"You got to be careful if you don't know where you're going, because you might not get there." I can think of no better way to open a new year than with the wisdom of the master himself, Yogi Berra.

Every week, your clinic welcomes a new shipment of patients referred for cataract surgery, each one of them laden with fears, concerns and, trickiest of all, expectations about what you'll be doing to their vision. Interspersed throughout the waiting room, a little farther along the production line, are the postops, who are experiencing firsthand the adjustment between what they're seeing and what they thought they'd see. It will come as no surprise that how closely those two factors match goes a long way to determining how successful a surgeon you're perceived to be.

What's pretty amazing, based on a study that came out last month, is that matching expectations with outcomes may be even more important than the actual postop visual status in achieving patient satisfaction.¹

An Australian researcher surveyed 120 patients one month before and one month after cataract surgery, measuring such factors as satisfaction with their vision, understanding of the procedure, and current and expected visual function.

Anyone who's watched the downhill run of reimbursement rates knows that cataract surgery, proudly and justifiably proclaimed the most successful surgical procedure in medicine, is the victim of its own success. " … 70-year-old patients expect cataract surgery to allow them to see like 20-year-olds," says the author. As technology, technique and outcomes improve, expectations are ratcheted ever higher.

The problem is each patient carries a singular definition of success, shaped by the experience of their friends, the counsel of the referring physician, popular media, Internet websites, and who knows what else. The successful cataract surgeon, it appears, is the one who takes the time to assure that the patient knows where this surgical journey can and can't take him.

"… health care professionals would be advised to pay more attention to patient understanding and expectations, even at the expense of improving patient outcome," the author concludes. "In this study, the degree of improvement in visual function was not significantly correlated with patient satisfaction at all."

1. Arch Ophthalmol 2004;122:1788-1791.