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    What to say when discussing MIGS with patients

    Surgeon shares advice for how to avoid risk of bias in glaucoma treatment recommendations


    Take-home message: When microinvasive glaucoma surgery is a potential treatment option, surgeons should present it as neutrally as possible.



    Philadelphia—Ophthalmic surgeons introducing microinvasive glaucoma surgery (MIGS) for the first time to patients will want to think carefully about how they describe the procedure and present treatment options to patients, said George L. Spaeth, MD.

    “We have a responsibility to enhance our patients’ ability to care for themselves, we need to help them more than harm, and we need to be fair,” said Dr. Spaeth, Esposito Research Professor, Wills Eye Hospital/Thomas Jefferson Medical College, Philadelphia.

    More in this issue: Rising to the challenge of persistant epithelial defects

    Patients need to make decisions about their care that is appropriately accurate. However, most often, patients make a decision based on the way that the physician presents treatment options, he said.

    “Our recommendations are rarely challenged,” he said. “Patients are reluctant to say that they don’t understand something. We’re really making that decision.”

    Specific to glaucoma, Dr. Spaeth’s presentation focused on how the zeal for a new type of surgery may steer patients specifically to MIGS and reveal a surgeon’s bias.

    The first goal of any physician is to help the patient, he said.

    “We hear frequently, ‘First, do no harm.’ That’s not a good principle,” he said. “We don’t want to harm, but that’s not our first goal. Our first goal is to help. Every treatment involves some harm.”

    Dr. Spaeth gave the example of telling a patient he or she has a narrow angle. The physician may worry about upsetting a patient with this news.

    “But by not telling them, it is harmful, as that deprives them of making a decision about appropriate care,” he said.

    NEXT: Improperly leading words

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