Dealing with difficult private Docs

[gunner05]

Ok, I've been in the optic biz for about six years now. I teched for a private doc for several years before jumping into opticianry as a lower level manager. I'm damn good at what I do, and my time on the Dr's side has given me a lot of valuable experience to help with trouble shooting problems with glasses and such. Too bad I don't have my own chair, phoropoter, and those nifty letters after my name.... But I digress.

My problem is that I have a few local Docs who have become a bit of a thorn in my side. The first is an opthalmologist who has a bad habit of sending the wrong Rxs out with patients. They come to us, fill them, then go back to him to complain that they can't see well. He looks at the glasses, tells the patient that they are wrong, but then gives them a new Rx "just since they are in." I made the glasses correctly the first time, this is just him covering his tracks and trying to make himself look good.

The second Doc is a young lady who has just started her own practice. A patient came in with an old Rx that was pretty close to being -4.00 -1.00 x 100 with a 2.25 add OU. New doc changes the os Rx to a -2.25 -1.75 x 160. Add power is dropped to a 1.75. This is nine months after the patient's last Rx with a different doc (who knows is stuff.) I didn't have the original Rx to begin with so I had no idea of the change, but we fit her in our most expensive lenses short of varilux. Patient can't see crap and goes back to the doc. Doc says the seg is too low (18 mm seg with a frame that has a B measurement somewhere in the mid to upper 20s). Patient's complaints are that she can't see up close out of her right eye, but can see distance fine. Her left eye has problems in the distance but can see up close fine. HMMMMM I WONDER WHAT THE PROBLEM REALLY IS? I call the office to talk to them, but the doc is adamant that we jacked up the measurements (we'll disregard the fact that I personally fit more glasses in a month than she ever has refracted) and that they need to be remade.

Doc number three writes kodak precise as the type of lens to use for a progressive. Guess who is the only doc in the area that sells that lens? Patient comes in wanting drill mounts so I put him in a trivex prog (trinity) and a hydrophobic ar. Off to specials lab it goes and comes back on power. Pt can't see so he goes to the optometrist for a recheck. No chair time is given, simply an auto lensometer reading on the prog to get a slightly off Rx (original was spot on when I checked it) and a nice little note from the doc's staff griping at me for not doing a kodak precise. Now the patient is wondering why he's not in the precise and feels that is what is wrong with his Rx. He's never been in that lens before, only an AO Compact and did wonderfully.

What would yall do in these situations? I've already resolved numbers one and two, but I fear I'm about to butt heads with someone on number three. I don't mind remaking things if they come out wrong, and in fact, am one of the first people to do so. I have made mistakes before and will own up to them, but I am getting really tired of dealing with stupidity like this.

[chip anderson]

1)Don't fill "outside precriptions'. If your office is prescriber owned it's illegal under the "common roof law" anyway.
2) Ruse to fill the doctor's Rx's that "always sends and amends his's Rx's" just tell the patient's you won't fill them because you always have to have him re-write and re-do his Rx's. He'll straighten up real fast as soon as this gets back to him (which should't take more than 3 patients).

Chip

[icare]

I'm in the same situation with a few ophthalmologists that can't refract to save their souls. Once in a blue moon, I'll actually re-refract the patient to get it right and solve the issue properly, but that's really a poor tactic and one that many opticians can't utilize. It's a poor tactic because we shouldn't have to provide a service for free nor cover the butt of the original faulty prescriber to whom we have little allegiance.

A patient that has to return to the prescriber for an Rx check and then follow up with a lens redo isn't any happier than the dispenser. Keep that in mind and make sure the patient realizes that you're on their side first and that you'll do more to solve their problem than anyone else. Regardless of the outcome, the patient will return for your expert service in the long run.

There is no reason to refuse outside prescriptions - at lease not here in PA. It's also a lot better to hack through the jungle of botched jobs that follows a poor prescriber than to motivate that same office to put in its own optical department. You may even be given the opportunity to refer those patients to your preferred prescriber.

