How do I argue this one?

**snl03** · 06-21-2008, 08:30 AM

Hi guys! Just thought I'd bounce this one off of you. How would you handle this?

Pt. cam in yesterday with a pair of PAL's that we made for her about a 10 days. She had been in 3 days ago claiming that she couldn't see well out of them and that she didn't think that they were right. I marked up the lenses and proceeded to check them out. Everything checked out perfectly, including the comparison to her old glasses for BC and PD's. She was ok and said that she was going to go back to her MD for an Rx check. Fine, no worries. Well, when she came in yesterday with a note from the MD saying that WE made the Rx wrong and they measured the Rx weak by .75D. I obviously popped the glasses back in the lensometer, I'm human, I could have made the mistake, but the lenses check out perfectly again.

Now I'm completely perplexed and I decided to call the MD office and just make sure they marked the PAL markings to make sure that they read them in the right place and not below or above the cross, that they're using a manual lensometer, not an automated one, etc. Well, I was basically told that I must be new to the business because they were obviously wrong. I told them I'd been in the business for 14 years, and that I had checked the glasses numerous times, (3 before they're even dispensed and then again a few times in the past 4 days) and that I wasn't seeing what they found for an Rx. Was it possible they hadn't marked the lenses before they read the RX? All I basically got was an indignant response that they checked the glasses at the top of the frame and it was wrong. (Fitting cross basically at half the B). They're refusing to look at the frames again, but I can't see the logic in remaking them again with the exact same....well.... everything just to have them tell the patient that it's wrong again.

I'm not bashing the MD or the OD in their office. I'm actually more concerned that the optician didn't mark the lenses before reading the Rx and then told the MD they were made wrong.

Any ideas on how to tactfully handle this?

Thanks in advance!

Lisa

**optical24/7** · 06-21-2008, 08:38 AM

"Tactfully" put them in a drawer for a week, call the patient up and tell them to come pick-up their "new" lenses. If they are still having a problem, have them come back in and mark the fitting and readings areas with an indelable marker, then send them back to the good Dr's office so they will know where to check the lenses at. There's no way to tactfully tell another office they don't know jack...

**For-Life** · 06-21-2008, 08:40 AM

Drive a truck through their walls.

But seriously, you are dealing with pride here. It is tough, because consumers tend to trust doctors more, because they are doctors. I would try my best to explain it to the patient. Then call the OD back and try to cautiously, humbley explain it again. However, in the end you may still lose on this one.

**fdplumb** · 06-21-2008, 09:14 AM

Lisa,
Your situation is a difficult one with no simple answer. Most of us have been faced with very similar situations. In my nearly 30 years (I must be crazy) in the industry, I have seen it numerous times. In your case I would read the Rx in her old glasses. I am guessing that the prescribing doc's tech stuck her old glasses in the auto-lensometer, not paying great attention to positioning and read the distance Rx in the progressive channel, giving the doc bogus info to begin with. He than wrote the Rx based upon the bad info and is still using this same bad info when considering his patients problem with her new specs.
If there is a change (maybe less minus for a myope) explain it to the lady and do what the previous poster suggested and mark them up and send her back to the prescriber. If you do find a change in Rx that doesn't make sense, another call to the docs office might be in order.
These are difficult situations and you obviously cannot question the docs competency to the patient or to his staff. Use tact and be as nice and sweet as you can be. Above all make your customer very clear that you will do whatever it takes to make her happy with her new specs.

Good Luck,
Frank

**chip anderson** · 06-21-2008, 09:15 AM

If you have frienly compeditors, a lab supplier, etc. Have each read the lenses and write thier findings. If one has an automated lensometer (yes, we both know this is not as accurate as a manual) but in the words of Ralph Drew: "There is nothing that impresses a doctor as much on lens verification than a computer print out."
Assuming that most of the results agree with you, copy send to doctor with a note that he should re-set his instruments.
But always remember rules #1 & #2.
1) Never trust anyone.
2) The doctor is always right!
In this case you aren't saying he/she made a mistake, you are saying his instrument did.

Chip

**DragonLensmanWV** · 06-21-2008, 09:21 AM

What gripes me and I'm sure all of you is when the DR sends them back with a note explaining how wrong they are, and accompanied with a new RX. In that case I explain carefully to the customer that the Dr failed to make the Rx correct in the first place and that's why they are changing it,not because the glasses were wrong.
I have had lenses come back from the (generally) OMD's office with a crayon mark on the lens where they held it up to the light and guesstimated where the seg was and sent them back as wrong. I've had them sent back with a note saying the add power is off, and it's clearly marked on the lens. I had one sent back with an extensive note detailing how there was way too much cylinder, and it's off 45 degrees, way too much plus and all kinds of waves in the lens. The even left their lensometer dots on the lens --- halfway down the seg and outside the corridor.:hammer::hammer:

