Peering into a patient’s eyes has become so second nature to us that, as eye care practitioners, we seldom think about the importance of eye gazing beyond the practicality of collecting diagnostic information. But eyes can reveal an abundance of information about the life of the patient. A wise clinician will take advantage of this opportunity to emotionally connect through the old adage, “Look a person in the eye.”
Modern medical clinicians and other health care personnel are continually becoming more efficient in record keeping and data collecting. Unfortunately, these digital notes do not translate to improved patient rapport. In 2010, Lisa Gualtieri, PhD, ScM, assistant professor in the department of Public Health and Community Medicine at Tufts University in Boston, penned, “Doctors need more eye contact with patients, not computers,” after one of her recent doctor visits, where a nurse sat at a laptop and fired away a series of questions without once looking over while typing.1
Pamela Ressler, RN, BSN, HN-BC, founder of Stress Resources and adjunct faculty member at Tufts University, indicated that medical professionals have prioritized information gathering over communication. “While it is essential to collect information to arrive at a correct diagnosis, simply collecting information without addressing the human experience creates disconnection instead of connection, often leading to dissatisfaction by both the patient and provider,” she said.
The reality is that our schedules are tight and our time is squeezed even further as the amount of information we are mandated to record increases. This, in turn, results in less patient interaction, which is dissatisfying for both the patient and the doctor. But, there are some things we can do to show our patients that they are valued and are important to us. Here are some ideas:
• Establishing good communication skills can improve patient outcomes. When patients are engaged, they better understand direction and are generally more compliant. This translates to improved eye health.
• Time your eye contact. Lee Hopkins, author of “Non-Verbal Communication in Business,” suggests breaking eye-to-eye contact into five-second increments. That is, look at the other person for five seconds, then look away. By doing so, you won’t intimidate your patients. I suggest practicing to perfect the timing.
• Look for social cues and follow up with questions. When you look into your patient’s eyes, you may see confusion, worry, fear, sadness, frustration, uncertainty or disapproval—emotions that are easy to read in your patient’s eyes. Follow up the observation by asking if you can clarify something, or acknowledge the apprehension and ask if you can provide more guidance. This simple step can go a long way in developing long-lasting patient relationships.
• Redesign your patient rooms. As we know, the implementation of electronic health records requires adding computers into the exam rooms. Danny Sands, MD, MPH, director of healthcare for Cisco Systems, says eye care practitioners should work around it. When there is a computer in the room, it is part of the conversation. Therefore, it must be positioned in a way that it can be a part of the conversation without being an imposition; Dr. Sands said to think of it as if there is another person in the room. The computer should be the apex of an equilateral triangle with the human participants as the vertices. If using a tablet, the computer should be held by the optometrist, as the patient sits by his or her side.
“Too often, the computer is an intruder in the room and the goal of the clinician is to interact with the patient as a means of entering appropriate information into the machine,” says Dr. Sands.1 To achieve this, it may be necessary to rearrange the exam room to better facilitate eye contact while using the computer. Better yet, hire a scribe, if possible, to do the record taking while you do the communicating.
Philospher Marcus Tullius Cicero put it best when he said, “Ut imago est animi voltus sic indices oculi” — The face is a picture of the mind, with the eyes as its interpreter. We must remember that it is a privilege to be able to connect with our patients, establish mutual respect and build a long and satisfying patient-doctor relationship.
1. Gualtieri L. Doctors need more eye contact with patients, not computers. KevinMD.com: Physician. 30 Apr 2010. Available at: www.kevinmd.com/blog/2010/04/doctors-eye-contact-patients-computers.html. Accessed December 2012.