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Thread: What the heck is wrong with these doctors?!!

  1. #1
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    What the heck is wrong with these doctors?!!

    Twice today customers have given me written Rxs, saying that their doctor said that there was no change from what they were wearing. But both were wearing 2.25 adds (engraved on the lenses, for crying out loud) and the doctors prescribed 2.00 adds. And the distance Rxs were different, too.

    I always try to check the customer's old glasses, but often they don't bring them because they wear contacts when they're picking out new frames.

    In the last few weeks I have had EIGHT doctor redos on progressives. One doctor wrote the Rx eye-for-eye. How did that happen? There is one MD who rarely gets it right on her first try; I dread getting her Rxs.

    I have a highly respected one-person retail boutique and if I were as sloppy with my work as these doctors are, I'd be out of business. Yes, my labs are very generous in not charging me, but why should they pick up the cost? It is such an appalling waste of money, time, supplies. (One customer came back saying that his doctor said "It happens all the time--don't worry, she adds the cost of redos into her prices.") I had to restrain myself from writing him a really nasty note.

    I've been in the business for 35 years and I've seen such a decline in the sense of responsibility that doctors have for the Rxs that they write. I know they're trying to see more patients to make up for their losses to insurance companies, but wouldn't you think they'd have more pride in their work? Why aren't they mortified when they've had more than one call from me about bad Rxs? And it's not just MDs; the eye-for-eye guy was an OD. He also reduced one patient's cyl from -3.00 to -.75 and was surprised that the patient couldn't see out of his new glasses.

    Thanks for letting me rant. I suspect everyone is having the same problem.

  2. #2
    Cape Codger OptiBoard Gold Supporter hcjilson's Avatar
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    After 35 years in the business, you really don't think the doctors are neutalizing lenses do you? Its the staff!
    I suspect the Doctor's staff are using an auto lensometer to neutralize the lenses. As you well know, that won't work most of the time. A "generic" letter explaining the situation to the doctors might well work in your favor if you offer to teach the tech's how to neutralize a pair of progressives. Do it at lunch time and bring the Pizza with you- its a great ice breaker, and your "students" could wind up to be a valuable source of new referrals.

    Good idea....?
    Harry J
    Last edited by hcjilson; 03-12-2008 at 06:46 PM. Reason: Clean up and addendum
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  3. #3
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    Aghhh, Virginia!

    I can't imagine the frustration.

    I know your opti-talents well, and know that you are the Miss Manners of Optics. We shared great times/Lugene days together, back when...

    And, the clientele you serve picks out amazing optical jewelry, and are very busy and really picky!

    We have alot of docs who post here, so let's do a call out:

    Hey Docs! What is reasonable, when an independent optical has lower volume/higher time/service ratio and encounters this problem?

    What would Judith Martin say...how would she handle this? (Is that her name? I'm still thinking Emily Post!)


    Or, not to hijack the thread, could the optician do a refraction (just incase), given the new Rx by a certified doctor?

    : )

    Laurie

  4. #4
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    Quote Originally Posted by hcjilson View Post
    After 35 years in the business, you really don't think the doctors are neutalizing lenses do you? Its the staff!
    I suspect the Doctor's staff are using an auto lensometer to neutralize the lenses. As you well know, that won't work most of the time. A "generic" letter explaining the situation to the doctors might well work in your favor if you offer to teach the tech's how to neutralize a pair of progressives. Do it at lunch time and bring the Pizza with you- its a great ice breaker, and your "students" could wind up to be a valuable source of new referrals.

    Good idea....?
    Harry J
    Our staff neutralizes the lenses - not the OD. They also use an auto. It works well. Lensometry is one of the hardest skills to learn as a tech. But a tech can learn it as well as a doc. And the new autos work well, except with an unknown prism. But a manual isn't any better in that regard.
    We don't have a lot of Dr changes - why? Because the dr pays for them. The best way to get a good Rx the first time is for the Dr to pay for the redo.

    I like the pizza and lensometry idea. Approach it mildly because the Dr (and the techs) are likely to think that they have nothing to learn from you. Maybe have a session on "progressive designs" and talk about how to read the add (from the markings AND the lensometer), and then it flows nicely into lensometry when you show that the lensometer will read -0.12 to -0.25 on the add compared to the markings. You could go on to mention the tolerance on cyls and why it is extremely important to get the axis correct when the cyl is high - even to the point of reading them again and making sure they are flat and the segs aren't twisted, etc.

    Yes Harry, It's a good idea.

