Laser eye surgery and time-limited offers

Background

Katie is short-sighted. She’s 55 and has always worn glasses for distance. Recently, her near vision is better when she takes her glasses off.

Katie sees an advert for a private practice ophthalmologist which says that she could get 20/20 vision with refractive laser eye surgery for half price.

Scenario 

Katie goes to the private practice ophthalmologist clinic and meets with a patient adviser.

The adviser tells her that the half price deal is very popular and runs out at the end of July. She tells Katie that if she wants to take advantage of the offer, she’ll need to pay a deposit straight away, as it is the 29 July. 

Katie is next shown in to meet the optometrist, Mr Paniani. After some tests Mr Paniani tells Katie she’s suitable for the surgery and explains what it will involve.

Mr Paniani asks if she has any questions but Katie can only think of two. She asks Mr Paniani whether she’d see clearly straight away and what could go wrong with the surgery. 

Mr Paniani says he’d expect her to be back at work after a week and know the full benefit of the surgery after three months. He also reassures Katie that hundreds of people have had this procedure at their clinic and that as long as she follows the post-op instructions the risks are very small. 

Mr Paniani asks her if she needs some time to think the surgery over but Katie says no as she doesn’t want to miss out on the half price offer. Mr Paniani prints the procedure consent form which Katie signs.

He also gives her a factsheet to take away. Katie thanks Mr Paniani and pays her deposit at reception on the way out.

Katie’s procedure is performed two weeks later, by Mrs Ludin. Mrs Ludin is the lead ophthalmologist at the clinic. The procedure goes smoothly. 

What happened next

A month later Katie has her follow up appointment with Mrs Ludin. Katie tells Mrs Ludin that her long distance vision has improved, but that she’s finding it hard to read menus and some books. She asks Mrs Ludin if this will settle down. Mrs Ludin tells Katie that it is normal for someone of Katie's age to need glasses.   

Katie explains to Mrs Ludin that her near eyesight had improved so much prior to the procedure that she had to take her glasses off to read. Mrs Ludin explains that that is a sign that her eyesight was beginning to deteriorate, if she used to be able to read with them on. 

Katie also complains that the ad told her she would have 20/20 vision and she wouldn’t have gone ahead if she knew she still had to wear glasses. Mrs Ludin explains that she does have 20/20 vision as that is the measure of how clearly you see things at a distance and hers has improved.

Katie leaves the appointment very upset.

What the doctor should have considered 

• Time-limited promotion. Doctor’s must market their services responsibility and follow the regulatory codes and guidelines set by the Committee of Advertising Practice (Guidance for all doctors who offer cosmetic interventions, paragraphs 47 and 49). An offer of this kind shouldn’t be available a few days before it closes (Committee of Advertising Practice guidelines, paragraphs 62-66). Doctors must not use promotional tactics which could cause patients to make an ill-considered decision (Guidance for all doctors who offer cosmetic interventions, paragraph 52).

• Who should be seeking consent. The doctor who will be carrying out the procedure has responsibility to discuss it with the patient and seek their consent. This responsibility mustn’t be delegated. Our guidance on sharing information and discussing treatment options (from Decision making and consent, paragraphs 42-47) states the importance of this exchange of information in the consent-seeking process. Doctors should tailor their discussions with patients according to – amongst other things – patients’ wishes and priorities, and their level of knowledge about the treatment options. Paragraph 17 of the cosmetic interventions guidance says doctors must ask the patient why they’d like to have the intervention and the outcome they hope for. 

• Time to reflect. Patients must be given the time and information they need to reach a voluntary and informed decision about whether to go ahead with an intervention. The amount of time patients need will depend on the complexity, invasiveness and risks of the intervention, amongst other things. (Guidance for all doctors who offer cosmetic interventions, paragraphs 24 - 27).