A Conundrum: Give em what he wants?

**NCspecs** · 10-19-2011, 10:07 PM

Here is the scoop.

Pt comes wandering into my Dr's office a week or two ago complaining about a competing office down the road saying that he was fed up with the way he has been treated and that he has had several remakes on his glasses. We chatted for a while and I noticed that the pt was wearing a frame that was a totally innapropriate fit for his facial structure (prominent bridge and close set eyes wearing a tiny oval flexon frame with a physio short crammed in a 16 SH). Pt complained about his reading (me thinking, "well no duh!") and also was unhappy with how much he had to move his head to find his best vision for any given distance.

I've been fitting Ziess GT2 3Ds and Individuals with a lot of success and so I thought he might be a good candidate for either. After explaining a few key points about the lenses he decided to try the Individual and in a frame with what I felt was a much more accomodating B measurement. I was incredibly confident that I could fix some of his key complaints. Pt had a new exam with our Dr and I ordered the lenses.

Pt came in today for his dispense and was not a happy camper. The distance correction was fine he said but the reading felt like it "sloped" into a "trapezoid effect". I had spoken with one of my go-to guys at Zeiss and he said that he had experienced that same effect but it went away over the course of a week. I asked my pt to try the lenses because they were so different from what he was wearing but it was a complete no go. Pt refused to take them home with him.

The Rx has barely changed and the pt's PD is the same in both pair. I would be okay with changing the pt into a GT2 3D and keeping the frame we chose but the pt decided that I must not know what I am talking about and now wants to go back into the old frame. I contend that the old frame is just going to produce the same problems that he came to me to fix. The guy wants a large reading and intermediate and I think I can give it to him... In the new frame. Any thoughts? Constructive ideas please, leave the snark in he "Is Opticianry Dead" thread. Thanks.

**cocoisland58** · 10-20-2011, 06:15 AM

All snark aside,sometimes they walk in the door with a complaint and it's hard not to become openly and postively gleeful. You can see exactly what the problem is and by golly you can fix it too. Sadly when they throw them back at you without giving that fix a chance there isn't much you can do. In my experience a customer who has admittedly been someone else's problem is going to become your problem too.

**chip anderson** · 10-20-2011, 07:16 AM

Have your or the patient concidered Bi or Tri Focals? Remember this patient's complaint is he can't see, not that he doesen't look pretty.

Chip

**Judy Canty** · 10-20-2011, 07:27 AM

Refund his money, give him his rx and allow him to become someone else's problem.

**optilady1** · 10-20-2011, 08:01 AM

Did the rx change a lot? What about his old pair. Not the small ones from the last place, the ones before that. If the crank still has, do they have little panto, or negative face form? Any change in the astig correction?

Unfortunately, the probable answer is that he's a nit picky kinda guy and nothing will make him happy. I feel your pain. We all do. We've all delt with this patient before. If all else fails, I would tell him, "I was confident that I would be able to give you the vision you were looking for, but it seems that it's not working, here's your money back, may I recommend XYZ optical across town?"

**Wes** · 10-20-2011, 08:15 AM

This is a good one for the "patients you don't want" thread.

**Diopterman** · 10-20-2011, 08:27 AM

I would GLEEFULLY refund his money and tell him the phrase that I learned from a fellow Optiboarder (Framebender):

"I am going to decline the opportunity to disappoint you again. I appreciate your interest though!"

I love that phrase!

**CCGREEN** · 10-20-2011, 08:54 AM

First think I ask myself when I have one of those opportonity issues come through my door is "do they have realistic expectation's?" If I deem they do not then I try to explain to them why I cannot accomplish what they would like. Then I explain to them what I can do for them and if they choose to let me work with them I document our conversation on the order and when they pick up the order and start in about how unhappy they are I can then point out that I have documented the previous conversation and that I had let them know of these issues before hand. (then I sit back and try not to smirk) I really just try to address the issues before they become issues, saves a lot of time, money, and hard feelings.

**Iroc** · 10-20-2011, 09:16 AM

I think it's sad in a way because you have pt's come in to see you asking for your help. Afterall, that's why we are here. But I can say more often than not, you're not going to please a pt. like this. I've even told pt's that I won't be able to help them see any better. That magic progressive I have up my sleeve still isn't going to give you that flawless vision you demand. Three remakes later I'm trying to take my eyes out with a spork. I feel for you and I think we've all been there. What should you do now? I don't know if you're like our office but we don't give refunds so I would go back to a hard progressive design where you can give him a set reading zone instead of the floating soft design that the individual uses. I wish I could be that Optical Superhero that can fix all, but alas, I've sporked out my eyes and can't see. What progressive lens would you recommend for me?

**AustinEyewear** · 10-20-2011, 09:17 AM

What is the pts approx age, occupation, what is his primary use and what was he wearing in the past that made him happy?

**chip anderson** · 10-20-2011, 10:19 AM

Oh my, my everyone wants to punt before tr;ying "old technology". We are appearently willing to let the patient go, or try a half-dozen competive brands of progressives and then blame the problem on the patient. No one here will even concider a bi or tri focal? If it's newer it's jus' gotta be bedda, right?

Ask yourself if you have never had patients who come in wearing multiple SV's, bifocals or trifocals stating: " I had no-lines before and I couldn't get used to them. I don't want to try them again." This patient is perfectly happy with his staus quo. Stick with it.