**scriptfiller** · 06-21-2008, 09:31 AM

We get notes from this particular MD stating we did this that and the other thing wrong, we look at the RX and 100% of the time he has made some sort of refractive change. In these cases we inform the pat it was the MD who made a change and had to alter his original findings and we show the pat the two RX's and remake to the "new" RX. In cases where we get notes from MD's where no refractive change has been made but they point out that the specs were made incorrectly we, obviously, mark the lenses and double verify ( two different people ) if both reach the same conclusion that the RX is correct then we "shelf" them for a week, it's magic work like a charm. The pat comes in to pick up the "shelfed" specs and 100% of the time state "I can see so much better". I have come to a conclusion that most MD techs are technically deficient in spectacle neutralization and PAL RX analyzation, YMMV.

**Barry Santini** · 06-21-2008, 09:53 AM

I'll do what you've done, and if I feel the eyewear checks out, I will then:

1. Be sure to actually verify the add, and not just identify the add markings.
2. If you're fortunate enough to have the *direction* of the error (plus or minus 0.75D), I would then simply put over the client, while they're wearing the eyewear, lenses that would bring your "wrong" glasses into Rx compliance. See what the client's reaction is.
3. Trial frame them with the original DV (and or NV) Rx - this eliminates your "wrong" eyewear from the equation (I'm sure Robert Martellano will agree with my on this suggestion).

Let me know what the orig Rx is. Perhaps a "2" has been mistaken (sloppily written?) for a "5".

Hope this helps

Barry

**HarryChiling** · 06-21-2008, 09:57 AM

Originally Posted by optical24/7

"Tactfully" put them in a drawer for a week, call the patient up and tell them to come pick-up their "new" lenses. If they are still having a problem, have them come back in and mark the fitting and readings areas with an indelable marker, then send them back to the good Dr's office so they will know where to check the lenses at. There's no way to tactfully tell another office they don't know jack...

Hah, that's funny I was thinking the exact same thing Magic Drawer.:cheers:

**Eyedoc71** · 06-21-2008, 10:21 AM

I would trial frame them to take the lenses out of the equation and/or check the calibration of your lensometer (or politely suggest that they check theirs!)...if all else fails, I'm all for the magic drawer.

**HarryChiling** · 06-21-2008, 11:06 AM

Originally Posted by Eyedoc71

I would trial frame them to take the lenses out of the equation and/or check the calibration of your lensometer (or politely suggest that they check theirs!)...if all else fails, I'm all for the magic drawer.

, Oh also just to clarify I was talking about the "Magic Drawer" not "Magic Drawers" which only helps on date nights. ;):D

**MelroseEye** · 06-21-2008, 11:20 AM

I have had this situation come up a few times in my own offices.If you have time, it's a good idea to go the the doctor's office with the patient so that the doctor has to face the person they are accusing of incompetence. I did this once, and after a good old embarassing lesson to the doctor's staff on how to read off a prescription, that particular doctor's office magically stopped having problems with my opticianry.

Now, back to the issue at hand. Is the job transitions, poly, etc? Has the patient had these options before? It would be curious to know the RX, and if this is one of the new digitally surfaced progressive add designs. A doctor, an optician, and a lab need to know how to verify these, as so many vertex adjustments and corrections can be made in the final lens calculations prior to surfacing based on a variety of factors. They WILL NOT read on power without making those corrections at verification. If this is true, you could ALL be wrong.

After you have ruled out rejection from all of those factors and rechecked vertex, face form and tilt as compared to the old specs, here is what I have said in the past:

"You went to see your Doctor because you trust him and his expertise concerning your eye health. I assume you came to see me because you trust me and my expertise in opticianry. He is an expert on your eyes and eye health, and I am an expert on how to correctly fit and fill eyeglass prescriptions written by your doctor. I am the expert on corrective lenses. But in the interest of mutual trust and in my unwavering commitment to your satisfaction, I will send these out to an independent laboratory for verification. If they find any innacuracy, we will remake them for you at no charge."

When the inevitable happens and the independent lab verifies accuracy, Have them produce a copy of the results if possible. The shelf treatment is one of the most effective tools we have. Time cures an amazing number of visual "problems". I have also had to confiscate an old pair of glasses in order to force a patient to wear the new ones long enough to adapt.

It is perfectly within your right to defend your skills and integrity while not saying anything negative about a doctor. Saying negative things about a practicioner or competitor only reflects poorly on the person saying it. We opticians get beaten up A LOT. We should step up to the plate to defend our expertise in our field. Lord knows, mass retailers are doing their level best to destroy the credibility of this profession.

Education is central to avoiding these situations. I have not lost a patient yet when I took the time to educate them about why I was correctly handling their case. The education process should begin the instant the patient first steps foot in your office. One can almost be assured the same has not been done by the doctor. Patient education is always key and will re-inforce the trust the patient puts in YOU.

