Learning to Communicate About Premium Lenses

In our practice we try to avoid technical terms when referring to premium lenses. ” Multifocal”, “pseudo accommodating”, “apodization”, etc., tend to be very confusing for patients.  Instead, we try to simplify it.  Many practices will use the term “premium lenses”.  However, many patients are put off by the concept of “premium” in any form.  This is especially true of the early post World War II Boomers.

Therefore, in our practice, we tend to call these lenses “advanced technology lenses”.  This allows us latitude in deciding which lens to choose specifically for the patient, since we use all of them.

For most of us, adding advanced technology lenses to our practice is a major change in our behavioral pattern.  Whether we are adding these lenses or trying to increase their usage in our practice, requires us to make substantial changes in the way we educate and communicate with our patients.  This change in education and communication requires substantial behavior changes on the part of us as doctors and on the part of our staff.

Early in my experience with advanced technology lenses, a colleague of mine asked me to assist him in increasing his effectiveness in communicating with patients regarding these lenses.  He’s a very personable and caring doctor yet, his ability to introduce advanced technology lenses to his practice was, to put it kindly, pathetic.

We sat down and talked about the way we learn how to change behavior, and we realized that he and I had very different approaches to the way we learn and communicate.

Over a period of time, I’ve developed the following fifteen principles of behavior change.  I believe that these principles apply not only to adopting advanced technology lenses but to all aspects of behavioral change in our lives.

Make sure you understand and can practice each principle before moving on to the next.

Believe in what you are trying to do.  This is the first and most important principle and everything else follows from it.  You must believe that the use of advanced technology lenses is one of the most valuable things you can do for your patients.  (See my former journal entries regarding patients’ responses to their perceived value of these lenses.)  When one of my patients decides not to have an advanced technology lens, I am actually sad for them.  I’m not sad because I will lose financial gain – I am sad because I know and believe that they will not experience the tremendous benefit and advantage these advanced technology lenses have to offer to them.

One surgeon in a recent journal article stated that you must believe in advanced technology lenses to the point that you would willing to implant one of these lenses in your sister.  But I believe that you need to believe in these lenses even more strongly than that – you must believe that these lenses are so valuable that you would implant one in your own eyes.  Hundreds of ophthalmologists world-wide have had these lenses implanted in their own eyes.  I personally know of at least fifteen ophthalmologists who have bilateral advanced technology lenses.  Virtually every advanced technology developed in the last ten years had been implanted in hundreds of MDs.  One prominent New York City ophthalmologist has even implanted advanced technology lenses in his own wife (a true believer and A VERY BRAVE MAN).  The only reason I waited so long, until 2009, to have my own lenses implanted was that as a high myope the lenses that I needed were not made in the power that I required.  Within one month of these lenses being available, I had my own surgery.  I couldn’t wait to have my surgery done!

Understand how your mind learns.   All of us are terrific students.   We wouldn’t be doctors, if we weren’t.  But few of us truly understand how we learn and how we can change our own behaviors.  The field of Neuro Linquistic Programming (NLP) offers a useful model of how the mind learns to change behavior.
The four step model that NLP offers to describe how the mind learns can serve as a yard stick to measure your own progress.  These steps are as follows:

Unconscious incompetence:  You’re doing something wrong and you don’t even know you’re doing it wrong.
Conscious Incompetence:  You’re doing something wrong and you’re aware you’re doing it wrong, but you haven’t yet fixed the problem
Conscious Competence:  You’ve learned the right way to do it and you’re doing it correctly by focusing your attention on it.
Unconscious Competence:  You no longer have to think about something or work on learning it.  You automatically do it correctly.  This should be your goal in becoming a skilled communicator about advanced technology lenses.
Acquire and apply knowledge in small chunks.  Some people are perfect students.  They want to gather every scrap of information they can before taking action.  Though they seem to be working hard, this may actually be a form of procrastination.  The best way to learn how to communicate with patients about advanced technology lenses is to simply take it one step at a time.  If you can’t directly make the recommendation for advanced technology lenses, simply describe advanced technology lenses to the patient as an “opportunity”.   (The next journal entry will be a series of “Dialogues”, which are scripts that we use with our fellows to help them in their approach with patients.)
There is no such thing as rejection, only feedback.  A lot of doctors get discouraged after offering advanced technology lenses and rejection by the patient.  They tend to take this rejection personally, seeing it as a comment on who they are than rather than what it really is:  feedback on what they’re doing.  Every time you approach a patient and are rejected in your suggestion, you have been presented with an opportunity to understand why they responded negatively and what you could have done to prevent that.  If you possess the ability to learn from your mistakes, then failure is literally impossible because each rejection brings you closer to perfection.
It’s never the patient’s fault.  Who do you blame when the patient rejects your suggestion for an advanced technology lens?  If you catch yourself saying that a situation was impossible, that the patients just simply didn’t want to listen or they couldn’t afford it, then you’re wrong.  It was your fault.  It’s always your fault.  And that’s a good thing, because it means you can control the situation.  So, never blame the patient or the situation.  Instead, demonstrate a willingness to examine yourself and accept criticism without taking it personally.  Only then can you accurately determine whether there was something you could have done to change the outcome, or if the outcome was truly unavoidable.
Learn actively, rather than passively.  Just as you can’t learn to play football by watching videos and posting in the football news groups.  The only way to learn how to develop an advanced technology lens practice is from real world experience.  Anyone can sit through a seminar and learn the principles, but the doctors who will advance in their advanced technology practice are the ones who learn to apply the principles in the office setting.
Don’t rehearse negative outcomes.   One of the biggest problems that doctors have when it comes to discussing advanced technology opportunities with patients is that they rehearse negative scenarios in their minds.   “The patient’s not going to want an advanced technology lens.”    “The patient won’t be able to afford this lens.”  “The patient doesn’t really need the advanced technology lens.”  Often, these negative self scripts become excuses not to try something new.  Instead, get into the office and start making approaches regarding the advanced technology lenses.  If any of these scenarios happen to occur in the office setting, then find out what to do.  This isn’t ski diving:  there’s little or no risk of actual harm from being unprepared.  Every encounter that you have will help you to learn how to improve your approach to the patient.
Be willing to go through the pain.  This process is not an easy one.  You will be forced to confront nearly every single thing that defines you – every emotion, every action, every belief.  You will sometimes be apprehensive about approaching the patient confrontation – trying a new technique or changing a behavior.  What separates the unsuccessful physician from a successful one is the willingness to push through the fear and do it anyway.  Here’s what Arnold Schwarzenegger, in his iron pumping days, had to say about it:  “If you can go through the pain period, you’ll make it to be a champion.  If you can’t go through it, forget it.”  And that’s what most people lack – having the guts to just go in and just say … I don’t care what happens.”
Don’t look to friends or colleagues for approval.  Not all of your friends or colleagues will understand the journey that you’re about to take.  They may tell you that they don’t like how you’re changing.  They may challenge the validity of your use of high technology lenses.  That’s okay.  It happens to everyone.  So, when you start attempting this process your colleagues may not welcome it – you’ve become a threat to their limiting beliefs in complacency about their own shortcomings.  Let it be their problem, not yours.
Be willing to test new ideas, even if they don’t seem logical.   Before I learned how to confront the process of high technology lenses, I considered myself an intelligent and successful person.  The logic that had gotten me so far in medicine was getting me nowhere communicating about high technology lenses.  In order to make a change, I had to try some new behaviors, even if they didn’t seem logical.  I said things that I would not have said before.  I tried new approaches to patients and I tried new techniques with which to communicate.   That’s when I realized that I had never really been using logic in the first place – because, as any good scientist knows before dismissing a new hypothesis, it’s necessary to test it first.
Once something works, figure out how and why it works.  There are some men who do great just following the instructions in these principles and repeating the techniques.  But, the ones who become truly successful in advanced technology lens technology are the ones who, after a series of successes, figure out why the routines work and what made them work.  There’s only one rule in the process of increasing your advanced technology surgery and the rule is this:  There are no rules only guidelines.  Once you understand the principles behind each idea, you’ll know when to follow the guidelines, when to dismiss them, and when to invent new ones.
If you don’t know what to do, don’t leave.  If you run out of information to share with the patient, you’re not going to learn anything by just simply running away.  Stay in the conversation and if you run out of things to say, push it for another minute or two before you decide to quit.
Hang around someone better than yourself.  This is the single best way to improve in any area.  Your mentor doesn’t have to be the top surgeon in the world, just someone who has a little more skill than you do.  If you don’t’ know someone to fill this role, instead of going out and speaking with the patients every day, go out and befriend someone who has skills in this area and ask if you can observe them.
Make sure that your ratio of effort to results in increasing.   When learning a new way of doing something, most people get worse at doing the task before getting better.  That’s normal.   But you’d be surprised by the number of people who keep putting more work into something after this transition period, even though their results stayed the same or barely improved.  So, make sure you’re increasing not just your knowledge, but also your results.  If you’re not, then take a break, review the rules, examine what you’re doing, consult with a mentor and push yourself beyond your comfort zone.
Finish what you begin.  Most people can accomplish just about anything within the realm of possibility.  Despite this, they never realize their dreams.  Either they quit before they reach their goals, ( and always with a seemingly good reason for doing so) or they don’t change their strategy when something’s not working.  Roughly 19 out of 20 surgeons who start attempting multifocal surgery will not stick with advanced technology surgery.  Don’t be one of these people.   Simply by not giving up you’ll already be in the top 5% of surgeons in the country.  It is a startling fact that less than 5% of all of the surgeons in the United States have implanted 100 or more advanced technology lenses.  The fact remains that advanced technology lenses are the future.  If you want to stay in the future, you  need to stay in the pursuit of skill with advanced technology lenses.