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Thread: This question goes out to O.D.'s:

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    OptiBoard Professional eyecarepro's Avatar
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    Question This question goes out to O.D.'s:

    I have a friend who works WITH, not FOR an Optometrist and she's encountered a little bit of a dilemma so I thought I'd pose the question to Optometrists. So the O.D. has been aboard now for about 4 or 5 months and has really helped hike up the business in my friend's optical store that was otherwise not doing so hot, just by being there and seeing patient's even a mere 2 days a week. What she doesn't understand is why, when the appointment book has 8, 10, 12, even 15 exams patient's come back over from their exam with no prescription change or no prescription at all- CONSISTENTLY. My friend has bent over backwards to help set this new O.D.'s practice up and books all the appointments throughout the week. The overall relationship with the O.D. is actually pretty good. It just seems like the O.D. does not make much of an effort to go out of the way to prescribe say, sunglasses for people who do not own any or to update their obsolete, non-optical, quality sunglasses, or prescribe sport goggles for all the kids who come in who play sports, or computer glasses for people who spend half their day with their eyes glued to a computer screen. She says all the patient's love the O.D. and there haven't been any complaints. It just seems like the O.D. is possibly under-prescribing.(??) People listen to their doctor before they listen to a salesperson. So if the O.D. prescribes something, not just an off the cuff suggestion, the patient is more inclined to want to follow the O.D.'s recommendations. My friend is frustrated because she thinks the patient's could be better served if the O.D. was just a TOUCH more involved in the process, not to mention the store's bottom line. I don't think I put this as eloquently as I could have. Hopefully most of the O.D.'s know where I am going with this...

    any thoughts?

  2. #2
    One of the worst people here
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    I am a strong believer that the OD should NEVER EVER sell in the refraction room. The OD should exam, and ONLY exam. Otherwise, it is a conflict of interest

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    Bad address email on file Eric the Eye Guy's Avatar
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    selling from the chair

    There is a fine line between sales and recommendation, and sunglasses are a perfect example. If the doctor says:
    "You really need a good pair of sunglasses because of the optical quality, guaranteed UV protection, polarization and frame quality. We'll give you a good discount if you buy them from us. See the optician and they will hook you up." -- then you've got a pushy salesman. If, on the other hand, the doctor says:
    "You know, a good pair of sunglasses is important to your eye health. We have a very nice selection, but if you don't like any of them, please visit other optical shops to find some you like, but please don't get them from a gas station" -- Now you have a doctor that is concerned about their patient's health. Nothing the doctor has said is untrue or could be considered "pushy", yet the optical shop will see a boom in sunglass sales.

    If you friend owns the optical shop, how about giving the doctor a percentage of the gross margin of the order?
    The same can be said for A/R, Free Form progressives, Trivex, etc.
    Good Luck

  4. #4
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    Perhaps I don't understand...

    You are criticising the man for not prescribing things that are not needed because your sales are low?

    To me it sounds like the O.D. has the highest ethical standards and you have none.

    I suppose that's the hazards of working on commission...

    Chip
    Last edited by chip anderson; 04-15-2009 at 05:55 AM. Reason: wanted to.

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    I also had the same issue with my practice,dr. would say no change.Considering you are probably paying for elec.,water,exam equip.,lease and etc.,you need to pay the bills to keep your office running.It is a good sign that the dr.you have has good ethics but,over the years being in the optical business working for private ods and mds with superb ethics they always made a reccomendation even if it was none or the slightest axis,cyl. or sph. change.I would bet anything that if it was their practice they would be making those recommendations.I would not give them a dime of your profit,I would kindly bring up that instance "If it was your practice, what would you do?"(to the dr.)

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    Rising Star OptiBoard Silver Supporter
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    This is a very interesting subject but hard to make generalizations or give specific advice. Online, virtually anything can be misinterpreted when read the wrong or right way.

    Patient trust in what prescription we arrive at has to be a very high priority. It seems to be rather easy to develop a reputation as a place that always coerces patient in to buying a new pair. At the same time, many patients get a new exam because they want/need a new pair of glasses.

