Medical Empathy in the Diagnosis of Glaucoma

The trend of seeking medical information on the internet is growing, with more and more patients turning to the web for insights after receiving a diagnosis or prior to consenting to a medical or surgical treatment. A quick Google search on the question, "What happens if I'm diagnosed with glaucoma?" often yields discouraging results, such as "Glaucoma can lead to blindness." Unfortunately, many individuals stop there, without delving deeper to discover that, with proper treatment and follow-up, the loss of vision can be prevented. This underscores the importance of effective medical communication, grounded in understanding patients' emotions and needs.

Delivering Bad News

At the time of diagnosis, it's crucial that patients receive not only information about the disease but also positive news, such as available treatment options and their success rates, to alleviate anxiety and build trust between the patient and the physician. In this article, we'll explore how to deliver difficult news to patients, especially the diagnosis of glaucoma, and how to address depression in glaucoma patients.

Understanding the SPIKES Protocol

When doctors have to provide a challenging diagnosis or long-term prognosis, they can follow a useful protocol known as SPIKES, which comprises six steps.

Step 1: Prepare the Interview

The first step involves preparing for the interview. It's essential to invite the patient into a quiet room, ensure confidentiality, and ask if they'd like a companion, such as a family member or friend, for support. The physician should allocate enough uninterrupted time to address all the patient's questions.

Step 2: Assess Patient Perception

The second step is to assess the patient's perception of the issue. Asking the patient what they already know about glaucoma can provide insights into their level of understanding and fears, enabling the physician to guide the discussion.

Step 3: Obtain Patient Permission

The third step is to gain the patient's permission to provide information about their condition. This step is often underestimated, as some patients prefer to delay or avoid discussions about their illness.

Step 4: Impart Knowledge and Information

The fourth step focuses on imparting knowledge and information to the patient. The doctor should provide information about the disease and possible treatment options concisely and tailored to the patient's level of knowledge. At this stage, highlighting the positive aspects, such as the treatment's success rate, is crucial.

Step 5: Acknowledge Patient Emotions

The fifth step involves acknowledging the patient's emotions. The physician should identify the patient's expressed emotions and their underlying causes. It's important to allow the patient to express their emotions, demonstrating empathy and understanding.

Step 6: Summarize the Conversation

The sixth and final step is summarizing the conversation. The doctor should ask the patient if they have any further questions, especially if they haven't spoken much, and explain the next important steps.

Depression in Glaucoma Patients

Depression is a reality among glaucoma patients, as demonstrated by studies. Research based on a Taiwanese population revealed that glaucoma patients had a significantly higher cumulative risk of depression than the control group. Significant risk factors for depression include advanced age, female gender, low income, substance abuse, and living alone.

Understanding the Link

Another study found that 12.5% of patients recently diagnosed with open-angle glaucoma reported symptoms of mild or more severe depression. Visual function reported by the patient was a major predictive factor for depression. Thus, it's crucial to recognize signs of depression in glaucoma patients.

Depression Screening

Depression screening can be conducted using a two-question questionnaire (PHQ-2) that asks whether the patient has experienced depression or hopelessness and whether they've had little interest or pleasure in doing things in the past two weeks. A score of 3 or higher indicates high sensitivity and specificity for depression.

Relationship between Depression and Suicide

Depressed patients have a higher risk of suicide, underscoring the importance of screening for depression and suicide risk. Suicidal ideation can be quickly screened using five simple questions.

Conclusion

Empathetic communication is essential in the diagnosis of glaucoma and the management of depression in glaucoma patients. Physicians should provide comprehensive information while acknowledging patients' emotions. Preventing depression and reducing the risk of suicide in glaucoma patients requires a team-based approach, involving clinical staff, family, and other healthcare professionals. Ultimately, it's important to remember that patient care isn't just about the disease but also about the individual experiencing it.

This text is based off a scientific article written by Dr Paul Harasymowycz and Dr Oksana Kaminska, you can read it here.