Attn: Prescribers!!!

[chip anderson]

More times a week than I can count I see patients who say: "The last time I saw the doctor he found a little change in prescription but not enough to get new glasses (or contacts) for so he didn't give me a prescription. Then since the patient is in for new glasses from either desire or traumatic event to the old ones, I call the doctor's office. The sweet thing in his office says: The doctor didn't issue an Rx at her last visit. Only after utmost prying and sweet talk do I get sweet thing to actually look in the chart or for heaven's sake actually ask the doctor, and find out the un-nescessary changes.
I am sure that the practioner had the patient's best interest at heart and either felt the patient would feel compelled to waste money on a new Rx, or felt that some unscrupulous optician would desend on the patient and talk her into some new outrageously expensive glasses.
The problem is this: 1) If the patient goes into an optical shop and brings it up, they have in mind getting new glasses for whatever reason. Wouldn't it be better if the patient had the most up to date information with them at this time. 2) If the patient had a copy of this particularly on contact lenses, when they are replaced either for disposable replacement or loss replacement the optician will incorporate this into the replacement without any addittional expense being incurred by the patient.
And while this may be strange concept I don't think there are any more unscrupulous opticians out there than there are unscrupulous prescribers.
At worst, one could give this Rx a notation: "Latest findings but not a significant change."
So my message here is: "Give the patient a copy of the Rx, it's why they came to see you in the first place!"
I'm sure you all feel the patient came in because of your brilliant medical diagnostic capablilities, but he really came in to see if he needed his glasses changed!

Chip

[For-Life]

I agree. The patient should come out with a written RX and a good understanding about the improvements that RX will offer.

We have one MD in town he always tells his patients that there is no change (though, we believe this to not be true in many cases). These tend to be seniors after their cataract surgeries. So now, you have this 90 year old lady who lost her glasses, and her last pair were done 15 years ago. Thus, no RX on file. She is bedridden and it is not exactly easy to bring her in for an exam.

[Chris Ryser]

So now, you have this 90 year old lady who lost her glasses, and her last pair were done 15 years ago. Thus, no RX on file. She is bedridden and it is not exactly easy to bring her in for an exam.

Simple solution for a correction: Call the doctor by phone, explain why you need the RX and he will fax it to you. Your 90 year old lady probably forgot why she went for an examination.

[cocoisland58]

I had an elderly lady bring a half of an Rx once. "only the right eye changed" she said. Well what might the left eye be I wonder. I could have taken it off her glasses but would much rather have it in front of me. So I had to call, once again.

[obxeyeguy]

I had an elderly lady bring a half of an Rx once. "only the right eye changed" she said. Well what might the left eye be I wonder. I could have taken it off her glasses but would much rather have it in front of me. So I had to call, once again.

I have had this happen also, but with a twist. Upon calling to get the Rx for the other eye, nice staff tells me "they didn't examine that eye", and they patient would have to return. Granted, this was a post op, but seriously, no record of any script for one eye??:hammer:Guess thats extra....

[For-Life]

Simple solution for a correction: Call the doctor by phone, explain why you need the RX and he will fax it to you. Your 90 year old lady probably forgot why she went for an examination.

Chris, we did. He did not have it. That is the whole point. She sees him once a year, but he never writes down the RX, because he says it never changes.

[Barry Santini]

This eyecare prescriber RX "gate keeping" is *the* most ridiculous thing in our industry. Why do we do this? Because, deep down in our heart of hearts, we hate eyewear too, and want to prevent anyone from spending even one more time on this unwanted item than they have too.

Other disconnects:

1. It trains everyone to think they only "need" eyewear when they have a "reasonable change" in their vision. So, the public is trained to believe that eyewear is only purchased for vision need. I can't tell you how many people keep their eyewear for years on end, while requesting me to nurse their repairs, 'cause they "don't have any change in the Rx."

Utter Nonsense!

As I've told people, you wear your eyewear every day. It needs to be cleaned and cared for (cleaning the lenses daily does not constitute "care"). And it wears, fatigues, discolors, chips, streches and soils, just like your clothing. My favorite saying: "Your are as uncomfortable wearing the same blouse or shirt 3 days in a row as you are comfortable wearing the same eyewear for 3 *years* in a row!"

Think about it!

2. Regarding small Rx changes (even monocular ones of "one step"):
Last time I looked, Rxs were written in 0.25D steps, and 5-10 degree axis shifts. These values are easy double ANSI tolerances in most cases. So if your client's Doc tends to say these things to their patients, tell them the same when they advise your customers that their eyewear "wasn't made right."

PEOPLE: Do you want to acknowledge and break from some truly ingrained bad attitudes, vocabulary and habits about eyecare/eyewear, or not?

Challenge yourself and your staff to "Think Different" (apologies to Apple).

Rant off:

Barry

[optical24/7]

Simple solution for a correction: Call the doctor by phone, explain why you need the RX and he will fax it to you. Your 90 year old lady probably forgot why she went for an examination.

.....................


At which they will tell you they need a signed "release"! Here's to helping granny......:hammer:

[For-Life]

part of this too is informing the patient and letting them decide when they want glasses. I have had many through my years tell me that their eye doctor tells them they do not need new glasses. They then tell them, they WANT new glasses. The doctor asks why, since there is no rx change.

The patient comes and sees me. We plead to the doctor to give the rx. The doctor finally does.

Some people like a change here and there

[Bill West]

Sometimes they will say, just a little change but not enough to make a difference.
I have had many people say to me, I'm having trouble and he did'nt find it next time I'm going somewhere else.
I always encourage them to get a second opinion.
As a refractionist if you find only a small change in one eye, write a new rx and let them decide if they want to fill it.