    Some prescriptions do not change very much over time, but it is also hard to believe 15 in a row had no change. Too many generalizations. Some have the exact same prescription and still want a new look. Some want to use their vision benefits they already paid for. Some need a different lens option (lighter, different PAL, etc.)

    Also, there certainly is less disposable income available right now which may affect the bottom line. If a patient sees "good enough" they may not want new glasses at this point, but establishing yourself as the place to go when they need something is a good idea.

    I've always felt it is not my job to nudge them to get a new pair (even in my office) but rather to give an honest assessment of what type of improvement they will get out of their new prescription if ordered. I'm sure others in my position could do a better job "selling" and have a better bottom line, but I like to sleep at night (and some of my patients are my neighbors!!!).

    As another aside, I've dealt with situations where I've felt pressured in to prescribing certain things. I did not feel comfortable in those situations and did not stay long.

    good luck.

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    I know I'm gonna get flack but I have known a rare few prescribers with substance problems that were afraid to change the Rx for anything on days when they got to work a little rocky.
    Even have a patient that used to work for one in a small town. She reported that the patient's would call her first thing in the morning and check to see what shape the good doctor was in, before coming in for thier appointments.
    Could you have a similar situation?

    Chip

  8. #8
    Optiboard Professional Bill West's Avatar
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    Setting up the OD

    Since 1978 I have set up several shops with a complete lane and waiting room and all things needed for the OD. Most of them did the exams and wrote the rx every time even when no change occurred telling the patient that if they ever needed a new pair they would have a written copy. I think this is the correct way to approach this. I had one or two who were too lazy or stubborn to take the time to give the patient their rx. One of them hardly ever found a change, this guy is not doing well after 15 years, working two days at a wally world, real dud.
    It's really simple, if they get an exam a written rx is in order. The first OD I ever worked with always talked to the patient and then wrote out rx's for glasses, sunglasses, piano glasses, golf glasses, ect. He was loved by them and was one of the "most successful" OD's I have ever known.
    Most people EXPECT help in seeing better when they get a new exam no matter how slight the change, give it to them and let them decide.
    As a rule none of us go to the MD to hear him say, can't find anything wrong. What are you doing there?

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    ABO-AC, NCLE-AC, LDO-NV bob_f_aboc's Avatar
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    I have seen very few patients come out of an exam with "no change". Usually it is only .25 change somewhere or a few degrees on the axis.

    There is nothing wrong with the doctor telling the patient that there was a slight change in Rx and it is up to them if they would like to update their glasses.

    Point out the fact that the lenses are scratched, or the finish is starting to corrode on the frame, or your glasses look like they are in pretty good shape, a good pair of sunglasses would do you and your eyes a lot of good.

    If there is truly no change in the prescription, there is nothing wrong with telling the patient. Just make sure they have a copy of the Rx in hand and let them know they can still get a back-up pair or readers or sunglasses or shooting glasses or whatever.

    If you want to improve sales, make sure the last person the patient talks to before they leave is you and not the doctor. It will take some time, but they will come back to you.
    A lack of planning on your part DOES NOT constitute an emergency on mine!

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    OptiWizard
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    [QUOTE=eyecarepro;293107]":" So the O.D. has been aboard now for about 4 or 5 months and has really helped hike up the business in my friend's optical store that was otherwise not doing so hot, just by being there and seeing patient's even a mere 2 days a week."

    So it sounds like the OD is helping the business...right???



    " It just seems like the O.D. does not make much of an effort to go out of the way to prescribe say, sunglasses for people who do not own any or to update their obsolete, non-optical, quality sunglasses, or prescribe sport goggles for all the kids who come in who play sports, or computer glasses for people who spend half their day with their eyes glued to a computer screen."


    Personally, I do not prescribe sport goggles, I would rather see the kids in contact lenses...

    I leave it up to the optician to do the "selling" of materials, add ons, etc. Am I wrong in believing that opticians are the most knowledgeable about all the latest products, designs, etc.?

    My job is to evaluate the vision and health of the eyes. To diagnose, treat, refer etc. without getting stuck in the exam room suggestive selling add ons...I actually spend more time suggestive selling people to take care of their eyes and of their health.

    Approach the situation as a team approach...and I think things will be fine. Let the doctor evaluate the eyes and vision, then after the exam have the patient sit with the optician to adjust the current glasses, discuss options available, etc...and also make recommendations or suggestive selling.

