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Cover Stories | May 2024

Pearls for Communicating With Perfectionists

Understanding and realigning the expectations of perfectionist patients is crucial to achieving satisfactory outcomes in refractive cataract surgery.

The importance of managing the expectations of perfectionist patients in refractive cataract surgery cannot be overstated. It is crucial not just to acknowledge their high expectations but also to gauge their influence. A significant part of our role as surgeons is to adjust these expectations and ensure that patients understand the realities of the procedure they will undergo.<


Cataract surgery is distinct from other forms of refractive surgery such as LASIK. It is imperative to set clear expectations about the cataract procedure’s flow, both pre- and postoperatively. Many patients who have a history of refractive surgery anticipate a similarly quick, simple process and do not fully appreciate the recovery timeline or gradual improvement in vision following cataract surgery. It is essential to communicate that experiences vary and prepare them for the immediate postoperative phase, which may include blurred vision.

Repetition and Clarity

I find repetition helpful in patient communication. Reiterating key points about surgery and expected outcomes can help patients retain the information. In my experience, it is beneficial to present information both orally and in writing. This helps reinforce the message and manage expectations.

Handling Misconceptions

The comprehensive nature of the treatment plan, including the frequency of visits to the clinic, can overwhelm patients. It is important to explain the necessity of these visits. If I suspect any misunderstanding or misalignment of expectations concerning the surgical outcome, I may schedule an additional preoperative visit. Such proactive communication helps build trust and ensure that the patient feels confident and well-informed.

Regarding postoperative care, especially when it involves comanagement with other health care providers, it is crucial to clarify the roles each provider will play in the patient’s recovery process. Misconceptions can lead to confusion and dissatisfaction. This is of particular concern with perfectionist patients, who may have specific expectations about continuity of care and personal attention.


I begin the conversation about IOL options by describing the limitations of implants compared to the natural youthful lens. This is particularly important with patients who have technical or engineering backgrounds and appreciate precise comparisons. The key is finding the right balance between what each technology can offer and the patient’s ability to tolerate outcomes such as glare and spectacle dependence.


Initial Consultation Insights

A patient’s response to the initial discussion of lens options can be telling. For instance, if they struggle to grasp the differences between options or cannot narrow down their choices, they may need more time and information. Asking them to restate what has been discussed can be beneficial. It not only confirms their understanding but also highlights any discrepancies between their expectations and what is medically advisable.

Behavioral Indicators

Patients who arrive at their initial consultation with an option in mind, particularly if they insist on a perfect solution or a specific IOL without understanding its limitations, are likely perfectionists. Careful handling is required to set more realistic expectations.

The level and nature of the questions patients ask can reveal their mindset. A focus on the technical details, such as lens optics or precise focal points, indicates that they have high expectations and desire control over the procedure’s outcome. They may require more thorough explanations and additional time for consideration.

It is important to observe how patients process the information presented to them. Someone who takes extensive notes but seems unable to engage in a discussion may be overwhelmed by the information or stuck on specific details. They may need time away from the clinical setting to reflect on the information.


The ability to recognize perfectionistic tendencies in patients is a valuable skill for surgeons. By listening to them, providing and repeating details, setting realistic expectations and giving them additional time to digest information if necessary, we can ensure that these patients feel heard and understood and are able to make informed decisions with confidence. A tailored approach can not only enhance patient satisfaction but also build the trust that is essential for successful surgical outcomes.

Sumitra S. Khandelwal, MD
  • Professor of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston
  • Medical Director, Lions Eye Bank of Texas, Houston
  • sumitra.khandelwal@bcm.edu
  • Financial disclosure: None
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