Ah Nettie, your showing your relative youth. Not sure about Stroppy, but Bippy was a word used in the early '70s. It was from a comedy show called Rowan and Martin Laugh-In. Everyone (in the country) was saying, "You bet your bippy". Of course, no one ever said what a bippy was. That was left to your imagination.Originally Posted by Nettie
Stroppy?? Sounds British to me. Perhaps someone can enlighten us.
Couldn't agree with you more on the issue.
It was always: "Bet your sweet bippy." Right before the fickle finger of fate award.
by handing them back their Rx. We would explain to them that they have to bring us a written Rx for what they want. We would not offer to let them use our phone.
The only one they could use is at the reception desk and I'm not going to have people walking into our office with somebody trying to negotiate with another office. That is really tacky! :finger:
Days where my gratitude exceed my expectations are very good days!
Jubilee came down from the mountain and sayeth:
“So she calls her insurance company to have them gripe me out.”
Yikes, now you have insurance companies interceding on the customers behalf. Next thing, you may call a call from her congressman or the Pope.
I stand corrected. A Sweet Bippy is always better than a regular one.
I think the answer is going to depend on whether you're in a licensed state or not, and what your state license allows. In Florida, if you are a Board Certified Licensed Optician you may "fill, fit, adapt a soft contact lens Rx". So I would trial a pr. of the desired lenses and if after slit lamp and acuity evaluation as long as there was no reason not to dispense that lens, I would document the eval. and dispense the trial lens. We would like it to be worn at least a few days befor ordering any supply. If it was a local Dr.'s Rx, I'd give the courtesy call to inform them of any changes and why so that they could have it documented what the patient is wearing. That info. is valuable for next year's exam.
"Stroppy", is British, for someone who comes on strong, and tries to bully their way into getting what they want! Doesn't work with this ex-pat Brit! :cheers: You can take the girl out of England, but can't take the English out of her!
Under these circumstances I would try to say: "Usual standards of practice dictate that you return to the prescriber for any contact lens refitting services. It would be an uncomfortable breach of medical etiquette for us to call a doctor and ask him to change his prescribing recommendations over the phone."
Of course, in real life, I would say, "Um...no way, dude."
We have this happen ALL the time- right along with people coming in with old, empty CL boxes or, better yet, really old and wallet-worn box TOPS. We absolutely will not dispense any lens other than what the patient has a written prescription for. When they come in with boxes (or partial boxes), we get the name and city of the professional who dispensed them. We will go as far as contacting the provider to have them fax us the original Rx. 99.9% of the time, the patient hasn't returned to that provider because they never paid for their original fitting or lenses and/or the prescription expired two or three years ago.
Of course, whatever the reason, when we refuse to dispense CL without a valid prescription, WE are the devil and the patient will "go to a doctor who wants their money......" The first couple of years on the job, I would just appologize and explain that it was not in their best interest. NOW I tell these patients that there are many institutions out there who "want their money," but I wouldn't trust my eye health OR vision to those who "want their money" so badly that they are willing to risk both in order to get a few bucks.
Anissa
I am SO using that line next chance I get!
:bbg:
It's like being a travel agent... I help people see the world!
some patients with a mild +Rx may suffer from accommadative dysfunction, convergence insufficiency, and as such, colored/clear CLs would NOT neccessarily help her refractice problems. Hence, this is where the DOCTOR is needed...we are trained to evaluate, patient educate, and prescribe the appropriate RX for them. Usually, they may need an NVO over their colored, +0.25 cl. Also, small amounts of astigmatism, while not affecting their distance vision, can cause near symptoms. Did they train CL techsopticians to identify and manage these problems??
Optometrists/some OMD's are the ones who ought to be fitting CLs, period. And yes, there are those OD's that rush through fittings with mild nearsightness/spherical RX b/c some patients don't want to return...they just want their RX so they can order from 1-800.
The optician should refer the pt back to the fitting OD for a refit. I ask EVERY pt what they are currently wearing and if they are happy. If not, I will fit them in the most appropriate CL based on needs/signs/symptoms. Please don't insult OD's by stating that we fit based on which rep manipulates us...that is so rediculous.
If you have credible evidence to support an allegation that an OD is being unethical in their CL/SRX fit, then you ought to report it to their board and not generalize and smear us...
Just my 2 cents
To those opticians that would refit the patient (assuming you are in an area that allows this and are trained to do so), how much do you charge for such a fitting?
