Psychology Applied to Optometry

Psychology Applied to Optometry

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


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


• 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


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...


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


• 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!


• 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


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


• 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


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


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


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


“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%


CAUSES OF NON-FULFILLMENT

A) PSYCHOLOGICAL FACTORS• Relative to the patient him/herself:

– Intelligence– Maturity– Character

• Aleviation of symptoms• Professional-patient interaction


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


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


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


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

TEMA 3: EL EXAMEN VISUAL

Documents

Psychology Applied to Optometry