Dr RX

[Barry Santini]

With all this back-and-forth discussions about the precision/fussiness (or lack thereof) with respect to both clients/patients and/or refractions/refractionists, I ask:

How does one reconcile all the above with the apparent "satisfaction" John Q. has with OTC readers, which are inherently *imprecise*.

Q: Is there a inverse correlation between cost and client satisfaction with eyewear/CLs?

FWIW

Barry

[Jubilee]

I actually believe there is Barry.

When patient's pay less, their expectations are often times lower..

"well since I only paid $5 for them, they do the job"

compared to

"For $450 I better see the fricken Bible on a grain of rice, see 180 degrees of infinity and take 20 years off my appearance!"

I don't think necessarily quality is the right word as is value. For $5 I am a lot more forgiving on something than I am on something I invested 10-100 times more on. The amount of money in correlation to expectations relates to ultimate value...

That and people don't feel as frustrated and guilty losing something worth only $5 compared to the cost of new pair of glasses...

[kws6000]

How can a re-do be due to patient error. It's not like they can overdose, or underdose or take the medication at the wrong time. The doctor is in charge of writting the Rx, total control, if he's any good he has a damn good idea of the Rx after dilated retinascopy. Patient response to his his questions should have little if any effect on the final result. Not to mention if he uses a reliable (if there is such a thing) automated machine before he starts, what has the patient got to do with poor Rx?
Is he telling the doctor I want to see distance at only 10 feet, or read at 10 inches?
Chip

You have obviously never performed a refraction.

The readings from autorefractors tend to give an idea of the the refractive trend but none of the ones that Ive used are accurate enough to put a lot of faith in.

Retinoscopy is also just a tool to use but it isnt accurate enough to base final results on.

In our dry climate,many patients give vague and inconsistent responses during the subjective part of the refraction.They also tend to be very vague regarding their desired wd for near/vdt RX's.

It would be nice if it was that easy.

[kws6000]

Again that is assuming the old model, I understand the scenario well, but if you choose as your professional judgement to split the difference then it was ultimately your choice. A few of yoru colegues on this thread even mentioned "fill it as written", "just do your job", etc. Our job is to fabricate according to the Rx, if the Rx is wrong the fault lies no where with the optician. If a doctor does not have a dispensary in the office like is the case with npdr, then he is not competition and you can trust his judgement is not or will not be affected by the post exam sale, but if the doctor has a dispensary they are competition and pony up for errors in their script. It has always been an optician courtesy to not charge the doctor for redo's as a way of keepign the refferels the doctor would send and in so doing strengthening the professional bond, but in this day and age that is a lost model and it is the dispensaries choice to revisit and discontinue the age old practice, not the doctors.

So I guess I should charge opticals for patient re-exams resulting from improperly made/fitted eyeglasses?

I have had a number of these lately due to improperly fitted progressive lenses or warped lenses.

[kws6000]

PS my track record is also pretty good,about 1 redo/6mos.

I can understand the opticians perspective about redoes ,especially with scripts from certain sources.However,it is the opticals choice whether to charge for redoes.

Personally,I feel the concept of dispensers paying for redoes is old school.You dont see pharmacies dispensing med changes for free because of lack of efficacy or a patient reaction and I dont see physicians paying for these med redoes either.

[HarryChiling]

So I guess I should charge opticals for patient re-exams resulting from improperly made/fitted eyeglasses?

I have had a number of these lately due to improperly fitted progressive lenses or warped lenses.

You could that would be your perogative, which is kinda the point here that both the refractionist and the dispenser have a monetary interest in the fabrication so why not just write the script in an easy to understand generic format so that it can be filled confidently and competently the first time around.

It's actually a pretty simple thing to do and would be a professional courtesy, I see you said you get 1 redo every 6 months which means I would talk highly of you when the patient visits me and at times the patient will say things about their office visit and if we get scripts from these doctrs that are majority accurate and written properly we tend to talk you up if not we suggest they use our practices doctors.