I do think patient expectations are driven less by prescriber recommendations and more by direct to consumer advertising. As a result, we should expect these types of things more and more. I think there are in fact patients who are written a prescription for a medication by a doctor, but the patient later wants something different they saw on TV or heard about from a friend. Same thing with contacts. I have plenty of patients who let me go through the entire fitting process and then ask about another lens they saw on TV (after history, etc.) Its a bit frustrating at times :)
Here is the key. Generally, and OD or CL fitting optician that arrives at a final prescription should be able to fully explain to a patient why those lenses were prescribed. Sometimes its due to an overnight wear rating, sometimes its the only one that fits correctly, and sometimes it is due to cost. But, there is a reason. If you can't explain why you fit a particular lens, then you are should rethink your protocol. However, I think it would be easy to explain why when they call and ask. Contact lenses are prescribed based on clinical findings, patient history, fitting parameters, and yes sometimes even patient finances. If something changes then extra time is needed to resolve the issue. It ain't going to be free in my office, and it ain't going to be done over the phone.
There certainly will be a bit of mild badmouthing on my part if a store/office calls and wants to change the parameters for whatever reason. I guess its nice that they call, but it just isn't going to happen. Doing so suggests "all contacts are the same" or "the doctor makes more money on a specific brand" and reinforces an all too common stereotype that is sorely in need of burial. I see it as looking out for my patient. They pay me for my expertise, and we arrived at that prescription for a variety of reasons. Once that prescription is finalized, it is written up and it is final, UNLESS I see them back for a refit.
Bottom line is that patient education is poor and expectations are not in line with current fitting protocols. The current passive verification is a whole other issue that has patient implications as well, and does very little to help with this process in my mind.
Just to get further off topic, there is a thread on another site discussing the legal ramifications of selling outside contact lens prescriptions. It was interesting that most ODs do not do it because of liability issues. There was no talk of selling to everyone to make a quick buck.
We would never allow a client to call your office and would advise them to return to you to be refit if they want lenses other than what they have an Rx for. We see quite a few that have an Rx for XYZ lens, but just want a couple of boxes of colors.
We explain to them that since all lenses fit a little differently that they should return to their Dr (Opticians in Colorado can not fit lenses on their own) and be refit for colored contacts.
:cheers:
Days where my gratitude exceed my expectations are very good days!
and if your are in a state that allows opticians to fit CLs; you would have a fitting fee for the new CLs,right? That would seal the deal I'm sure
The release of contact lens Rx's for Private Labels. I work in an Optometric practice and we would never let a Private Label Rx go out the door. All that's going to do is tick off the patient and make us look unprofessional. It ticks us off when patients with outside Rx's come in with Private Labels we have never heard of before.
No, not all OD's are ethical; and of course, not all Opticians are ethical either. However, I'm pretty sure that is the case with almost all of the health care industry. There's no sense fighting over what we all know. There are those of us on both sides of the fence who are doing the right thing and we should be proud that we put our patients' welfare first.
Remember what I said about the O.D.'s who went through Souther College of Optometry who told me that if they had not subvertivly fit thier roomate's they would never have seen a contact lens on an eye before licensure.
What was that word, trained?
Yes, I've heard this before from you chip. Perhaps they were joking, perhaps they were lying, perhaps they hated contact lens fittings and avoided at all costs. There were standards which we all had to meet. I highly doubt that person really cares much about contact lens fitting today. They're probably in some lasik-only clinic, or ocular disease referral center somewhere. Not every OD is a contact lens expert. Regardless, to graduate from Southern you must attend numerous lectures on a wide variety of subjects, pass multiple examinations, and clinicals for four years. Four years, its a doctorate degree. We aren't just sitting there twidling our thumbs the whole time like you seem to believe.
Southern is one of the more respected schools of optometry, with a push towards ocular disease management while at the same time retaining what has made optometry such a good profession: primary eye care, optics, contact lens, etc. Once again, you do a disservice to this whole community by painting with such a broad stroke the education of optometrists based off of what one person said at one point in time. Once again, I think its a shame your vast knowledge of optics, opticianry and the overall industry is tainted on this forum by such innappropriate, self-serving comments.
I'm actually inclined to believe you've made the whole thing up;)
Last edited by orangezero; 03-04-2007 at 08:55 PM.
Orange:
They did tell me they did a lot of reading, saw a lot of slides and attended a lot of lectures. But this was supposedly the extent of "training" on contact lenses.
No one showed them actual lenses on the eye. Stained them, showed them how modifications could be made to the lenses and showed them the difference these changes made by thier own hands could make in actual clinical setting. But perhaps that passes for "training" now.
Just as it has been my observations that OMD's are no longer "trained" to be intelligent enough to refract over rigid lenses. Just pull them out and refract.
Chip
Well, you were lied to then:hammer: I distinctly remember having to modify RGPs, increasing minus, increasing plus, etc. before we could "pass" and see patients in clinic. Its been a few years, but there were lots and lots of labs where we looked at contacts on each other's eyes. RGPs were always stained, burton lamps and slit lamps and all... We had enough pre-training. Its always scary to see real live patients the first time, but there were professors around to guide us when it happened. You had to start somewhere using all the knowledge we learned in lecture.
The only thing I can think of is how after something becomes second nature, you tend to think of it as easy and take for granted the training it required to learn, like any new skill. But, its a disservice to the profession and a mistake to trivialize such matters, imo.