  5. #5
    Cape Codger OptiBoard Gold Supporter hcjilson's Avatar
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    I've found that if the reticule is not centered slightly above the fitting cross (MRP) that the auto will show innacurate power readings. Maybe I should say accurate but not within the context of the Rx. I work within an Ophthalmology practice and when I first arrived none of the techs knew how to find the reference point. That makes it difficult to get an accurate reading. I was under the impression that Virginia was talking Ophthalmology rather than Optometry (other than the eye to eye case) Most of the OD's in our area are spot on with this sort of thing, because they tend to do their own neutralizations. (this is NOT meant as a put down for OMD's but rather an observation)
    "Always laugh when you can. It is a cheap medicine"
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  6. #6
    Rising Star slubberdegullian's Avatar
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    Quote Originally Posted by VirginiaBurton View Post
    Twice today customers have given me written Rxs, saying that their doctor said that there was no change from what they were wearing. But both were wearing 2.25 adds (engraved on the lenses, for crying out loud) and the doctors prescribed 2.00 adds. And the distance Rxs were different, too.

    I always try to check the customer's old glasses, but often they don't bring them because they wear contacts when they're picking out new frames.

    In the last few weeks I have had EIGHT doctor redos on progressives. One doctor wrote the Rx eye-for-eye. How did that happen? There is one MD who rarely gets it right on her first try; I dread getting her Rxs.

    I have a highly respected one-person retail boutique and if I were as sloppy with my work as these doctors are, I'd be out of business. Yes, my labs are very generous in not charging me, but why should they pick up the cost? It is such an appalling waste of money, time, supplies. (One customer came back saying that his doctor said "It happens all the time--don't worry, she adds the cost of redos into her prices.") I had to restrain myself from writing him a really nasty note.

    I've been in the business for 35 years and I've seen such a decline in the sense of responsibility that doctors have for the Rxs that they write. I know they're trying to see more patients to make up for their losses to insurance companies, but wouldn't you think they'd have more pride in their work? Why aren't they mortified when they've had more than one call from me about bad Rxs? And it's not just MDs; the eye-for-eye guy was an OD. He also reduced one patient's cyl from -3.00 to -.75 and was surprised that the patient couldn't see out of his new glasses.

    Thanks for letting me rant. I suspect everyone is having the same problem.
    I said this before and i will continue to say this again anybody, wether its an md, od ect ect.. should all work in a wholesale lab were you learn everything at a much faster pace so when you do go to a snail working enviroment your brain won't cramp up from working to slow:hammer::hammer::D
    If you don't stand up, You don't stand a chance.

  7. #7
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    Our doc has trouble with neutralizing progressives so we double check for him. We use only manual lensometers which I find highly accurate. You do have to be high in the lens but really how does anyone miss the add when it's stamped on the lens?

  8. #8
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    Hi I'm new to the forum, this is great.
    I understand Virgina's frustation, I'm an OD and I hate to do RX rechecks as well...I always trial frame the Rx before giving to patients, so I would suggest to trial frame your customers, if you think the rx may be off...But it may not always work on some customers who can't make up their minds, one or two, three or four in refraction you know what I mean...
    Last week I had to do two rx rechceks, patients couldn't read.. bought from two differnt stores, turned out the seg heights were too low. The reading portions were cut off...Now how did that pass the inspection before dispensing to the customers??

  9. #9
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    Neutralizing

    If you can't learn to use a lensometer than you need to find a new job. I'm sorry but using a lensometer is not that hard. AS for the autolensometer---NO THANKS. As for reading a progressive you have to mark the lens first....if you are neutralizing a progressive without dotting it up theres no way you're gonna get it right.

  10. #10
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    I have the Opposite problem

    What to do when a patient takes their Rx elsewhere and it gets botched?

    They come back to me thinking the Rx is incorrect. Yesterday I burned 15 minutes and my highly trained techs spent an hour with the lady. My Rx was dead on as it has been the last 4 times.

    The pt is very sensitive and they missed the PDs by 3 mms in a progressive, changed the material and the brand.

    Who should get billed for my time? The patient, the other optical, or no-one?

    I think I'm instituting a new program where the patients get billed. Maybe the patients will learn it isn't cost effective to go to a commercial joint.

    Not to point any fingers, but at one of my extern sites they would always re-refract the patient if the Rx was from an ophthalmology office! And I don't believe in techs refracting, sad to think docs don't take the responsibility seriously.