I would not be surprised if said Doctor was pushing this patient to have lenses made in his/her own office so that they can be done "correctly".
That is not ethical. Often when you get the patient to admit the doctor's staff was indeed trying to sell them, the patient will see through it and sometimes become very angry at the doctor. What goes around comes around.

**HarryChiling** · 06-21-2008, 11:31 AM

Originally Posted by MelroseEye

I have had this situation come up a few times in my own offices.If you have time, it's a good idea to go the the doctor's office with the patient so that the doctor has to face the person they are accusing of incompetence. I did this once, and after a good old embarassing lesson to the doctor's staff on how to read off a prescription, that particular doctor's office magically stopped having problems with my opticianry.

Now, back to the issue at hand. Is the job transitions, poly, etc? Has the patient had these options before? It would be curious to know the RX, and if this is one of the new digitally surfaced progressive add designs. A doctor, an optician, and a lab need to know how to verify these, as so many vertex adjustments and corrections can be made in the final lens calculations prior to surfacing based on a variety of factors. They WILL NOT read on power without making those corrections at verification. If this is true, you could ALL be wrong.

After you have ruled out rejection from all of those factors and rechecked vertex, face form and tilt as compared to the old specs, here is what I have said in the past:

"You went to see your Doctor because you trust him and his expertise concerning your eye health. I assume you came to see me because you trust me and my expertise in opticianry. He is an expert on your eyes and eye health, and I am an expert on how to correctly fit and fill eyeglass prescriptions written by your doctor. I am the expert on corrective lenses. But in the interest of mutual trust and in my unwavering commitment to your satisfaction, I will send these out to an independent laboratory for verification. If they find any innacuracy, we will remake them for you at no charge."

When the inevitable happens and the independent lab verifies accuracy, Have them produce a copy of the results if possible. The shelf treatment is one of the most effective tools we have. Time cures an amazing number of visual "problems". I have also had to confiscate an old pair of glasses in order to force a patient to wear the new ones long enough to adapt.

It is perfectly within your right to defend your skills and integrity while not saying anything negative about a doctor. Saying negative things about a practicioner or competitor only reflects poorly on the person saying it. We opticians get beaten up A LOT. We should step up to the plate to defend our expertise in our field. Lord knows, mass retailers are doing their level best to destroy the credibility of this profession.

Education is central to avoiding these situations. I have not lost a patient yet when I took the time to educate them about why I was correctly handling their case. The education process should begin the instant the patient first steps foot in your office. One can almost be assured the same has not been done by the doctor. Patient education is always key and will re-inforce the trust the patient puts in YOU.

I would not be surprised if said Doctor was pushing this patient to have lenses made in his/her own office so that they can be done "correctly".
That is not ethical. Often when you get the patient to admit the doctor's staff was indeed trying to sell them, the patient will see through it and sometimes become very angry at the doctor. What goes around comes around.

Wow, I'm gonna print and frame that. :cheers:

**Barry Santini** · 06-21-2008, 11:38 AM

Just tell the patient that their Rx "expired" before they received the eyewear!:hammer:

Barry

**tmorse** · 06-21-2008, 11:52 AM

Originally Posted by HarryChiling

Hah, that's funny I was thinking the exact same thing Magic Drawer.:cheers:

In cases like this we give it 'DDT'... (Dark Drawer Treatment). I prefer the term 'Magic Drawer'. :cheers:

**Happylady** · 06-21-2008, 01:19 PM

Has the doctor's office recheck the patient or did they just look at the glasses and decided they were wrong?

If the doctor hasn't done a re-exam then it is possible that the rx isn't right and the magic drawer won't work.

**Eyedoc71** · 06-21-2008, 02:03 PM

Have you actually trial framed them? Your task could be as simple as putting their rx into a trial frame and walking them out and asking what their vision is like. If it sucks, let them know who they need to work it out with...if it's really good, figure out what's wrong with the specs (I know you guys REALLY like selling polycarb, but it's problematic at best).

**snl03** · 06-21-2008, 02:04 PM

Hi guys! Thanks for all the advice. I've used the "magic drawer" on several occasions when warranted and find it a valuable tool, similar to "faith cures" or "psyche adjustments". I think what really frustrated me this time around was that 1. They assumed I was wrong and must be new to the industry, and 2. The fact that the doctor told the patient we were wrong when they didn't even read the glasses correctly.

Original Rx was:

-7.50 -1.50
-7.50 -1.25
Add 2.75

Can't remember the axis for them. Vertex distance, PD's, BC's everything was identical. Not a lot of change from her previous Rx. The MD is relatively close so I may wander over to the office with the patient and do a lensometry crash course with the optician if needed.

