Managing the Anxious Patient

Most optometrists have encountered it at least once – a trembling, sweating patient in your chair, fists clenched, and a nervous laugh after every sentence. Patient anxiety is not unique to optometry. Many people feel some degree of nervousness or discomfort going into any sort of healthcare setting. However, as we know that patient anxiety can be detrimental to both the optometry consult and the final outcome,¹ it is beneficial for both the clinician and patient if steps are taken to make your patient feel more at ease.

Causes of Patient Anxiety

There are two general types of anxiety – state anxiety and trait anxiety. State anxiety refers to a psychophysiological state in response to a particular situation. Conversely, trait anxiety is an inherent personality characteristic more frequently noted in those with anxiety disorders.²

State anxiety in your optometry patients without an anxiety disorder can occur for many reasons, including:³

• Fear of a negative diagnosis
• A past negative experience at a healthcare appointment, such as receiving substandard care or having their concerns dismissed
• Feeling like they don’t/can’t understand what’s happening; a feeling of powerlessness

Anxiety in your patients can be so acute as to elicit a physiological response, commonly observed as white coat syndrome, where a normally healthy blood pressure rises into hypertension range in the clinic.

As anxiety can cause irrational behaviours and inhibit your patient’s ability to comprehend or comply with instructions, it is in your best interests as the optometrist to address this thoughtfully.

6 Ways to Manage Anxiety in Your Patients

1. Know how to identify the anxious patient.

Anxiety can present in many ways. In some people, outwardly visible signs may be entirely absent. A patient experiencing anxiety in your chair may:

• Come across as rude, snappy, or curt
• Tell you they get nervous during eye tests (or any medical appointment)
• Breathe rapidly and heavily
• Appear tense in their posture
• Seem distracted

If you suspect your patient is uncomfortable or anxious, you could gently ask them how they're feeling about their appointment. This can serve as an icebreaker and a way to put them at ease as you acknowledge their discomfort.

2. Consider the setup and environment of your practice.

Our environment can influence our emotions and psychological state. Consider a stark white room with rows of cold, hard plastic chairs and blank walls. Compare this to a waiting room with colourful posters on the wall, comfortable chairs appropriately spaced, warm lighting, and a cheerful receptionist. The former illustration has the potential to induce anxiety even in a patient not prone to it. In contrast, the latter has a greater likelihood of making your patients feel at ease.

3. Keep calm yourself.

It can be a reflexive response to begin to exhibit jittery, nervous traits yourself in front of a patient exuding anxiety. However, rather than getting yourself and the patient even more worked up, take deliberate steps to keep yourself calm, your movements measured, and your language even. If you have an anxious patient who demonstrates this through being short and rude, avoid the temptation to get offended and angry. Techniques to keep yourself calm include:

• Deep breaths
• Reminding yourself that the patient’s behaviour is an expression of their anxious state
• Focusing on the task at hand
• Repeating a calming word or phrase in your mind

4. Explain to your patient what’s to come.

It can help to alleviate some anxiety by understanding what you’re about to do and why. For example, “I’m going to measure your eye pressure next. Similar to blood pressure, we want the pressure in your eyes to be within a certain range. If it’s higher than expected, knowing this can allow us to take steps to bring it back to normal. This device is just going to sit in front of your eye here, and you might feel a little tickle as I take the measurements, but it won’t hurt.”

You may even choose to outline the entire eye exam at the very start of the consult if you notice your patient looking nervous. This can also be a good moment to introduce some humour to help your patient feel more at ease and to connect better with you as a person rather than a clinician.

5. Adjust your communication accordingly.

Your language can be used to help your patient feel more comfortable as well as de-escalate rising anxiety throughout the duration of the exam. Carelessly throwing around medical jargon is often unhelpful as patients don't understand what it means, and these unfamiliar terms can provoke more anxiety.

The way you explain your findings is important. Try framing problematic observations in a more positive light. However, avoid downplaying the significance as it may impact patient compliance with your subsequent treatment recommendations. Instead of "I'm seeing some damage to your corneas from contact lens overwear. If we don't do something about this now, you could end up with a sight-threatening keratitis,” consider “The surface of your eye is looking a little rough from wearing the contacts too many hours in the day. We can get it feeling happier and healthier by following these steps...”

Research has shown that patients are more likely to be satisfied with their care if they are given the opportunity to partner with the practitioner in a treatment plan and if the practitioner provides sufficient information.⁴ Give your patient plenty of chances to ask questions and do your best to have them walk out from the consult feeling like they know what’s going on.

6. Practise empathy.

Empathy is an essential skill for any human in society, and even more so for a healthcare provider in clinical practice. Remember the patient in your chair is a real person with fears and desires. If they're like three out of four Australians, vision is their most valued sense.⁵ Normalising their experience in your consulting room, including any feelings of anxiety, will only help them feel more comfortable and increase the likelihood they will return to your care.

Summary

Though managing an anxious patient can present some challenges to the optometrist, seeing your nervous patient leave your room smiling and at ease is rewarding. It may take some time to develop some tools and techniques that will effectively calm your anxious patients. However, it is well worthwhile and keeps those patients coming back.