Q: Is there a inverse correlation between cost and client satisfaction with eyewear/CLs?

Now your thinking 20/20. ;)

[OHPNTZ]

Harry,

Hypothetical question: You could go to an OD for an eye exam. That particular OD has a set amount of chair time...say for an example 30 minutes. The OD offers you one of two options:

1. He/she could precisely refract you to the utmost clarity of the Snellen Chart, convert any plus cylinder to minus cylinder for the optician, write a detailed description of your acuities...with diagnosis reflecting the acuity on the script for the optician, and await any phone calls to clairify the refraction to the optician. However this comes at the expense of the OD discussing or determining the actual health of your eye due to time constraints. Maybe pass over that you have what appears to be pseudoexfoliation syndrome vs. glaucoma, what needs to be performed as baseline testing, and answer any question you have regarding the situation...

OR

2. The optometrist tries his or her best to get you in a functional spectacle rx...but not to the utmost of an expert optician's clairity. This optometrist then performs the most thorough health examination you have ever recieved, and in the process of diagnosing and discussing pseudoexfoliation syndrome, answers any and all quesitons you have, and gets you scheduled for the proper testing...at the expense of a handwritten spectacle rx script that has simply sphere/cyl/add with a mix of plus and minus cylinder...and isn't eager to interrupt chair time to speak with an outside optician.

You're paying for an Eye EXAMINATION. So do you pay for the refractionist with his/her top notch refraction and average diagnostic skills or do you pay for the average refractionist with the top notch diagnostic skills?

[HarryChiling]

Harry,

Hypothetical question: You could go to an OD for an eye exam. That particular OD has a set amount of chair time...say for an example 30 minutes. The OD offers you one of two options:

1. He/she could precisely refract you to the utmost clarity of the Snellen Chart, convert any plus cylinder to minus cylinder for the optician, write a detailed description of your acuities...with diagnosis reflecting the acuity on the script for the optician, and await any phone calls to clairify the refraction to the optician. However this comes at the expense of the OD discussing or determining the actual health of your eye due to time constraints. Maybe pass over that you have what appears to be pseudoexfoliation syndrome vs. glaucoma, what needs to be performed as baseline testing, and answer any question you have regarding the situation...

OR

2. The optometrist tries his or her best to get you in a functional spectacle rx...but not to the utmost of an expert optician's clairity. This optometrist then performs the most thorough health examination you have ever recieved, and in the process of diagnosing and discussing pseudoexfoliation syndrome, answers any and all quesitons you have, and gets you scheduled for the proper testing...at the expense of a handwritten spectacle rx script that has simply sphere/cyl/add with a mix of plus and minus cylinder...and isn't eager to interrupt chair time to speak with an outside optician.

You're paying for an Eye EXAMINATION. So do you pay for the refractionist with his/her top notch refraction and average diagnostic skills or do you pay for the average refractionist with the top notch diagnostic skills?

I would chose neither, I see a OD that competently does both. Dr. Scott Klasman his office is about 60 miles or 1 hour from my home, he charges for the exam even though we have worked together and offers to comp it. I also catch flack from the doctor I work with that would comp me the exam and be a heck of a lot more convinient. His refractions are the best and he takes his time, he does medical exams, but in my case their is no conditions that I need to spend much time on so there isn't much need for that.

In the case that I did have a condition I would see an ophthalmologist that specialized in the area I had a condition and then go see Dr. K for my refraction, if the OMD offered to refract I would politely refues, if Dr. K would offer to monitor or go over my condition I would explain that I am seeing a specialist for that. Speaking of which I need to make an appointment.:D

[chip anderson]

Most people think they are seeing you for the very best you can do at all of your services. Most doctors have at least enough egomania to at least state that is what they are doing.
Now we have begun to reach a point were some OMD's have begun to think that they are too important to take time with the patient and to preform less than surgical services (refraction). Until now I didn't realize that O.D.'s were trying to reach the same plane. I can put drops in the eye now, I'm too important now to take the time to do my best at refraction.

