Dr Robert Fante on the Need for Patient-Physician Conversations to Set Expectations Around Treatments

Patients may have unrealistic expectations of how a new treatment or procedure may help them, and the conversation between the patient and physician is crucial for setting expectations, explained Robert G. Fante, MD, FACS, president of the American Society of Ophthalmic Plastic & Reconstructive Surgery and facial plastic surgeon and cosmetic surgeon, Fante Eye & Face Centre in Denver, Colorado.

Transcript

How do you manage patient expectations when a new treatment comes out and they start to get excited and get their hopes up?

In reaction to new treatments, of course, patients do get very excited, and oftentimes maybe have unrealistic ideas of how helpful it could be for them. And we do need to explain to them the reality is: what it will fix, what it won't fix, what it's likely to do, what it's likely not to do. And part of the problem with the physician-patient relationship is that we're busy. We have a lot of patients to see, oftentimes doctors have a tendency to run behind, which I'm sure is no surprise to anyone watching this. And so, we try our best to give patients all the information we can.

Fortunately, the technology has helped us somewhat in that we have the ability to have videos and websites and social media and a variety of other things that can help us to inform patients of what's available and how it's likely to help them and who might be a candidate. But for individual people, there's really no alternative to the face-to-face discussion that should happen between a doctor and a patient regarding something. And we have to go through, carefully explaining to them what it will do and what it won't do. And a lot of it involves asking the right questions and watching carefully as we have the discussion to get to what it is they're hoping for.

One of the problems we have, for example, with use of various kinds of medications and surgery is that they may be hoping that it's going to give them something that's really unrelated to the process. You know, the classic example is someone who might want to have something improved in their appearance with the hope that it'll save their marriage. And we all know that that may or may not really help.

And so, getting to those details can be important related to something like one of these medications, such as teprotumumab, for example, that the underlying question may be, you know, how soon can I return to work? Which may or may not be something that we address unless the question is asked specifically. And so, as a physician, it's important for us to sort of get to the questions that will be important to them.

Without an initial setting of expectations with patients, how might their satisfaction with treatment be adversely affected?

The problem can be that the patient has then either unrealistic ideas or unanswered questions. And what will happen then is they might come in either frustrated after partial treatment, for example, if they've received several doses of a drug that they were hoping would do something that it's not doing, or if they've had an operation, and their outcome isn't quite what they hoped it would be.

And fortunately, most patients are fairly open about that, and will tell, if not the doctor, who they may have some reasons for not wanting to disappoint you, they'll tell the staff. And so most physicians are careful to talk to their staff—nurses and techs—and find out, you know, is this person satisfied? Are they not? What's happening? What's going wrong? And most people are able to tell their own story, either with their body language or their verbal language, and we have to pay very careful attention along the way to make sure that we're responding to what's actually happening to them.