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    I agree with Rising Star "optometrist".... We as opticians are the expert in what type of lens materials, coatings, frames will make our patient's vision better. Just because they have no change in their prescription does not mean their complaint or problem (s) is solved. Review their complaints...compare to their vision and what type of lens they are currently in. I bet some of those complaints can be solved with a computer, sunglasses, reading only.... etc. Verbage such as "I see the doctor did not find a change in your vision to support your complaint of reading.... lets take a look." Maybe this person who wears a progressive reads a book a day and needs a reading only lens for this great hobby.... and nothing is better than a reading only lens for that.

    We all have our place in this field and our places do overlap...we can hope our optometrist partners will suggest products but it is not their expertise....yes it helps the bottom line, but all they have to do is refer to us as the optician who is the "expert" in wearing and fitting their prescribed prescriptions.

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    Master OptiBoarder
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    I work with two ODs. The older one often comes out of the exam room, hands me the record and say's "No real change, I doubt they want anything". I say "Sure they do" and more often than not once you start talking to them you realize that they fish for a hobby and do not have Rx suns, or they have no back-up glasses at all, or their lenses are scratched. When you work with a doc that assumes no one wants to buy anything unless they have had a half diopter change you have to work twice as hard.

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    Master OptiBoarder
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    Seems like ODs are damned if they do and damned if they don't. If they sell from the chair in their own practice, they are unethical. If they don't do it in an optician's practice, he/she is either drunk or lazy...

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    Bad address email on file k12311997's Avatar
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    Quote Originally Posted by OHPNTZ View Post

    Personally, I do not prescribe sport goggles, I would rather see the kids in contact lenses...
    when the kid get hit in the eye with an elbow, baseball, tennisball, etc. contacts will do them a lot of good. sport googles should be required wearing for organized sports whether or not a Rx is needed.

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    OptiBoard Professional eyecarepro's Avatar
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    Question For O.D.'s Continued...

    I appreciate all the feedback on this matter. I was certainly NOT implying that the O.D. should do any selling of products whatsoever. I made a mistake putting it like that. I agree that it is the optician's duty to inform, educate, and sell to the patient, NOT the Dr's. This is not a situation where my friend owns the business. She works for a chain that leases the space to the O.D. While her sales are down (along with alot of businesses right now) she has no expectations that the Dr. should make any product specific recommendations, just keep the patient's best interest in mind and not assume that just because there was little or no change in their prescription that they might not be interested in filling it anyway. I agree with Bill West that if a patient gets an exam, whether there was a change in the prescription or not, they get a written prescription. Period. It doesn't have to be so black and white. You are not wrong, OHPNTZ, the Optician is trained to be up to date on all the latest, greatest products out there, and the Optician should be the one selling. I'm a firm believer in preventative maintenance in every aspect of one's life, eye health included. I am SO NOT attacking optometrists in any way, shape, or form. I deeply respect the work that most do. Is it crossing the line for an O.D. to prescribe sunglasses to those who don't wear any, especially when Pinquela, Pterygium(s), and/or the beginning stages of Cataracts is noted during the exam? No upselling required. Bottom-line aside, it's about what is going to improve the quality of the patient's life ultimately. Why go to a Dr. to have him or her evaluate a condition, only to send you away with no recommendations on how to treat the ailment?
    "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone".
    At the risk of running around in circles here, I think everyone catches my drift. I never intended this thread to be an examination of anyone's ethics, just opinions.

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    I think an O.D. should not comment, other than to say the RX hasn't changed. Even saying the optician will look over your spectacles and be with you in a minute, is better than sending them to the cashier with a bill for an exam.

    The hornets nest is this?
    1.) Is it ethical to not inform ... i.e. best practice is a back up pair of specs in your RX if you need them to drive, etc. or AR coating will help alleviate some night driving issues, etc.

    2.) Someone with a +1.50 add in an enhanced reader may now be interested in progressives ... how will they know unless the O.D. sells in the room (that is if the O.D. won't hand over to the D.O.)

    3.) you catch the drift right?