Oh my, my

[Fezz]

This optometrist then performs the most thoroughhealth examination you have ever recieved

My OD Optiboard Brethern know I am am not about jabbing OD's:


But.......

OHPNTZ,

Maybe the Ophthalmologists out there would giggle a bit at your "Most thorough health examination" delusions.

Come on Doctor..........lets be a little more humble.


;):cheers::D:cheers:;)

[HarryChiling]

That particular OD has a set amount of chair time...say for an example 30 minutes.

That doesn't soud liek the best patient care to me.

[Stonegoat]

OHPNTZ,

I disagree with you. I perform the best refraction I can, every time. I am an excellent refractionist, and I strive to be even better...I think the refraction is an extremely important part of my exam.

I also perform very thourough eye health exams....I would pit my skills against any OD or OMD.

I don't believe that a patient should have to choose between a good refractionist or a good eye health diagnostician....an OD worth his salt will be both.

[steff]

OHPNTZ,
I too, must respectfully disagree with you. I have a set amount of chair time with a patient. Absolutely. You simply cannot run a practice if you don't have a set time for appointments. If I have a little complication with my health examination (which requires me taking a little longer), I'll just book the patient back for a follow up appointment for the refraction. I get to spend the time with the patient that I want to, the patient gets the care they deserve, and I get fairly compensated for my time that I spent with them.

IMHO, everyone wins.

steff

[OHPNTZ]

The question was purely hypothetical...

I don't skimp on the refraction, nor do I skimp on the health examination.

The proposed question was to get people to realize that in a busy office, with attention placed on primary care optometry, likely the optometrist does not have the time to field phone calls and to write extensive notes on an rx script pad for an outside script...

[OHPNTZ]

Factor in the low reimbursement rates from vision insurances, and this in the approach that is created.

I've seen some MDs who have technicians do the refractions. I have also seen some optometrists who let patients go blind within their offices (ie glaucoma) but provide one hell of a refraction.

[chip anderson]

Odd, I have known OMD's who actually treated injuries, ran the office for a full day and taught in medical schools full time, and strangely, they found time to talk with us lowly opticians. Many of them even talked with thier patients. Just don't see how they mannaged to get along. Some would even give a free 45 min. instruction course if us lowly types asked a question.

Oh, my, my.

I do wonder about you O.D.'s given "the most thorough medical exams" can I fire my internest and just go to the O.D. now since all my medical problems can be diagnosed and treated by the O.D.?

[Jubilee]

well we also see that low reimbursement rate from vision insurance as well. That dispensing fee really goes far... Same for discounted plans that if you have any remakes, you lose any profit on the job...


If you don't have time to field calls from arrogant opticians trying to make sure they understood your desires, simply write all the pertinent information on the script. BCVA's, "signs correct", "not suitable for bifocals" what have you. The extra minute to mark this is going to save all of us time later. Us meaning, you, me and the patient.

The patient afterall is the one seeking services and being given the run around as we try to fill things right the first time, and they just want their darn glasses and to be able to see out of them.

Heck, redo you darn rx forms and just have the more common comments on them able to be checked off... or a simple recommendation form that has various things to be checked off...

Also, why can't your staff be able to field a lot of these calls? I know that I typically take care of any rx verifications, professional questions, etc that arise for my doctor. Occasionaly there is something that I don't get by reading the record, but in those cases I ask for his explanation and then I get to return calls, and perform followups unless it is of a severe medical nature. (ie the patient having troubles after cataract surgery...or a OMD reporting a complication)

As my old boss used to say.. if you don't have time to do it right, when are you going to find time to do it again..avoid the hassle by being clear in the communication to start with.

[steff]

A full circle we have come :D

Wasn't the point of this thread that optoms shouldn't write anything but numbers on their scripts? That SVD/SVN or no progressives, or polycarbonate really shouldn't be written on the script? That opticians didn't like calling optometrists to check if a change was ok?