As far as handling the faulty docs themselves:

• Get to know the doctors "somehow." Meet and greet them whenever possible and let them know how much you appreciate getting their work. Explain that you are there to assist them with their patients and that you enjoy doing so. Butter them up. If you don't, you'll lock horns and the crap will escalate. Feed their egos and they'll at least work with you. I know it's a hassle and you probably know the drill.
• Once they are in that position, let them know that some of the work has been very costly and that you can't afford the work if there are too many that are reprocessed. You've got to be blunt. They want their patients to be satisfied, too, and they may be willing to listen if you put it in that perspective.
• Explain that you don't want to give the reprocessing bills to the patients, but you may be forced to do so if some other arrangement isn't made. The preferred arrangement would be the prescriber's willingness to cover the redo cost when it occurs. If the doc doesn't offer it as an option, suggest that it may be a way to solve the issue.
• If the doc does not concede, courteously withdraw and take matters into your own hands. As a last resort, have the patient sign a waiver that he is willing to pay for any necessary reprocessing in order for you to fill that particular doctor's Rx. It will make it clear to the patient that it is only that particular doctor that is the problem. And when the patient gets the bill, guess who they'll take it back to for a remedy? - that's right, the original prescribing doctor. The patient and the doctor will both be unhappy.
• When that docs office calls to gripe, be sweet as honey and ask if they'd rather have your bills forwarded to them directly without the patient knowing it.

I hope this helps.

[HarryChiling]

Find a prescriber near you that you trust, sit down with them and explain the situation. That you have many incompetant boobs in your area that think they need buttering up and shmoozing to do their jobs right. Offer to reffer your patients their and have them bill you for the services (at an agreed upon discount of course). Now use those scripts for you glasses. Now every time the shoddy doctros scripts come into your office, you will be taking and giving the patient a second opinion and giving the other doc you refer to some business while getting an Rx you feel comfortable with. Chalk the cost of the exam up as a loss or roll it into the price fo the frame and lenses, but it's better than a remake on some lenses.

You may even want to pick and choose, when the lens choice is made which patients go this doc for the second opinion. Like a high end lens definately goes where a stock lens would be trivial.

My guess is that when the doc writeing these erroneous Rx's finds out they will come visit you and schmoze you.

[DragonLensmanWV]

Ok, I've been in the optic biz for about six years now. I teched for a private doc for several years before jumping into opticianry as a lower level manager. I'm damn good at what I do, and my time on the Dr's side has given me a lot of valuable experience to help with trouble shooting problems with glasses and such. Too bad I don't have my own chair, phoropoter, and those nifty letters after my name.... But I digress.

My problem is that I have a few local Docs who have become a bit of a thorn in my side. The first is an opthalmologist who has a bad habit of sending the wrong Rxs out with patients. They come to us, fill them, then go back to him to complain that they can't see well. He looks at the glasses, tells the patient that they are wrong, but then gives them a new Rx "just since they are in." I made the glasses correctly the first time, this is just him covering his tracks and trying to make himself look good.

The second Doc is a young lady who has just started her own practice. A patient came in with an old Rx that was pretty close to being -4.00 -1.00 x 100 with a 2.25 add OU. New doc changes the os Rx to a -2.25 -1.75 x 160. Add power is dropped to a 1.75. This is nine months after the patient's last Rx with a different doc (who knows is stuff.) I didn't have the original Rx to begin with so I had no idea of the change, but we fit her in our most expensive lenses short of varilux. Patient can't see crap and goes back to the doc. Doc says the seg is too low (18 mm seg with a frame that has a B measurement somewhere in the mid to upper 20s). Patient's complaints are that she can't see up close out of her right eye, but can see distance fine. Her left eye has problems in the distance but can see up close fine. HMMMMM I WONDER WHAT THE PROBLEM REALLY IS? I call the office to talk to them, but the doc is adamant that we jacked up the measurements (we'll disregard the fact that I personally fit more glasses in a month than she ever has refracted) and that they need to be remade.

Doc number three writes kodak precise as the type of lens to use for a progressive. Guess who is the only doc in the area that sells that lens? Patient comes in wanting drill mounts so I put him in a trivex prog (trinity) and a hydrophobic ar. Off to specials lab it goes and comes back on power. Pt can't see so he goes to the optometrist for a recheck. No chair time is given, simply an auto lensometer reading on the prog to get a slightly off Rx (original was spot on when I checked it) and a nice little note from the doc's staff griping at me for not doing a kodak precise. Now the patient is wondering why he's not in the precise and feels that is what is wrong with his Rx. He's never been in that lens before, only an AO Compact and did wonderfully.

What would yall do in these situations? I've already resolved numbers one and two, but I fear I'm about to butt heads with someone on number three. I don't mind remaking things if they come out wrong, and in fact, am one of the first people to do so. I have made mistakes before and will own up to them, but I am getting really tired of dealing with stupidity like this.

