We learned it before medical school, probably even before we learned to read. Caring for a patient—or a parent, or a spouse, or a child, or a pet—is an art that involves trust, compassion, empathy, sincerity, and patience. Especially for retina specialists, whose patients may be dangling on the edge of blindness, a caring composure is therapeutic in its comfort. We all strive to connect with every patient, but we realize that some patient encounters pose greater challenges than others. We thank our mentors, teachers, colleagues, and patients, to whom we accredit the following observations and tips.-Darrell E. Baskin, MD; Jeremy D. Wolfe, MD; and Chirag P. Shah, MD, MPH

SHOW OFF A GOOD TEAM
A finely tuned office is like a great soccer team: everyone works together to move the ball forward until it finds the back of the net. Your patient's retina care experience and subsequent impression of you begins to form long before he or she reaches your examination chair. Impressions are formed from the scheduler on the other end of the telephone, the front desk person, the assistant checking their vision, and the technicians performing the optical coherence tomography and fluorescein angiogram. By the time you are face to face with a patient, he has already met your team and has a flavor of the captain. Choose good people and reward kindness. Further, be mindful of the atmosphere and culture you foster in the office.

CLEANLINESS
Despite your elegant ILM-peeling skills, the closest you will get to godliness, at least in the eyes of your patients, is determined by your cleanliness. Wash or sterilize your hands in front of the patient. Also, you or your assistant should clean the slit lamp in front of your patient. Obviously, keep every inch of your office clean, tidy, and professional.

CONNECTION
Connecting with the patient begins the moment you walk into the room. The best tips are the most obvious. Make eye contact. Despite the 40 patients waiting to see you, treat the patient in the room as if he or she is the only patient coming to see you today. Greet your patient with a handshake and “Mr.,” “Mrs.,” or “Ms.,” unless he or she is a child or you have permission to use his or her first name. Jot down interesting tidbits about your patient and bring them up during his or her next visit. In a busy practice, it is hard to remember personal details of every patient. Patients will appreciate you asking about their grandson's wedding or their recent trip to Florida. Introduce yourself to family members and thank them for accompanying your patient. After all, many of them took a day off of work to bring their parent to see you. Play with your patient's children or grandchildren. Most kids love peeking through the slit lamp, and parents or grandparents love the attention you give to their little one. Try your best to not turn your back to the patient during the encounter. For those who have a scribe, it may be easier to focus on the patient and not on the chart. For those without a scribe, consider putting the chart in your lap so you can face the patient. For those with an electronic medical record system, you may have no choice but to turn and face the computer screen. Some physicians input data into a tablet computer, allowing them to face the patient.

SECOND SET OF EARS
Involve the family in caring for your patient. Though there are exceptions, it is almost always better to have a second set of ears in the room when counseling patients. This is particularly true when delivering bad news or discussing the risks of surgery. Patients may shut down when learning they have a blinding condition or need surgery; family members can help reexplain things to the patients while providing a level of support that you cannot.

WORST DAY OF YOUR PATIENT'S LIFE
You will be meeting retinal detachment patients on the worst day of their lives. They go to sleep with normal lives and normal vision, not expecting to be blind the next day. Even we myopic ophthalmologists cannot fully understand the dramatic impact of a retinal detachment that reverberates into every aspect of one's personal and professional life. It is scary, and it happens to innocent people. Subconsciously, it may be tempting to rush through the emergency add-on patient so you can stay on schedule. Putting yourself in the patient's shoes is one the most important aspects of caring for a retinal detachment patient, eclipsed only by successfully fixing the detachment (with good postoperative vision and no proliferative vitreoretinopathy).

WHEN YOU ARE RUNNING BEHIND
You are running late, again. It happens, but patients and physicians alike prefer punctuality. In an effort to improve the patient's waiting experience, consider playing educational ophthalmic videos in the waiting room. This helps pass the time while answering some of your patients' questions. Also, keep your patients moving. They can move from the waiting area to the assistant taking the history, to a different waiting area, then to the technician performing the OCT and/or fluorescein, back to a waiting area, and then finally to you. Of course, patients would rather stay on schedule than run laps around your office. If you are behind consistently, scrutinize your schedule. Are you not allocating time for emergency visits? Are you kidding yourself by booking three patients every 15 minutes? By the end of the day, you will see all of your patients, but you can work to improve the flow. Further, have your staff apologize on your behalf, and offer coffee or a snack while the patients are waiting (especially your NPO diabetic patients).

Approaching an angry patient who has been waiting patiently—and then impatiently—for you takes time and composure. You are stressed, and the patient is heated. Always apologize for being late. Some would consider joking to the patient upon entering the room to lighten the mood: “I thought you would never get here.” If you are late because of an emergency, let the patient know. You can even relate it back to the patient, if he or she was once an emergency patient. For the most irate patients, schedule their follow-up visits at the start of the day so you do not have the opportunity to make them wait again.

USE HUMOR APPROPRIATELY Patients perceive you as an authority figure, a professional, and a doctor who is helping them maintain vision and quality of life. Know yourself, and be yourself. With this in mind, it is OK to use humor during appropriate situations. Of course, this decision is physician- and patient-dependent. For instance, after reviewing postoperative instructions with a male patient and his wife, his spirits may be lifted if you instruct him to refrain from housework for at least a year. Either that or his wife will smack you.

NEVER BLAME THE PATIENT
In your career, you may care for a handful of patients who remain scornful and even hateful despite your genuine efforts to earn their respect. In these situations, when all else fails, you may need to end your patientdoctor relationship. Despite any visceral inclinations that may be buried deep beneath your white coat, never blame the patient. Instead, blame yourself. say something like this: “The most important aspect of the physician's relationship with a patient is earning trust. I have failed you as a physician and was unable to garner your trust. Thus, I cannot provide you with the best care possible. I would like you to continue your care with one of these fine physicians, who I hope will do better than I in earning your trust.” Give them a list of retina specialists in the area from which to choose. These tips only begin to address on the intricate art and skill of establishing a solid rapport with every patient, a goal that must often be accomplished within just a few minutes. As always, know yourself, your stressors, and your biases as you continue to attempt to connect with your patients.

Darrell E. Baskin, MD; Jeremy D. Wolfe, MD; and Chirag P. Shah, MD, MPH, are second-year vitreoretinal fellows at Wills Eye Institute in Philadelphia, PA, and members of the Retina Today Editorial Board. Dr. Baskin may be reached at darrellbaskin@gmail.com; Dr. Wolfe may be reached at jeremydwolfe@gmail.com; and Dr. Shah may be reached at cshah@post.harvard.edu.