Argument with ophthalmologist, am I wrong?

[HarryC]

Good morning everyone!
Need a little advice with a situation I ran into yesterday. My company frequently has "two for" sales that include cr39 lenses. A gentleman came in yesterday to take advantage of the sale, however the doctor wrote on his rx in big bold letters "FDA safety guidelines-polycarbonate lenses".
I have always been told that the law states I must fill an rx as written, therefore I informed the customer of the additional charge for poly. Needless to say he had a fit. I explained the reasoning behind the charges, and if he didn't with to pay them to have his doctor rewrite the rx without the poly stipulation.
So the guy calls the doctor, who in turn calls me. This doctor basically said that what he wrote is a reccomendation and I can sell the customer plastic if I wanted. At that point I humbly asked mr. Ophalmologist to rewrite the rx without the poly on it, and he refuses. He claims he never heard of such a stupid law saying I have to follow his rx.
Am I wrong in this? If the doctor doesn't know the laws then why the heck does he practically quote it on the Prescription?
Basically what I would like to know is if what I'm saying is accurate. Could I fill a prescription in plastic if the doctor states poly?

[MikeAurelius]

IMHO, the written "FDA safety guidelines-polycarbonate lenses" could easily be interpreted to mean that if you are putting the lenses into a Z87 frame, then the lenses must be polycarbonate. FDA does not (as far as I know) require safety lenses in a street-wear frame. Does the patient have only one eye, or is otherwise impaired in one eye?

By writing in the "FDA safety", he's giving you an "out" to dispense anything as long as you are not dispensing Z87 eyewear, in which case you should dispense polycarb.

Yeah, it's a jailhouse lawyer view, but better than and cover your butt.

My two cents in any case.

[rdcoach5]

A verbal OK is sufficient, I would think. It's similar to when we call the Dr and ask if he wants the same 4 diopters of prism that a patient has had for the last 10 years and the Dr forgot to write it on the Rx. That happens too often and is resolved by a phone call. I don't know why the Dr. would not re- write it, however. If he's that busy, he could just delegate it to one of his staff.

[chip anderson]

You managed to make a mountian out of a molehill. A verbal Rx or OK is more than sufficent. The only reason you need the Rx in writing is that if someone should complain (like to the Board of Optometry) you need proof that you had one. If the doctor is friendly (and trust me as someone who has made this mistake far too many times, argueing with him isn't the way to keep him friendly) he will furnish one should any problem arise. If you have a "safety glass" Rx there is no reason why you can't make him a dress wear pair of glasses to begin with, you just can't put them in a safety frame or tell him that they are safety glasses. You can make him safety glasses if he wants and you can also make him some glass drilled rimless glasses if you dare. No expsplicit sanction from anyone required.

Now if you made glasses for him and allowed him to believe they were safety OSHA approved safety glasses, then you would have a problem, and then only if some injury and complaint should occur.

Chip

[EyeManFla]

Sorry guys, but when it comes to doctors' and their Rxs, a verbal isn't worth the paper its not written on. I've had it come back and bit me in the butt way too many times.

[NCspecs]

A verbal OK is sufficient, I would think. It's similar to when we call the Dr and ask if he wants the same 4 diopters of prism that a patient has had for the last 10 years and the Dr forgot to write it on the Rx. That happens too often and is resolved by a phone call. I don't know why the Dr. would not re- write it, however. If he's that busy, he could just delegate it to one of his staff.

+1

I know that sometimes that this can be kind of a sticky situation but in this case you got the ok from the MD, roll with it. Frankly I'm amazed you actually spoke to him- I always get a tech! Chip is right, don't make it a bigger deal than it needs to be.

In situations like this, I document, document, document. That way if you deal with any issues in the future you can point to your documentation and say you did your due diligence.

[J.P.]

I've gotta agree with Mike here. If they are "Safety Glasses" and you are using a "ANSI Z87.1" Safety rating guidelines, then you must follow the rules.

I have never and would never make "Safety" frames and lenses without A Z87.1 Stamped frame or without Poly lenses at least 3mm thick with the safety thickness stamp on them. This is my standard of ruling in my dispensary. I have Military Bomb Techs get their glasses made from me and Poly and Trivex are the only materials I will use with no less then a 3mm center thickness.

Now, this Doc must have no clue that his orders are what we must follow unless they have nothing written on the RX. It's just like going to the pharmacy. They can not change the Dr's orders without verbal or written changes, neither can we, or at least I don't. Are you wrong for arguing with him? I say NO. I stand by my rules, and if a doctor orders something that I believe is well outside the patients best interest I'll state my case.


I found this for anyone that wants to know the FDA Guidelines on Safety Lenses pages 4 and 5, of course ignore the glass part on page 4 (Sorry Mike LOL)
http://www.fda.gov/OHRMS/DOCKETS/98f...64-gdl0001.pdf

[pseudonym]

Sorry guys, but when it comes to doctors' and their Rxs, a verbal isn't worth the paper its not written on. I've had it come back and bit me in the butt way too many times.