  11. #11
    Rising Star slubberdegullian's Avatar
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    Quote Originally Posted by partyoptician View Post
    If you can't learn to use a lensometer than you need to find a new job. I'm sorry but using a lensometer is not that hard. AS for the autolensometer---NO THANKS. As for reading a progressive you have to mark the lens first....if you are neutralizing a progressive without dotting it up theres no way you're gonna get it right.
    I worked for an essilor owned lab inwhich 3 supervisors didn't even have a clue on how to turn on a lensometer let alone use one and yet they were the first ones to belittle the ones who did know how to use it just to make themselves feel good.No wonder all the smart lab techs get snowballed out of these places as gossip and intimidation is more important than learning anymore than you have to:hammer::hammer::hammer::hammer:
    If you don't stand up, You don't stand a chance.

  12. #12
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    I work for 2 OD'S but we share an adjoining reception area, with a busy Opthamologist practice as well, which consitutes 40% of our eyeglass business. They are constantly coming over to me to get prism readings, their auto's just don't get the prism right, as opposed to our manual lensometer. But, secondly, we were getting so many rx's back with weaker adds than patients rx from time before, that I went to the head honcho opthamologist and told him the situation, and reccomended they get a green light by essilor that more easily shows up the markings(ie: the add strength) on progressives. He took my heed, and his techs use it all the time, and have taken care of that particular problem. But we have many remakes from their side, as opposed to the OD side, because our OD'S do their own refractions, the other side relies on their techs.

  13. #13
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    Quote Originally Posted by IndianaOD View Post
    What to do when a patient takes their Rx elsewhere and it gets botched?

    They come back to me thinking the Rx is incorrect. Yesterday I burned 15 minutes and my highly trained techs spent an hour with the lady. My Rx was dead on as it has been the last 4 times.

    The pt is very sensitive and they missed the PDs by 3 mms in a progressive, changed the material and the brand.

    Who should get billed for my time? The patient, the other optical, or no-one?

    I think I'm instituting a new program where the patients get billed. Maybe the patients will learn it isn't cost effective to go to a commercial joint.

    Not to point any fingers, but at one of my extern sites they would always re-refract the patient if the Rx was from an ophthalmology office! And I don't believe in techs refracting, sad to think docs don't take the responsibility seriously.
    You should probably do what we opticians do daily...suck it up! It's all a part of doing business. You spend a few minutes doing a re exam and you are done. We on the other hand spend a few minutes on a dr. redo and have some expenses involved in the remakes. Not bad mouthing you or other ods or omds, it's just the way of life.

  14. #14
    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by IndianaOD View Post
    I think I'm instituting a new program where the patients get billed. Maybe the patients will learn it isn't cost effective to go to a commercial joint.
    Can you say "restraint of trade?"

    We wouldn't want to violate the FTC Eyeglass I or II rulings would we. On the other hand, suppose that you found a "commercial joint" that was so inept that they failed to even come close to filling your Rx's accurately. What could you do? Who exactly are the eyeglass police? Do they even exist? Have you ever heard of a business being shut down by a regulatory agency?

    The reason that there is so much incompetency today is that there is no one to hold anyones feet to the fire.



  15. #15
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    I occasionally neutralize the patients glasses myself, but usually have one of my staff do it. They use an autolensometer, which is generally ok. However, sometimes they get it wrong....especially cyl axis, and that causes me problems during my refraction, because I'm wondering why things have changed.

    It's crucially important that techs neutralize an Rx properly, as the OD will likely modify whatever subjective he/she gets to something closer to the habitual to increase adaptation. However, if the in initial neutralization is incorrect.........big problems.

  16. #16
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    We have nothing by auto's in the new office I work in. Don't like em. Their one saving grace, and it's a small thing... they can check for prism to a much closer power than manuals, so when we're laying out our lenses to be cut, they can be SPOT on. *shrug* I'd still rather have my old b&l :\

  17. #17
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    Hi All:

    In 2007 the candidates missed the following percentages on the practical exam I administer. All candidates have completed an apprenticeship or graduated from an AAS program prior to taking the exam. This information is submitted without comment.

    Roy

    mounted progressive addition lenses:
    neutralize the distance portion of the lenses 27
    determine the add power 06
    measure prism reference point height 36
    measure fitting cross height 31
    measure prism thinning 41
    analyze the lenses for unwanted vertical prism 35
    measure monocular P.D. 32

    mounted bifocal lenses:
    neutralize the distance portion of the lenses 27
    determine the add power 40
    measure the distance between prism reference points 45
    measure the “near P.D.” 26
    identify the seg width 16
    analyze the lenses for unwanted vertical prism 47

    mounted single vision lenses:
    neutralize the distance portion of the lenses 31
    analyze the lenses for unwanted vertical prism 23

  18. #18
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    Welcome Wagon!

    Welcome to Optiboard Oniod and IndianaOD!

    Jump on in...the waters is fine!

