TODAY’S PRACTICE

APRIL 2005 I CATARACT & REFRACTIVE SURGERY TODAY I 91

Fear is a word that has a broad defini-

tion. In refractive surgery, it is often said

that there are only two obstacles to

patients’ having a procedure: price and

fear. I agree, and this month, I want to

explore the topic of fear in greater detail.

G E T T I N G PER SPEC T I V E

Early research into consumers’ behavior related to

refractive surgery exposed three sources of fear in

patients: a fear of pain, a fear of going blind or experi-

encing a complication, and a fear of the procedure’s fail-

ing to address their particular prescription. These con-

cerns serve as barriers in consumers’ decision-making

process and are completely justified from their perspec-

tive. Providers, while not dismissing these fears, tend to

address them from their own clinical perspective. For

example, they may describe complication rates to

patients by saying, “this problem occurs in fewer than

one in 1,000 cases.” Although such an explanation is

perfectly logical, it is much more reassuring to the doc-

tor than the patient. Instead, you as the clinician should

address prospective patients from their perspective.

Understand that the seemingly irrational fear patients

feel for the safety and security of their eyesight is akin to

that which parents feel for their children. Parents keep

close tabs on their kids’ whereabouts in order to guard

them against even the most remote threats, rational or

irrational. Although today’s parenting norms may seem

like overkill when compared with a logical, data-driven

analysis of risk, just try telling that to a young mom or

dad. A similar emotional response (fear)

drives the behavior of refractive surgery

patients and outweighs the rational data

every time.

F E A R A N D T H E M AR K E T

I conclude that the dip in refractive sur-

gery procedural volume experienced in

the US from 2001 to 2003 had more to do

with consumers’ fear than anything else.

By 2000, consumers’ awareness about

LASIK was extremely high, and many posi-

tive news stories had demonstrated the

procedure’s efficacy. As the media began

to focus on negative stories, however, con-

sumers’ concern seemed to shift from effi-

cacy (“Will this improve my vision?”) to

safety (“Will I have long-term problems?”).

The fear of a surgical complication pre-

vented a lot of people from going forward

When FearIs the Factor

Understanding how to deal with this key emotion.

BY SHAREEF MAHDAVI

Figure 1. The milestones for refractive surgery line up with the typical con-

sumer’s decision process. Each step is marked by a different emotional state

of the consumer that the clinician needs to manage properly.

“[Fear] drives the behavior of

refractive surgery patients and

outweighs the rational data every time.”

TODAY’S PRACTICE

92 I CATARACT & REFRACTIVE SURGERY TODAY I APRIL 2005

with LASIK. In addition, an abundance of low-price

advertising created a new fear: that of being ripped off

by the high fees charged by premium providers or con-

versely by discount providers who might cut corners to

offer such low prices. Either way, consumers were totally

confused, and marketers know that such confusion

leads to inaction.

C AN T ECH N O LO G Y O F FSE T F E AR ?

The beginning of a turnaround for LASIK began in late

2003, with both total procedural volumes and average

surgical fees increasing nationwide. Technology has

fueled this revival by reducing the potential for intra- and

postoperative complications. Customized LASIK treat-

ments, which are touted as more accurate and precise

than conventional LASIK, are addressing the night-

vision–symptoms bogeyman that previously scared off

many consumers. The femtosecond laser, which removed

the microkeratome blade from the LASIK equation, also

appeals to consumers’ desire for a safer procedure.

Surgeons and LASIK counselors have seen how these

technologies, when properly explained, go a long way

toward lessening patients’ fears and helping them move

forward in the decision-making process. This is especially

true for those surgeons who have adopted the Intralase

FS laser (Intralase Corp., Irvine, CA). They report both

faster decision-making by refractive surgery candidates

and higher rates of conversion to surgery (based on data

from my report, Measuring the Impact of Femtosecond

Laser Technology on Procedure Volume and Pricing, April

2003).

T H E RO L E O F T H E PROV I D E R

Forming a RelationshipRefractive surgery providers need to better manage the

prevalence of fear among consumers. In Figure 1, a model

of the decision-making process shows where fear comes

into play. In the awareness phase, the consumer’s emo-

tional state is one of hope: he has seen/heard the ads,

read the stories, and talked to friends who zealously

endorse refractive surgery. Being rid of glasses is an

extremely attractive fantasy. But, when that consumer

picks up the phone to inquire about the procedure, a

mental switch takes place. His fantasy is replaced by logic,

and all his “what if?” questions are immediately front and

center in his mind. All of the caller’s mental and emotion-

al barriers are in place, and he is seeking verbal cues that

give him permission to say, “no thanks,” and end the

inquiry. This context should help you understand why

that most common of initial questions—“How much

does it cost?”—is not really about price at all. Rather, it

masks the real questions that have to do with fear.

Trust: the Antidote to FearIt is critical that the first phone call allow the caller

and the counselor to form a bondMost providers tell

me that their goal during an interested individual’s first

phone call is to schedule a consultation. A better goal

would be to create an environment that begins foster-

ing trust between the caller and your practice.

As in all relationships, trust is earned, not automati-

cally given. In a brand new relationship between a

caller and a LASIK counselor, trust is the proper foun-

dation for everything else in the discussion: technology,

pricing, safety, etc. The counselor earns the caller’s trust

by being honest, straightforward, and forthcoming.

This goal requires the counselor to do much less talk-

ing about the practice and the procedure and much

more attentive listening to uncover the caller’s needs

and motivations.

Business relationships that succeed do so because

the client feels special, as if he truly matters. This is the

key for your phone counselors, because making a caller

feel special will go a long way toward building trust and

reducing his fear so that he feels confident in proceed-

ing. Some counselors build relationships naturally over

the phone, whereas others need some practice. This

skill is critical in an environment where the phone is

usually the first means of contact with a prospective

customer.

COM BAT I N G PAT I E N T S’ F E A R S I S YO U R

C H I E F CO N CE R N

In summary, providers need to take the fear factor

much more seriously when counseling patients, espe-

cially during the initial phone call and visit. Empathy

helps. As we’ve all seen, a low price can’t squelch high

fear. Technology is a factor in decision-making, but its

importance to prospective patients is secondary to a

bond of trust between them and the provider. ■

Shareef Mahdavi draws on 20 years of medical device

marketing experience to help companies and providers

become effective and creative in their marketing and

sales efforts. Mr. Mahdavi welcomes comments at (925)

425-9963 or shareef@sm2consulting.com. Archives of his

monthly column may be found at www.crstoday.com.

“Making a caller feel special will go a

long way toward building trust and

reducing his fear so that he feels

confident in proceeding.”