We've all had to deal with situations like these. A lot of MD's simply do not refract well. Brilliant surgeons and treaters maybe, but refractionists? Not so much.
I wonder why you did not fill the last Rx with a Precise? It does come in Trivex. We fill our own Rxes with whatever lens best fills the customers' needs. If an outside Rx comes in with Varilux written, then they get Varilux, or whatever brand the Dr. prescribed. If the Dr. prescribes a specific lens, then we make sure that's what they get. Granted, all MDs should be banned from owning an autolensometer and relying on it for RX check, especially in progressives should be banned. At least until they get trained to actually use it. We've had lenses come back from a MD's office with a nasty note about how off power, excessive off-axis cylinder and such and they leave the lensometer dots on - halfway down the seg and at the edge of the corridor.:hammer::hammer:

[Andrew Weiss]

My experience: At one office where I worked, we actually did send a bill to the prescribing Dr for the Rx redo. He paid the bill, and we never saw another Rx from him. Therefore, I'd say sending a bill to the prescribing Dr is a last resort. I'd also say that sending a bill to the patient and having the patient then go to the prescribing Dr will most likely guarantee that you'll never see again either that patient or any more of that Dr's Rxs.

[OPTIDONN]

We have the same problem with several locations near us. One clinic was sending inaccurate RX's all the time. There was a period where we had to redo 60% of all RX's that came from this clinic!! We were losing money hand over fist! We made it a policy that any RX from this clinic that looked significantly different from the previous RX needed to be checked by our Doc at no charge. It may seem like a pain but much of our business is from outside RX's. Patients began to appreciate how thorough we were. Them seeing us examine RX, frame, lens design, material selection, coatings etc. and seeing us go through great lengths to make thier glasses work the first time! This builds a great deal of respect between the patients and our staff. Often these more clinical settings may not be willing spend the time with a patient.

As for the stupid staff at this other location, I feel ya' on this one! This is a great motivation to educate yourself!! In fact this is one of the reasons why I chose to persue my ABOM. On more than one occasion we have recieved a note from some dumb *** optician saying we "should have matced base curves" on a new pair of progressive lenses. In fact recently I recieved just such a note. I typed a nice letter on some fancy professional stationary with ABO-AC printed after my name. I explained why keeping the same base curve in a progressive lens would cause more harm than good and how how measuring the base curve of a progressive lens is not very accurate. I also pointed out that maybe the axis change of 30 degrees in a -1.25 cyl may be the problem (this was from an outside rx that we did not check). I made it nice and technical explaining every aspect. I only try to do this with a few locations that have made it a habit to criticise our staff and our quality to patients who have purchased glasses from us.

Take these notes that you get and put them up on your wall. I did this and I call it my "inspirational wall of hate". If I get stuck on an article or lose my motivation for studying I just look at these dumb notes and it puts a fire under my butt! The best way to combat these tings is to know your stuff. If the Dr. thinks that not using a Kodak lens is the problem you should be able to fill them in on details of the designs and show why one may be better for this patient than another. You need to be able to show these other "opticians" and explain why thier logic may be flawed. The more you know the more respect you'll get from patients and even other practices. But never forget be professional!! Don't trash talk the other practices infront of the patient or criticise the quality of thier work! And when the time comes that you need to send a note to another optician keep it professional, technical and accurate! and it never hurts to show that you have advanced certifications (chances are they don't).

[ziggy]

If so see if he/she would be willing to "re-refract" these patients comming from these offices. Even if you had to pay the doc a little to do this it would be cheeper than remaking lens or loosing a patient.

[optical24/7]

1)Don't fill "outside precriptions'. If your office is prescriber owned it's illegal under the "common roof law" anyway.


Chip

What law are you referring to Chip? If it's the separate door law that used to be in effect in Tx., that laws changed. Most Dr's now have open reception areas/dispensaries at their locations.

[drk]

If your office is prescriber owned it's illegal under the "common roof law" anyway.
Chip

Chip,
What are you smoking, now? That's just plain wrong.

[drk]

To the original poster:
1.) As an optician, you are in the business of filling outside Rx's. It's your job description. Figure out a way to deal with...

2.) ...Prescribers that can't prescribe their way out of a paper bag.

It's going to get worse, not better.

Listen, just tally the costs of all your remakes for 12 months. Divide that by how many jobs you think you're going to do next year (take a rough guess...try 4/day.)

Divide last years' remake cost by #projected jobs this year.

Add that to you price structure.

Repeat next year.

Why are you *****ing so much? Is others' incompetence somehow unfair to you? Of course not.

[chip anderson]

"Common Roof Law" is a federal court decision that for a while got ophthalmologist out of the dispensing business. I used to have a copy but have not been able to obtain a copy since changing locations a few times.
Ruleing said that doctors (at the time this ment M.D.'s) must share a common roof with the dispensary they had financial interest is and could not fill Rx's from prescribers who did not share the common roof.

Chip

Of course for obvious political reasons no optician had the nerve to bring one to prosceution for same.

