How Patient Questionnaires Can Streamline Ophthalmology Workflows and Improve Patient Candidacy

by John Hovanesian, MD and Matt Geller, OD
Jun 18, 2020
6 min read
67 views

Moving patient history taking online can save time for both you and your patients—and improve care and candidacy numbers, as well.

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A middle-aged male patient, who you’ve been treating for glaucoma, comes in for a checkup. During the checkup, they mention that they’ve been dealing with severe depression for the last few years. Upon further questioning, you find out that they’ve been prescribed antidepressants from their doctor that don’t seem to be working.

Immediately, your mind jumps to the beta blockers that the patient has been taking. You switch their glaucoma medication, and voilà . . . depressive tendencies disappear seemingly overnight!

Patient stories like these are not unusual. A patient neglects to tell their primary care physician about the eye drops they’re taking; the primary care physician tries to find a solution and fails—turns out the missing link was a full patient history.

Of course, intake forms take time and can feel like a burden for patients, leading them to skip questions when they feel like all the paperwork they’re filling out won’t be read anyways. It’s up to the practice to solve this issue: how can doctors ensure that patients aren’t omitting information (even unwittingly)?

Patient history to patient treatment

As a practitioner, it can be difficult to have a comprehensive conversation with each patient. Delegating taking patient history to staff can sometimes result in missing or inaccurate information due to miscommunication.

Dr. John Hovanesian, founder of the web-based service MDbackline, jokes, “When a patient goes through a cataract surgery, they’re essentially getting married to their lenses—and they need to be prepared for that choice.” Humor aside, he points out, “Now, we’ve got a wide variety of different choices that give patients different vision, and it is and should be a patient choice. However, patients are not necessarily prepared for this choice.”

The choice of IOLs prepared for a patient should be limited: after all, while it’s a patient’s prerogative to choose the lens that best fits their lifestyle, it’s the doctor’s responsibility to offer them a selection of lenses that are most appropriate for their needs. This is the key reason Dr. Hovanesian founded MDbackline: to facilitate conversation between patients and practitioners, and enable patients to inform their doctors of changes in their medications, health status, and more.

Some patients may simply be unaware that certain information is important to mention, or even not have noticed these issues. Someone who’s middle-aged might simply blame their feelings of lethargy on their age, not on depression. Furthermore, they might not know to mention depression at all until prompted.

Patient communication and understanding what isn’t said

“In ophthalmology, we’re great at biometrics,” says Dr. Hovanesian. “We measure the body with great precision, whether we’re using topography, OCT, or endothelial cell counts. But we’re not always great at measuring what’s going on in a patient’s head—their psychology.”

That’s why in-depth—yet efficient—patient history questionnaires are so crucial. The best of these focus on psychometrics, rather than biometrics, for the purpose of taking a comprehensive patient history. Questionnaires aren’t meant to replace biometrics, but supplement them for better patient care and communication.

Patient communication (aka bedside manner) isn’t always taught in schools, and even for doctors who pride themselves on excellent patient communication, it’s hard to devote enough time to get to know everything. Plus, there’s human error—you might forget to ask a question, and the patient might forget to supply information.

A comprehensive patient history questionnaire is designed to collect all the information that could be helpful in patient history, and even to catch things that the patient may not have been aware of by asking a series of qualitative and quantitative questions that patients can answer on their own time before their appointments.

Here’s an example from MDbackline:

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Image from MDbackline.

Once the questionnaire is completed, MDbackline’s software generates a patient vision profile that documents their symptoms directly from their responses, including any additional comments they want their doctor to know. This is where patients have the opportunity to leave comments like, “I am nervous about the idea of eye surgery”—a question that many practitioners might not think to ask, but which actually makes a major difference for the patient.

How exactly does a good patient questionnaire streamline the patient experience?

There are two major benefits to an online questionnaire that a patient can access on their own: first, it cuts down on in-office time, a major concern in our current situation. Second, it can drastically change your patient candidacy numbers, if a patient is filling out a questionnaire in a comfortable environment where they have access to their own records and time to think about their responses.

Changes to intake efficiency

While the patient completes their questionnaire, their healthcare team can know exactly what information they need and kind of education would be most appropriate and useful for them.

If patients are given tailored learning materials, not only will they likely provide a much more comprehensive—and useful—account of their own medical history, but they will be prompted to think about their own situation and be more analytical.

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Example from MDbackline.

Taking a full patient history before the patient even enters the office saves countless amounts of time. You’ll be able to review their information before walking in, which means that the face-to-face time you spend with the patient is much more efficient and valuable for you both.

Changes to patient candidacy numbers

It helps to know details of your patient’s life and what they use their vision for. Are they an avid reader? Do they drive frequently? Do they work in an environment with bright or dim lighting? Knowing these aspects can help you to really target patient care.

Additionally, you’ll be able to “rule out” certain procedures. It becomes much easier to make a decision when you have all the information you need at your fingertips.

Streamlining practice efficiency with accurate information

Using a comprehensive patient history questionnaire, you’ll be able to provide patients with choices and options that are customized to their wants and needs. By determining what the patient wants for their vision, you’ll be able to ensure that they’re given the best treatment for them—after all, what works for one patient may not be optimal for another, even if they have the same underlying condition.

A questionnaire is meant to improve the human connection between the patient and the doctor, not replace it. Not only does it facilitate conversation and effective history taking, but it truly allows for more personalized treatment, and the human touch that only a doctor can bring.

What do you use to manage patient history taking? Share your experience in the comments!

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About John Hovanesian, MD

John Hovanesian, MD is an eye surgeon in Orange County, California and a clinical faculty member at the UCLA Jules Stein Eye Institute. He founded MDbackline in 2012 to address needs of patients, doctors, and the health care industry. He does strategy consulting and research for over 20 health care companies and has published two textbooks and dozens of journal articles in his field.

About Matt Geller, OD

Dr. Matt Geller is an entrepreneur with a track record of developing successful online platforms to solve problems in the healthcare space. Matt is the co-founder and CEO of CovalentCareers and NewGradOptometry.


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