    :cheers::cheers::cheers:
    :cheers::cheers::cheers:

  19. #19
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    Redhot Jumper awful........................

    That is pretty a w f u l


  20. #20
    Cape Codger OptiBoard Gold Supporter hcjilson's Avatar
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    Thank you Roy.....

    Quote Originally Posted by Roy R. Ferguson View Post
    Hi All:

    In 2007 the candidates missed the following percentages on the practical exam I administer. All candidates have completed an apprenticeship or graduated from an AAS program prior to taking the exam. This information is submitted without comment.

    Roy

    mounted progressive addition lenses:
    neutralize the distance portion of the lenses 27
    determine the add power 06
    measure prism reference point height 36
    measure fitting cross height 31
    measure prism thinning 41
    analyze the lenses for unwanted vertical prism 35
    measure monocular P.D. 32

    mounted bifocal lenses:
    neutralize the distance portion of the lenses 27
    determine the add power 40
    measure the distance between prism reference points 45
    measure the “near P.D.” 26
    identify the seg width 16
    analyze the lenses for unwanted vertical prism 47

    mounted single vision lenses:
    neutralize the distance portion of the lenses 31
    analyze the lenses for unwanted vertical prism 23
    I intimated what you have posted in another thread not too long ago, and a few members jumped down my throat for trashing opticians. As I said in that thread, the results point to areas we need to improve our teaching. That goes to all three of the O's. Tests are not only measures of knowledge, they are measures of teaching.
    "Always laugh when you can. It is a cheap medicine"
    Lord Byron

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    www.capecodphotoalbum.com

  21. #21
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    And if only methods would solve it

    I feel for you, as I am now "putting up" with same situations, while attempting training/ explanations constantly with drs/ techs.

    Most even great Opticians do not understand progressive lenses, short of actual lens optics today. If you looked at the REAL MAPPING of a PAL lens, you would find the clear RX aperature is smaller than most lens measuring devices, where designed distortion (oops -meant blending area) is interpreted into power/cylinder deviation, as in working with crossed cylinders.
    How many of us have explained to patients the clearest vision overall is with Segmented multifocals, but the tradeoff for PALS is better localized vision and cosmetics (or words to that effect).
    Thought I'd stir the pot a little, sorry!
    Denny

  22. #22
    Just An Optician jediron1's Avatar
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    Quote Originally Posted by AdmiralKnight View Post
    We have nothing by auto's in the new office I work in. Don't like em. Their one saving grace, and it's a small thing... they can check for prism to a much closer power than manuals, so when we're laying out our lenses to be cut, they can be SPOT on. *shrug* I'd still rather have my old b&l :\

    Ahhhhhhhhhhhhh the old B&L we had one in every office when I first started, loved that lensometer basically indestructible and was right on. ;)

  23. #23
    Just An Optician jediron1's Avatar
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    Quote Originally Posted by hcjilson View Post
    I intimated what you have posted in another thread not too long ago, and a few members jumped down my throat for trashing opticians. As I said in that thread, the results point to areas we need to improve our teaching. That goes to all three of the O's. Tests are not only measures of knowledge, they are measures of teaching.

    hc your right but there is one thing you can't deny that the test scores show there is a greater need for getting the basics across, because if they have come from an accredited school of higher learning and are still getting these scores you better look at who's doing the teaching.

    just my 2 cents which is not worth 2 cents any more ;)

  24. #24
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    Wow! What a response!

    Laurie, how nice to hear from you again!

    Harry J, you are indeed the voice of reason. However, I'm not taking your excellent advice because: 1. I work alone, so I would have to do this on my day off. 2. This problem is so wide spread, I would have to see lots of doctors' techs. 3. Well over half of the offices have their own optical dispensaries and I would be stepping on many toes! And the biggest, of course, is that it's a lot easier to complain to y'all and get supportive feedback!! Posting that message last night did make me feel better!

  25. #25
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    Quote Originally Posted by rbaker View Post
    Can you say "restraint of trade?"

    We wouldn't want to violate the FTC Eyeglass I or II rulings would we. On the other hand, suppose that you found a "commercial joint" that was so inept that they failed to even come close to filling your Rx's accurately. What could you do? Who exactly are the eyeglass police? Do they even exist? Have you ever heard of a business being shut down by a regulatory agency?

    The reason that there is so much incompetency today is that there is no one to hold anyones feet to the fire.



    Nope, If I recheck them and it was my fault there would be no fee. If the fact that they went somewhere else and gave them all the money and waste my time because of it, then there is a fee.

    They can charge less because their staff aren't trained and they don't use good products. That IS NOT my fault, and my time and my staff's time has a price!

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