[optical24/7]

When was this a law Chip? In the 33 years I've been in this business I've never encounter, witnessed nor heard of this law.

[gunner05]

To the original poster:
1.) As an optician, you are in the business of filling outside Rx's. It's your job description. Figure out a way to deal with...

2.) ...Prescribers that can't prescribe their way out of a paper bag.

It's going to get worse, not better.

Listen, just tally the costs of all your remakes for 12 months. Divide that by how many jobs you think you're going to do next year (take a rough guess...try 4/day.)

Divide last years' remake cost by #projected jobs this year.

Add that to you price structure.

Repeat next year.

Why are you *****ing so much? Is others' incompetence somehow unfair to you? Of course not.

Honestly, I'm just seeing what other people's ways of dealing with these situations are. Situation one and two, have been resolved, as I said. The first one involved me actually going and talking to the opthalmologist and literally telling him that I'd stop suggesting him as a good doc for any sort of surgeries or even for doing exams under medical insurance. He gets a lot of referrals from us so that would hinder him quite a bit. He got the message and hasn't caused an issue since. The second one, I actually remade the lenses without AR for the patient and did exactly what the doc said I should do. I burned a pair of progs, unfortunately, but I also have a patient for life now since I looked more competant than the doc did. I discussed, ad nauseum, with the patient why her vision was not working out right, what the doctor probably tried to do (I believe she was trying to not over minus the patient, but can't be sure... I do applaud that, but it's not always that simple,) and why moving the seg height up wouldn't fix anything. I've discussed this issue with both bosses above me and we're in a "wait and see" approach to see if we have any other issues with this doc before doing anything else.

I don't want to ruffle too many feathers, but at the same time, I have too much pride in my work to be whatever. I love doing what I do and just wanted to see how yall would have handled the same situations.

[chip anderson]

I find that the opthalmologist nowdays really appreciate your referrals when they are getting established, after a two or three years when that old appointment book starts getting filled. You are first choice after he has failed to entice them to go to his dispensary (he may or may not have had one at first). In years past the doctor was good for referrals not only of the patient's you sent him but also any of his family members that saw him later, not so now.
Nowdays the referrals we get from established doctors are: Patients we sent them that refuse to go to the company store. Nuts he wants to get rid of. Patients with difficult problems like keratoconnus, five diopters of cylinder wanting bifocal contacts, and the like. If it's easy, like teenage myopes wanting contacts, he or the company store does it.
Once the doctor gets established especially if he has several associates you become less and less important to him no matter how skillfull you are.
I have ophthalmologist all over the state that will tell you when asked that I am the best there is at contact lens fitting or prosthetic eyes. But am I getting the easy and profitable contact referrals, not by a long shot. Kind of miss those teenage myopes.

Chip

[bt5050]

well it seems like we all have had our fair share of perscribers that like to place "Blame " on anyone but themselves -

To be honest - we had a few that loved to bash us - also- and never take the blame - for issueingthe wrong rx -
there was nothing i could do to build a relationship with this guy - and i have a feeling that it has to do with his wife running his optical - and wanting everyone to go there - for there glasses - but who am i to say -

anyways - after about the 5th time - i heard we made them wrong - i started making copies of the rx - and when the pt came in - and told me this - i acted suprised - as usual - apoligized - however i started pulling out those 1st rx's - i did not gave to explain anything - the pt saw it with their own eyes - and drew their own conclusions - i never said i word about it -

these pts became my pts for life - and i see them - and their entire families year after year -
like i said - i did reach out to the office - try to make a relationship - but always got the cold shoulder -

I just love when they write a certain pal down - and if there is a actual error in refraction - and the rx - changes - it comes back with a comment on NOT a varilux lens - non adapt - and i just laugh esp since the pt was never in a pal before in their life -

as for my friend that either does a poor refraction - or makes a error in writing the rx - i send back that written rx - #1 and #2 - with the pt - because with this guy - it is more then likey - the 3rd time is a charm - and actually works ( and is usually the org rx anyways - LOL ) - I am sure to pose the ? to him - on my recheck for i send back that i was a bit confused - when i get 2 differant rx's - and i circle his comments -

I try my hardest not to burn bridges - and usually will always take the error - and cover for some - since as you know - it is suicide - when a doctor hates you - and they let all the pts know it - but this one - i could care less -
my suggestion - is if you reach out - try to have a meeting or better yet - try to get him outside his office ( his comfort zone ) - and do lunch you are more opt to get somewhere - unless - he is one that looks down upon everyone that does not have OD - or MD after their name - or is his wife for that matter -

B

[chip anderson]

Take it from a guy that has burned a lot more than most (sometimes with just a post). Never burn one!

Chip