But, I think your point is also the dearth of new RGP contact lens fittings and the trend toward soft lenses. This could be a whole other topic.
I wouldn't say its a matter of ethics. Its more a matter of customer service. Pharmacists do it all the time when doctors Rx high priced medications that a patient can't afford, yet there is an alternative that is much cheaper. I've even had that happen when my OD rx's an eye drop that is expensive.
I've called Doctors to ask if they would change the Rx. Really all they have to do is look at the K's and decide if the new Base Curve will work. There aren't any new measurements to do. I'll do that if I have the time, and the Dr., or the tech that answers the phone will make the call from there. Sometimes they'll do it, most times they won't without a refit charge.
Think about the medical liability for a second? Its real. Maybe not frequent, but it does happen. Does a practioner want his last patient contact (before a central corneal ulcer) with a patient to be another dispensing office on the phone requesting a change in prescription because the lens is cheaper, or simply because its something they have in stock?
When I fit someone in lenses, I take into consideration many factors such as price, wear schedule, history, etc, etc. and come up with a best fit solution for the patient (with his/her input). When a patient leaves, goes to another office or store, and calls requesting a different prescription it generally is unsatisfying to me because somewhere along the line something has gone wrong. I doubt this would honestly happen much, unless they are 10 months from their last fit and looking to avoid an exam.
The thing that does happen a lot is that despite all the discussion of the options, the patient waits till we are done with the fit and are about to walk out and then says, "gee, I'd like to try these lenses my friend wore." Much more frequent and irritating :)
Sure, the place selling the lenses doesn't care about liability (for many that I've dealt with it never even occurs to them). Its all about customer service and selling product and being as simple as possible for the patient. And if you think they are only product AND you have virtually no liability, I can understand why you'd think these were simple issues.
I'm sure chip would agree with me that things have been dumbed down far enough, but to say a lens has the same BC and therefore would fit the same is a bit simplistic. I'm not sure if that is what you are saying though.
There are times when a "better" lens isn't always better for a particular patient. Newer isn't always the answer. What works for their friend may not work for them. Its the prescriber's job to figure that stuff out, thats why we get paid for the fitting.
Honestly, I doubt I'd get too upset with someone calling, but I'd be more likely to think the shop was trying to upsell or convince them to get a new exam at their store. And, I think somewhere along the line the patient-doctor relationship isn't quite as strong as it should be. Not because they don't buy lenses from me, but rather because they either left my office confused or they didn't ask their regular doctor for advice on new lenses. Doesn't happen to me very much.
Medications are a whole other ballgame.
What I tell patients when they ask why they have to have a new fit, is that a contact lens is not just BC, Dia, and power. Material also affects the fit, and accounts why sometimes, though the bc is the same.. power will change slightly. It shapes the eye just a bit differently.
Material can also affect comfort, oxygen permeability, and a slew of other "non power" related but important factors as well.
While it may seem like a PITA, the idea is making sure the patient doesn't spend a whole lot of moola on something that is not going to work, or even worse, be detrimental to their eye health.
Cassandra
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
"Its all about customer service and selling product and being as simple as possible for the patient. And if you think they are only product AND you have virtually no liability, I can understand why you'd think these were simple issues."
If I have the time, I am willing to make a call for the patient. Its then the Doctor's call on what he/she wants to do. Contact sales don't make me very much money, so if I don't have something more profitable to do, like begging for change at the bus station down the street, I'll make the call. If the Doctor wants to say "no," thats fine with me.
I have been on the receiving end of that call, showed my OD the chart and he simply looked at the K's and wrote an RX, so thats why I think its that simple. You are the one writing the RX, so you have to make the call. I will say on the business side of things though, that many times the patient will feel alienated and go elsewhere in the future. Whether thats fair or not is a different issue, but customer service oriented businesses are seldom fair.
Chip,
I know an optician who received his license by having someone else sit for the exam. Gosh. I wonder if they all get their credentials this way?
What's your point? It seems to me, from many of your posts, that you just like to smear optometry.
Sorry folks. Gotta fight fire with fire.
Last edited by fjpod; 03-06-2007 at 06:28 AM.
Fij: My point is that opticians were fully qualified to fit, develop, etc. Contact lenses when most O.D.'s were afraid of them (Back when we had to take moulds of the eyeball, make casts of this, hand grind and modifiy the lenses. Mix our own solutions, etc. And now that "science" has got contact lenses fitting so simple that a blind pig can do it, some O.D.'s run around saying: " Us O.D.'s is so well trained, that no one but us should be able fit contact lenses, or measure a seg.ht. or determine bifocal type, or modify an Rx to focus at a given distance for piano use."
It's not us opticians that every year try to influence the legislature to restrict O.D.'s. It's not us that try things like the Bates method, other culty treatments.
Chip
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