like to feel that they have been listened to and understood by their doctors. One way to indicate this to the patient is by giving a summary of their problems. In addition, this will give them a chance to add any details that you probably missed when you presented the summary.
12. Finally, at the end of the appointment, make sure to explain the diagnosis and treatment plan as many times as needed using simple words and ask the patients to repeat what they have understood.
13. Leaflets related to their eye condition may be offered to enhance their understanding of their condition from a reliable resource.  
14. Always ask if there are any questions before the patient leaves the room.

Summary

It is crucial to calm an anxious patient. This will firstly help the patient to feel more relaxed and comfortable during the consultation. Secondly, it enhances the patient’s ability to focus and provide the information needed during history taking without forgetting any important details that might alter the management plan substantially. They also will not misinterpret the diagnosis and treatment instructions. As a result, the patient will be more satisfied after the appointment and probably better treatment outcomes will be achieved.  

Further Reading

Elliott B. David, (2021), Clinical Procedures in Primary Eye Care, 5th Edition. Elsevier Ltd.

Court H, Greenland K, Margrain TH (2009), Evaluating the association between anxiety and satisfaction, Optometry and Vision Science 86(3):p 216-221, March 2009. | DOI: 10.1097/OPX.0b013e318196cf59