I love this job, I really do, but sometimes I really hate being the redheaded step-child. :hammer:(No offense to any of you who might be redheaded step-children)

Thanks again! I'm going to show this post to my co-worker on Monday.
Lisa

**ilanh** · 06-21-2008, 02:05 PM

You guys are making it overly complicated. The solution is simple. You take the patient to your overlay template or OLA book (I assume that you have an overlay template for every progressive you dispense). You mark the lenses infront of the patient so that they can see the fitting cross clearly. You then take the spectacles to an automated lensometer and position the fitting cross in the dead center. Make sure the patient is observing that the fitting cross is centered. Push the "read" button and show the little paper that comes out to the patient. Now take the prescription that the doctor wrote and compare it to the paper Rx that you just generated. Any patient, no matter how much of a layperson they are, will understand this simple and intuitive demonstration. If necessary, send the generated Rx to the M.D's office with the note (reading taken at the fitting cross as measured on the official OLA template for this brand).

**Eyedoc71** · 06-21-2008, 02:16 PM

Originally Posted by ilanh

You guys are making it overly complicated. The solution is simple. You take the patient to your overlay template or OLA book (I assume that you have an overlay template for every progressive you dispense). You mark the lenses infront of the patient so that they can see the fitting cross clearly. You then take the spectacles to an automated lensometer and position the fitting cross in the dead center. Make sure the patient is observing that the fitting cross is centered. Push the "read" button and show the little paper that comes out to the patient. Now take the prescription that the doctor wrote and compare it to the paper Rx that you just generated. Any patient, no matter how much of a layperson they are, will understand this simple and intuitive demonstration. If necessary, send the generated Rx to the M.D's office with the note (reading taken at the fitting cross as measured on the official OLA template for this brand).

And THIS, my friends, is why I have an automated lensometer.

**HarryChiling** · 06-21-2008, 04:24 PM

Originally Posted by ilanh

You guys are making it overly complicated. The solution is simple. You take the patient to your overlay template or OLA book (I assume that you have an overlay template for every progressive you dispense). You mark the lenses infront of the patient so that they can see the fitting cross clearly. You then take the spectacles to an automated lensometer and position the fitting cross in the dead center. Make sure the patient is observing that the fitting cross is centered. Push the "read" button and show the little paper that comes out to the patient. Now take the prescription that the doctor wrote and compare it to the paper Rx that you just generated. Any patient, no matter how much of a layperson they are, will understand this simple and intuitive demonstration. If necessary, send the generated Rx to the M.D's office with the note (reading taken at the fitting cross as measured on the official OLA template for this brand).

Hey Ilanh,

Don't use the OLA book as a template the markings are not to scale, and if you want a great place to get layout templates go to www.thelensguru.com it's run by a member from here "TLG" greeat site and great resource bookmark it.

**kws6000** · 06-21-2008, 05:58 PM

Originally Posted by Eyedoc71

Have you actually trial framed them? Your task could be as simple as putting their rx into a trial frame and walking them out and asking what their vision is like. If it sucks, let them know who they need to work it out with...if it's really good, figure out what's wrong with the specs (I know you guys REALLY like selling polycarb, but it's problematic at best).

I agree.This approach would give you the answers you need really quick.

**chip anderson** · 06-21-2008, 09:24 PM

Like Ralph Drew said:
"Nothing impresses a doctor more than a computer printout."

I heard him say this around '65 and I don't think it was by any means the first time he said it.

Chip

Seriously, I would get several opinions from several opticians and a lab other than myself before confronting the doctor. Even then some doctors "never make mistakes." Some are quite reasonable. Some are even so nice as to overlook it when you really do make a mistake.

Chip

CYA

**optigrrl** · 06-21-2008, 11:09 PM

Originally Posted by ilanh

You guys are making it overly complicated. The solution is simple. You take the patient to your overlay template or OLA book (I assume that you have an overlay template for every progressive you dispense). You mark the lenses infront of the patient so that they can see the fitting cross clearly. You then take the spectacles to an automated lensometer and position the fitting cross in the dead center. Make sure the patient is observing that the fitting cross is centered. Push the "read" button and show the little paper that comes out to the patient. Now take the prescription that the doctor wrote and compare it to the paper Rx that you just generated. Any patient, no matter how much of a layperson they are, will understand this simple and intuitive demonstration. If necessary, send the generated Rx to the M.D's office with the note (reading taken at the fitting cross as measured on the official OLA template for this brand).

Exactly.

**renee1111** · 06-22-2008, 12:54 PM

Originally Posted by Eyedoc71

(I know you guys REALLY like selling polycarb, but it's problematic at best).

Polycab is the last lens material that I choose. I use Trivex if the frame is a semi-rim, (it carries a one year warranty against chipping or cracking, where as CR-39 doesn't.) Yet, sometimes it's inevidable, and like it or not, poly is the only durable alternative.