(saying this all with tongue firmly in cheek)... :-)

steff

[HarryChiling]

A full circle we have come :D

Wasn't the point of this thread that optoms shouldn't write anything but numbers on their scripts? That SVD/SVN or no progressives, or polycarbonate really shouldn't be written on the script? That opticians didn't like calling optometrists to check if a change was ok?

(saying this all with tongue firmly in cheek)... :-)

steff

I noticed that a while back, pertinent information is the key here as Jubilee and many others have pointed out. Don't write Varilux or Physio only write opposite signs correct or segment to bisect pupil.

[OHPNTZ]

Odd, I have known OMD's who actually treated injuries, ran the office for a full day and taught in medical schools full time, and strangely, they found time to talk with us lowly opticians. Many of them even talked with thier patients. Just don't see how they mannaged to get along. Some would even give a free 45 min. instruction course if us lowly types asked a question.

Oh, my, my.

I do wonder about you O.D.'s given "the most thorough medical exams" can I fire my internest and just go to the O.D. now since all my medical problems can be diagnosed and treated by the O.D.?

I've been to, interned with, and shawdowed MD who see about 55 patients a day. And these are MD's who are awesome. They spend possibly 5-8 minutes with a patient...tops. It is a whirl as they enter and leave one of 7 exam rooms. I doubt that these MD's would have the time for anyone, including an OD's, phonecall.

As for a quality OD, Chip...if you have a quality OD who is trained in disease/primary care...many diagnosis and proper referal and/or proper testing or treatment can be determined by this OD...and let's hope that everyone on this board has one...

[Fezz]

I doubt that these MD's would have the time for anyone, including an OD's, phonecall.

I am very lucky I guess. We have several local, very busy, MD's that will promptly get on the phone when one of our OD's call. We also have a few MD's who promptly get on the phone when I call...and I'm just an Optician!

I guess it is a mutual respect thing. We have built strong relationships built on trust, respect, and a mutual desire to do whats best for our patients.

We don't cry wolf....but when we do-they listen!

[tmorse]

Here is something I sometimes write:

spectacles Rx indicated for 367.4
OU +1.00 +1.00 axis 090 with +2.50 Add.

Why should this be a problem?

367.4??? is this supposed to be a distance in mm? If so, why not say 14 1/2 inches or, better yet, indicate "READERS".

Reminds me of an OD here n British Columbia who obviously didn't understand lens accuracy or tolerance charts...

He wrote an Rx: -2.00 -0.75 cyl x "165 1/2 ". That's right, an axis within 1/2 of a degree unit.

But you??? You must have excelled in Arrogance 101 class. :hammer:

[obxeyeguy]

367.4???

Silly rabbit. Its the diagnosis code for prysbyopia.

[Barry Santini]

Reminds me of an OD here n British Columbia who obviously didn't understand lens accuracy or tolerance charts...

He wrote an Rx: -2.00 -0.75 cyl x "165 1/2 ". That's right, an axis within 1/2 of a degree unit.

Aahh, but I have to beg to differ with you on this one. I would *love* for rx parameters to arrive in 0.5 degree increements, as well as 0.12D powers. If done with care, it sets the stage for proper tolerancing of work ordered against these specifications. It's all about keepin' centered on the *sweet spot*.

Barry

[HarryChiling]

Says competent doctor

spectacles Rx indicated for 367.4
OU +1.00 +1.00 axis 090 with +2.50 Add.

Say competent optician

367.4??? is this supposed to be a distance in mm? If so, why not say 14 1/2 inches or, better yet, indicate "READERS".

Replies another competent optician

Silly rabbit. Its the diagnosis code for prysbyopia

Replies lowly servent,

HarryChiling: Not in Canada.

Presbyopia could have easily been looked up, but he diagnosis code is just that a code and without the cipher cannot be readily interpreted. Wow that was a great example, maybe a national Rx standard to make things easier?