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COURSE SYLLABUS
1. Psychology and visual health2. Non-verbal communication3. The visual exam4. Performance of the optometric exam5. Giving bad news6. Difficult patients and managing complaints
THEME 3: THE VISUAL EXAM
STRUCTURE OF THE THEME:
1. Case history: first contact2. Intermediate phase3. Final phase4. Errors and verbal interventions to avoid5. Information and non-fulfillment
THEME 3: THE VISUAL EXAM
1. 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
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
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...
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
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!
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
THEME 3: THE VISUAL EXAM
3. Final phase• Enumerate the detected problems and afterwards,
inform• Short sentences and illustrations• Neutral vocabulary
NEUTRAL EMOTIONAL
TUMORPERMANENTINCURABLENERVIOUS
APREHENSIVEANTIBODIES
CANCERCHRONICMALIGN
NEUROTICHYPOCONDRIAC
AIDS
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
THEME 3: THE VISUAL EXAM
• 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
4. Errors when giving information and verbal interventions to AVOID
THEME 3: THE VISUAL EXAM
VERBAL INTERVENTIONS TO AVOID1. Unimportant conversation2. Judgements, accusations, criticisms3. Preaching4. Exaggerated sympathy 5. Pressuring, threatening or arguing6. Lots of continuous questions7. Extensive self-revelations8. Intellectualization, hyperanalysis
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
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
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%
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
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
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
THEME 3: THE VISUAL EXAM
SOLUTIONS1. 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
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
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