:finger:EVERYONE WANTS TO SEE THE BEST THEY CAN, INCLUDING YOU.:hammer:

[Bill West]

So my message here is: "Give the patient a copy of the Rx, it's why they came to see you in the first place!"
I'm sure you all feel the patient came in because of your brilliant medical diagnostic capablilities, but he really came in to see if he needed his glasses changed!

This should be taught in every optometric school.:cheers:

[Barry Santini]

1. Please write found visual acuities next to each eye
2. Please note if Rx written represents "no change".

The problems here are techs who neutralize the client's eyewear *incorrectly* and then say "there is no change". Or, the Doc noting on their record that the previous *found* Rx is no different than the one found *today*, wherein they say "No Rx change".

But...the client never filled that last (or sometimes previous) Rx Change.

Yes, it's good to know what life is like on the *other* side of the Rx!

Barry

[Barry Santini]

As a refractionist if you find only a small change in one eye, write a new rx and let them decide if they want to fill it.

Interestingly, Rx changes "in only one eye" are one of the biggest flags for me when I do Rx analysis. I need to make sure the change will be "ok".

Changing binocular (accomodative) balance is not for the faint of heart!

Bottom line: Make sure the visual need symptoms match the change in Rx

Barry

[peregrinerose]

The only time I don't issue an Rx at a visit is if the patient is there for a med visit only, say glaucoma iop check, red eye, etc. If I have a refraction code (92015), there has to actually be a refraction. And even if it's exactly the same as every other refraction for the last 100 years for that patient, it's still got to be in the chart. Anything else is just plain sloppy (not to mention possible fraud if the insurance or patient were billed for a refraction code).

With regard to the 90 year old situation, any doc that won't issue the script is just plain ignorant. I can't imagine withholding that. I've even done countless home, hospital, and nursing home visits to fit/dispense/fix glasses for patients (whether initially mine or not). I haven't had a problem getting a script from another doc for those patients, but I admit, it's nice to throw around the 'doctor' title as needed... it seems to get me a lot farther than having one of the opticians in the office call over. It's sick and wrong that things sometimes work that way, but unfortunate reality.

[drk]

You seem to not understand how things work, Chip, despite your highly-touted innumerable years of experience.

You see, there are these patients out there that have something called "eye disease". There are visits that are focused on evaluating and managing these "eye diseases".

Prepare yourself for a shock: refractions don't occur at every visit!

Yes, I know, I know, we lowly ODs are mere refractionists in truth, but since we are tinkering around with eye disease, we have to pretend we're ophthalmology and only refract (and charge!) when there is a drop in acuity.

Hey, here's another secret, brace yourself: A refraction is not a prescription! Yeah, crazy, crazy! Sometimes a "diagnostic refraction" is done? What's that, you ask? That's a "quickie" that is intended to see if reduced acuity has a refractive error component. (It's kinda like a pinhole acuity...ask your favorite trustworthy surgeon about that.) A diagnostic refraction will probably be recorded, but it doesn't rise to the level of a prescription...

Yes, a prescription is not a refraction. A prescription means "take for", as in "take these lenses for your problem". The process of evaluating and managing refractive error includes a prescription. That process is not always done.

If you have any more questions, though I be only a money-grubbing OD, I will try to answer it. I'm sure, though, you will see through to my optician-oppressing, patient-cheating, ophthalmology-wannabe underlying motivations.

[Barry Santini]

Definitely enlightening, drk!

Thanks for the post!

Barry

[hcjilson]

Definitely enlightening, drk!

Thanks for the post!

Barry

Did you mean before.....or after it was edited??

[Barry Santini]

Did you mean before.....or after it was edited??

I didn't take note of the editing. I like his response as it stands now.

Barry

[fjpod]

Darn, Chip, I forget that I am supposed to set things up for a sale. I'm gonna have to remember to help you make mo' money.

[drk]

I'm sure you all feel the patient came in because of your brilliant medical diagnostic capablilities, but he really came in to see if he needed his glasses changed!

Chip

Yes, actually I and most Drs. do have patients that in for our "brilliant" medical diagnostic capabilities...

...that DO NOT come in to see if their glasses needed changing.

Optometrists (and/or Ophthalmologists?) are refractionists, right Chip?

Optometrists (and/or Ophthalmologists?) are delusional and see medical problems where none exist, right, Chip?

How is this kind of stuff tolerated here on Optiboard? I demand to have Chip banned or severely disciplined for publicly trashing professionals.

[obxeyeguy]

...

[chip anderson]

I didn't say you were not brilliant diagnostician, I didn't say you need to make me more money. What I did say is the reason the patient goes to see you (at least 99.9% of the time) is to see if their glasses need changing. I also did say that a scrupulous optician will not talk the patient into new glasses if not needed (at least I won't). But if changes are found obviously a refraction was done. If you tell the patient you found minute changes that are not worthy of getting new glasses at this time, give the patient a copy of same!
Then if the patient is getting new glasses for whatever reason (replacement or style change) They will be made with the most accurate prescription!

Now why are you taking offense at this?

Chip

[fjpod]

....(at least 99.9% of the time) .... .

Incorrect.

[fjpod]

Now why are you taking offense at this?

Chip

Because it's quite obvious you just want us to hand a patient a new Rx so as to imply that they need a change, and so that you can make more money.
C'mon Chip, we can see right through ya.

[hcjilson]

Will you so called professionals stop shouting! It bothers those of us here to enjoy the site!