Chip

**Chris Ryser** · 10-20-2011, 10:42 AM

I am totally with Chip. The guy wants to see clear for near and far..............give him the clearest, a large 35mm flat top and he will just love for your newest technology.

**Uncle Fester** · 10-20-2011, 11:34 AM

First recite to him Ryser's Rule- "The success of a progressive is directly proportional to the willingness to wear a progressive" and gauge his reaction.

Experience has taught me that when I get this type of challenge across from me at the dispensing table to tell them I will fit you only with an understanding that they must be worn for at least 2 weeks and if it again doesn't work we would redo them into a FT at no additional charge. The progressive money is "at risk". If the new redone pair is also unsatisfactory than history proves to us that progressive's are not for them period. If they balk at this then so be it. You've probably saved a lot of money and aggravation.

**optilady1** · 10-20-2011, 11:37 AM

Originally Posted by Uncle Fester

First recite to him Ryser's Rule- "The success of a progressive is directly proportional to the willingness to wear a progressive".

Experience has taught me that when I get this type of challenge across from me at the dispensing table to tell them I will fit you only with an understanding that they must be worn for at least 2 weeks and if it again doesn't work we would redo them into a FT at no additional charge. The progressive money is "at risk". If the new redone pair was also unsatisfactory than history is showing us that progressive's are not for him period. If he balks at this then so be it. You've probably saved a lot of money and aggravation.

+1

**NCspecs** · 10-20-2011, 02:03 PM

Thanks to everybody who pitched in with useful info. I appreciate the help! My fiance was the person who suggested I throw this up on Optiboard and let some of my peers weigh in with their perspective.

Chris and Chip- I am totally on board with your solution of a FT anything. Unfortunately he does want to "look pretty". He even suggested how I could improve the bevel of his lenses to suit his liking. This guy is not going to bite on the Flat Tops but I will suggest it all the same. All he can say is no, right?

I think, after discussing things with my Zeiss guy, that the real problem is that he was used to a short corridor progressive and the Individual was too long of a corridor for him. I think he could have loved them in time but he is, shall we say, rigid. My bad. I'll own up to that. But it was with good intentions. IF I can get him to play ball I'd like to have him keep his new frame and I with fit him in a GT2 3D short with a slightly lower SH. I just HATE his previous fit because I know that if I give in to using that tiny little oval frame he will never truly be satisfied.

I called the Pt and proposed the change to the different progressive this morning. He said he would call me back. Now we wait.

**NCspecs** · 10-20-2011, 02:05 PM

Originally Posted by Uncle Fester

First recite to him Ryser's Rule- "The success of a progressive is directly proportional to the willingness to wear a progressive" and gauge his reaction.

I could not agree more! I tell this to people all the time. :)

**chip anderson** · 10-20-2011, 02:24 PM

My Zeiss people have told me that the individual can be done down to a 13mm corridor. Have used some (maybe not to 13) with nothing but WOW.

Chip

**optilady1** · 10-20-2011, 02:35 PM

I've found that the last few years of short pals have been the best, and now find myself putting people into them more often then not, no matter the frame size. People are too lazy to move their head to find the reading, so I give 'em a short and they can go on being lazy and never have to move their heads again.

**jediron1** · 10-20-2011, 02:53 PM

Originally Posted by optilady1

I've found that the last few years of short pals have been the best, and now find myself putting people into them more often then not, no matter the frame size. People are too lazy to move their head to find the reading, so I give 'em a short and they can go on being lazy and never have to move their heads again.

Your one smart cookie Connecticut Optician!

**chip anderson** · 10-20-2011, 02:54 PM

Unless I missunderstand Pals entirely, one should not have to move the head vertically to read. One will have to move the head horizontally to read wide pages and as far as I know, short corridor pals aren't any wider than long ones. They may widen a little sooner, but the overall vision peripherally isn't any better.
Optilady, sounds like you have been putting your segs too low.

Chip

**harry888** · 10-20-2011, 08:48 PM

NCspecs,

Cut your losses. Any remake will never be right and on your dime. Refund.

Harry

**Iroc** · 10-21-2011, 09:23 AM

Is is just me then that has pt's that complain the near is too low on these floating corridor'd lenses like the individual? If I raise the seg ht. it still puts the add at the bottom of the frame, does it not?

**optilady1** · 10-21-2011, 11:46 AM

Originally Posted by chip anderson

Unless I missunderstand Pals entirely, one should not have to move the head vertically to read. One will have to move the head horizontally to read wide pages and as far as I know, short corridor pals aren't any wider than long ones. They may widen a little sooner, but the overall vision peripherally isn't any better.
Optilady, sounds like you have been putting your segs too low.

Chip

Not to say that I've never put a seg too low, but I always but the seg center pupil. But some people who hold their reading material at certain spots do need to raise the head a little with certain pals, and lately, I've found my patients like to get into the reading a little sooner. Just my own observation.

**gatorbait** · 10-25-2011, 02:58 PM

I have never had that problem with the Individual. But I do agree with Chip. If all else fails, Bi/Tri them and after that kick em to the curb. I wont give a refund unless they try them and either have a dr's change or a refit. It sounds like the guy wants magic glasses. Tell him/her that Empower(only read never tried) may be the closest he/she is gonna get!

Has the patient ever worn progressives prior to this? With Success and if so what type of progressive?

**chip anderson** · 10-25-2011, 04:08 PM

You know, in all the texts I have read, all the courses I have taken, I have many times heard the term: "Patient Needs".
Never once have I heard the term: "Patient wants."

Chip