    I think your friend just needs to explain it isn't about high sales or more money, it's about doing the right thing by the patient. Informed patients are loyal and repeat and refer.

    Mary Sue

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    Where does the doc work the rest of the week , Could the business be going there ,I have seen that happen. Does the doc get all fees for exams and contacts or are they salaried.

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    Rising Star
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    I started a practice 6 months ago and see a heck of a lot more "your Rx hasn't changed" exams than I want, and I'm the OD! I start every exam with a question about whether or not the patient has had an opportunity to look at frames, did they find anything? Or maybe a question about what kind of problems they are having with their current glasses (scratches, chips, peeling coatings, etc). But sometimes you get what you get. Some CL Pt's do not want back-up glasses, even when I tell them they need them (gasp!). Sometimes, they have a perfectly good pair, and just came in for their annual exam because (get this...) because it's been a year since their last exam and I told them to come in annually!

    I think everything will be OK in the long run because we don't pressure them into purchasing glasses when they don't require a change AND they indicate that they are NOT in the market for a new pair. I think they'll come back when they are ready (GOD, I hope so anyway!)

    Quote Originally Posted by k12311997 View Post
    when the kid get hit in the eye with an elbow, baseball, tennisball, etc. contacts will do them a lot of good. sport googles should be required wearing for organized sports whether or not a Rx is needed.


    I agree, I Rx the Rec Spects, not CL's, except for football and then they should wear a helmet shield with the CLs to keep fingers out. (too many complaints of the Rec Spects fogging up in the helmet)

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    Quote Originally Posted by chip anderson View Post
    I know I'm gonna get flack but I have known a rare few prescribers with substance problems that were afraid to change the Rx for anything on days when they got to work a little rocky.
    Quote Originally Posted by chip anderson View Post
    Even have a patient that used to work for one in a small town. She reported that the patient's would call her first thing in the morning and check to see what shape the good doctor was in, before coming in for thier appointments.
    Could you have a similar situation?

    Chip
    Wow, when I first read this, I thought it might be a troll....

  20. #20
    Master OptiBoarder
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    I read half way through this thread and decided to chime in. I would say it is nearly impossible not to have any recommendation for a patient coming in for an examination. Most patients have no idea what products are available or that problems they take for granted could be solved with a new Rx or a different design lens. The average patient get examined once every 2 years. A dedicated doctor should spend the time understanding about the patients lifestyle (work, hobbies, etc) and get involved in improving a patients life for the next 2 years. This is the part I miss most about practicing. Selling is when your end goal is financial. Questioning and prescribing to your patient to find a way to best help them is being a doctor.

    If that doctor worked for me I would kick him/her out. They are killing time in my practice and definitely not considering what is visually best for the patient. This is a practice/business killer.

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    Master OptiBoarder OptiBoard Bronze Supporter
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    Two quick "true" stories.
    #1
    4 Opto"s who own and work in their building with retail space, right next door to their office ....rent the space to a new young optician. The dr"s idea is that the rent from the optician will pay the mortage on the building and they will save money. Six months later the optician is bankrupt and his store is closed. WHY, because the dr' were to , stupid the organize themselves, so that each one would feed one or two Rx's per day to keep the opticain paying his rent.

    #2
    Same senario but these dr's are smarter and "ONLY" send all of their Rxs to the opticain renting in their building. As a result NOBODY optically related any where else see's any more of their Rx's. But, the office is in a major city ...directly downtown...and most of the clients come from the surrounding suburbs. So their opticain survises but when mrs xxx's son breaks a part of the eyeglasses or needs an adjustment, they run to their local suburban optician for help. "Sorry mrs xxx we have no parts or pieces for that frame you will have to go back where you bought the eyeglasses". "But that's all the way downtown, and it $20.00 to park ... and Johnny doesn't get out of school till 3PM so I will be stuck in rush hour traffic....and they don't work at night...and they are not open on Saturady".

    "Too bad mrs xxx you should have brought your Rx to your local optician or optometrist.

    There should be an open use of all three optical professions working togeather for the betterment of the profession and the care of their client/patients.

  22. #22
    OptiBoard Apprentice
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    Why why why do most people in this business feel that one pair is all the patient should have or only new eyewear after the hopefully "annual" exam.

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