Let’s dive back into that mental health and optometry topic. The patient’s mental health, I mean, and not ours. Nationally, it’s been troubling to read about at least one suicide in the lasik post-op period. Most of us have had patients who really grind on the results, with subsequent agony in the post-op period. From there, a former FDA official is running around the talk show circuit, saying that lasik results are mostly bad and that the procedure never should have been approved. None of these issues have prevented me from helping the patient consult and undergo this amazing, life-changing procedure.
Our lasik results have been stunningly positive for all of the 22 years that we’ve offered the service. The philosophy is “right patient, right surgeon.” Our consultant has done thousands of procedures but does not run a mill for lasik. He charges a fee that allows for unlimited follow-up care without question. I always tell patients that if price is the leading draw to a surgeon, they are telling you right up front that their priorities are with the economics and not with the results. It’s a litmus test. Patients who are willing to pay for top quality are the ones that we want in our program.
Let’s get right out in front of this and say that our surgical colleagues are operating on PEOPLE, and not just their eyes.
Warts and all, people present with a variety of pretenses, some hidden and some not. I’ve wondered if we can somehow screen for some of the personality factors that would lead to a difficult post-op course, regardless of the quality of the results. Elective and cosmetic surgeries have their own stressors, for both patient and surgeon.
Can we formally test patients, as in, a “check-up from the neck up?” Probably not. Not many of us are licensed in the mental health field. Testing implies that there will be expert interpretation, and our licenses are explicit in saying that we are not experts. (This old psychology major would LOVE to run the even older Minnesota Multiphasic Personality Inventory on lasik candidates. The interpretation is not so hard, but again, we lack certification to do so.)
So, what CAN we do?
Here’s my take. It’s a counseling-light approach in the mental health arena, not a testing approach. My pre-lasik discussion goes something like this: “It looks like you have the basic things in order to make lasik consultation reasonable. You have the right age, the right kind of prescription, and it appears to be stable. Corneal thickness, surface health, and topography are favorable too, but the surgeon makes the final call.”
Now for the mental health part:
“Although your eye measurements are fine for lasik, our science has taught us to talk about something else. The STRESS of going through refractive surgery is too much for some patients to handle. I’m concerned that since you’ve had xxx issue and taken xxx medication for it, this all may be a bit hard on you, especially if things don’t go smoothly. Do you follow what I am saying?”
“Now, I am not going to ask questions about your mental health history, but it’s been our concern that patients who have been treated for things like anxiety, depression, or mania MAY have difficulty with the natural problems that can occur in the normal post-op period…..”
A poster on ODs on Facebook expressed concern on the “Do you follow what I am saying?” question. It’s all in the gestures and intonation that accompany it. By the time I ask the question, the attentive patient is already on the edge of his or her seat. You can HEAR them thinking, “What does mental health have to do with eye surgery, for crying out loud?”
The opportunity is perfect for a caring, professional discussion, which keeps them coming back for more.
It’s the elective aspect of lasik that adds to the challenge. Think about it. The patient is contemplating surgery that is not required for health and well-being. It’s being performed on perhaps the most important of the five senses. In the event of a problematic result, or even if the subjective experience does not measure up to that of friends or relatives, the spin can be overwhelming. Let’s help these patients to stack the deck in terms of mental health, too, and develop the ability to determine when the deck is stacked against them. For now, caring professionalism and a measure of “street smarts” must carry the day for us.