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Psychology Applied to Optometry

Psychology Applied to Optometry. COURSE SYLLABUS. Psychology and visual health Non-verbal communication The visual exam Performance of the optometric exam Giving bad news Difficult patients and managing complaints. THEME 3: THE VISUAL EXAM. STRUCTURE OF THE THEME:

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Psychology Applied to Optometry

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  1. Psychology Applied to Optometry

  2. COURSE SYLLABUS • Psychology and visual health • Non-verbal communication • The visual exam • Performance of the optometric exam • Giving bad news • Difficult patients and managing complaints

  3. THEME 3: THE VISUAL EXAM STRUCTURE OF THE THEME: 1. Case history: first contact 2. Intermediate phase 3. Final phase 4. Errors and verbal interventions to avoid 5. Information and non-fulfillment

  4. THEME 3: THE VISUAL EXAM • Case history: first contact GOOD RAPPORT • Smile, extend your hand…always? • Read the patient’s history prior to first contact • Greet the patient and their family, calling them by name. Treat them with respect • We introduce ourselves (name and title) to the patient and family and introduce the other people present

  5. THEME 3: THE VISUAL EXAM • First minute: the patient always plays white • Focus on what the patient says to us (and what they do not say) • Focus on the language that they use

  6. THEME 3: THE VISUAL EXAM An interview can fail if: • We do not look at the patient at the beginning (or the other way around) • We perform a different task while we talk • We talk instead of listening • There is high reactivity • There are too many Adaptors • We smile excessively • There is noise, people coming and going...

  7. THEME 3: THE VISUAL EXAM 2. Intermediate phase • Get the patient to express him/herself (in order to negotiate later) • Antagonism: causes diminished adherence to the instructions • Constructive antagonism: constructive criticism

  8. THEME 3: THE VISUAL EXAM • Do not be overly optimistic • Low reactivity (2 sec) and functional silences • Verbal or non-verbal facilitation • Speculative technique: tuning • Verbal and non-verbal empathy…but be careful!

  9. THEME 3: THE VISUAL EXAM • To favor elaboration of ideas or emotions: • Repetition of phrases • Clarification • Signaling • Go from open questions to closed ones • Suggestions if open questions do not allow us to obtain information • Effort by the patient to respond and provide reliable answers

  10. THEME 3: THE VISUAL EXAM 3. Final phase • Enumerate the detected problems and afterwards, inform • Short sentences and illustrations • Neutral vocabulary

  11. TEMA 3: EL EXAMEN VISUAL • Clear diction and appropriate intonation • Visual-tactile compliments • Bidirectionality • Exemplify • Lay out instructions and changes in detail • Double-check comprehension of the information. Careful not to patronize!! • Take note of cognitive deficits that make efforts useless • Avoid habituation

  12. THEME 3: THE VISUAL EXAM 4. Errors when giving information and verbal interventions to AVOID • Giving instructions without having explained the problem • Technical concepts • Mixing the exploration of problems with the recommendations • Monotonous voice • Too many concepts in too little time • Sentences joined together without period for assimilation • Interrupting the patient when they are speaking or asking questions • Spending too much time with certain patients

  13. THEME 3: THE VISUAL EXAM VERBAL INTERVENTIONS TO AVOID • Unimportant conversation • Judgements, accusations, criticisms • Preaching • Exaggerated sympathy • Pressuring, threatening or arguing • Lots of continuous questions • Extensive self-revelations • Intellectualization, hyperanalysis

  14. THEME 3: THE VISUAL EXAM NON-VERBAL CONDUCT OF THE EXAMINER • YES:Eye contact, Illustrators, vocalization, agreement • NO: “from dictation” position, low tone, covering the mouth, coughing, crossing the arms, body leaning backwards or at a 45º angle with respect to the speaker, hands in pockets or hidden, staring, too many Adaptors or excessive smiling

  15. THEME 3: THE VISUAL EXAM 5. Information and non-fulfillment INFORM, BUT… • Correct information does not guarantee healthy conduct • A person does not modify his/her habits because we tell them they are dangerous • A person who doesn’t pay any mind to our recommendations is not necessarily malinformed • Many well-informed people act as if they hadn’t received any information about their problem • We tend to give less information to people with in a lower socioeconomic level

  16. THEME 3: THE VISUAL EXAM “Every patient is a potential disobedient” • INCIDENCE OF NON-FULFILLMENT: • Subjective tests: interviews and questionaires • Objective tests: electronic devices in the containers • Norell and Grantstrom (1980): control with electronic devices. Results: • Subjectively: 97’1% • Objectively: 76%

  17. THEME 3: THE VISUAL EXAM CAUSES OF NON-FULFILLMENT A) PSYCHOLOGICAL FACTORS • Relative to the patient him/herself: • Intelligence • Maturity • Character • Aleviation of symptoms • Professional-patient interaction

  18. THEME 3: THE VISUAL EXAM B) FACTORS OF THE ILLNESS ITSELF • The seriousness increases the adherence to the treatment and the chronicity diminishes it C) TREATMENT FACTORS • Degree of alteration of habits • Duration of treatment • Good supervision • Time in the waiting room

  19. THEME 3: THE VISUAL EXAM PROFILE OF A DISOBEDIENT • Greater proportion of men than women • Bad communication between patient and professional seems to be the principal cause of non-fulfillment • 50% of patients do not ask their doctor everything they would like to • Healthcare professionals are basically incapable of recognizing and differentiating an obedient patient from a disobedient one

  20. THEME 3: THE VISUAL EXAM SOLUTIONS • Contractual method The Department of Health in England has designed a pamplet about adjusting to contact lenses for offices and consulting rooms: • The different types of contact lenses • The risk factors associated • The instructions to follow • Lens check-ups

  21. THEME 3: THE VISUAL EXAM 2. Patient’s education • Good communication skills between patient and professional: • The word • Written instructions • A record of periodical revisions via in writing and phoning to remind • Attractive information

  22. TEMA 3: EL EXAMEN VISUAL

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