Two particular docs in our area are writing things like "Crizal" and "Poly" on the Rx. This is NOT written in the little recommendation boxes, but directly under the Rx. We have the same problem with these crazy sales where they get the low price for plastic with additional charges for A/R.

When I call the doc, he says it's ok to order whichever lens the patient wants with or without the A/R. Won't fax a new script, or says he will but it doesn't come.

I was told in school to fill what the paper says and don't take chances even if the customer walks. My manager agrees.

What say you, EyeManFla? In what ways can leaving off the A/R for instance, or using Teflon when the Rx specifies Crizal bite you?

[optilady1]

Unfortunately, every doctor is different. Some consider the things that aren't numbers written on an rx as a suggestion, and other's consider it law. You won't know unless you work with the doctor, so I would say since you work in a setting where this doctor isn't going to oversee anything you are doing, than use your optician brain and make wise and common sense decisions based on what's best for the patient.

This was always an issue when I worked at the LC, when it wasn't easy to get a Varilux, and people came in from local doctors with it written on the rx all the time. It's always fun explaining that their world known and respected doctor didn't know everthing there was to know about glasses.

[chip anderson]

Lest ye forget!
Rule #1 of the Optical Business: "The Doctor is always right!
Rule #5 of the Optical Business: "The biggest sin in the optical business is not reading the prescription.
When you tell the patient the doctor doesn't know everything there is to know about glasses, you are implying that you do know everything there is to know about glasses.

Chip

[Robert Martellaro]

...make wise and common sense decisions based on what's best for the patient.

That's my recommendation also.

[RT]

The US Food and Drug Adminstration (FDA) only has regulations for dress eyewear (21 CFR 801.410). OSHA regulates safety eyewear, and recognizes ANSI Z87.1-2003 as the latest standard for performance. So the statement "FDA safety guidelines" cannot correctly refer to safety glasses. Safety glasses can be made of any material for basic protectors (frame marked Z87, min thickness = 3.0mm), and can be made of any material for impact protectors as long as the material has passed the Material Qualifcation test. ANSI Z87.1-2003 does not mention polycarbonate by name.

As long as the dress eyewear has been made impact resistant and passes the drop ball referee test, they pass the FDA guideline. Nowhere in 21 CFR 801.410 is polycarbonate mentioned.

[optilady1]

If one is fool enough to suggest that the doctor is wrong in so many words than one deserves what one gets. If one gently explains that there may be a better way than what the doctor has suggested, and the patient decides to go with what the doctor says anyway, than one has done everything they can without making a fool of themselves.

[HarryC]

I have a good friend who is a district manager for Wal-mart corporate. I asked his opinion on this matter and he indicated that any optician that filled the rx in plastic would have been terminated immediately. Even with a verbal ok from the doctor.
It seems that folks who work for chains are more closely under the watchful eyes of the board of health. I feel much better about my decision now.

[optilady1]

I have a good friend who is a district manager for Wal-mart corporate. I asked his opinion on this matter and he indicated that any optician that filled the rx in plastic would have been terminated immediately. Even with a verbal ok from the doctor.
It seems that folks who work for chains are more closely under the watchful eyes of the board of health. I feel much better about my decision now.

At least you are getting backed by your manager. NOthing in this world is black and white. There's also nothing wrong for sticking to your belief of what you feel is correct.

[chip anderson]

As long as we are here, what about when the doctor prescribes an add and the patient wants SV?
Are we being illegal if we fill it in SV?
Me, I think not provided we discuss the reasons for and against. If the patient is a -2.00 and has a plus 2.00 add, and prefers to take thier glasses off to read why not?

Chip

[mdeimler]

It's the same as if my PCP gives me an RX for 3 pills/day but I want to be cheap and make them last longer and only take 2. He did his part and his a$$ is covered. No harm, no foul. He verbally told me to take 3. What I do is ultimately up to me.

[HarryC]

What if he prescribed 50mg of Viagra, but you feel you only need 25mg? If you convince the pharmacist to give you the 25mg version can the phamacist be held accountable for not following the rx?

[J.P.]

What if he prescribed 50mg of Viagra, but you feel you only need 25mg? If you convince the pharmacist to give you the 25mg version can the phamacist be held accountable for not following the rx?

HAHA, I'm so gonna ask my OD if her can write me Viagra and watch the look on his face turn into a hysterical laugh, LOL ...... not that I need it

[CME4SPECS]

Materials and lens types, and brands that are written on an Rx are suggestions, they are NOT part of the Rx.

[Uncle Fester]

What kind of lenses are we talking about?

If it was sv or bi's I'd have probably just quietly made them in poly.

[kat]

I have mixed emotions about this, I agree that usually things like Crizal, FDA Safety, etc are recommendations. I have no problem with that, but I was always tought that we can interpret the Rx to make SV, Mid-range, specialty distances, etc. off of the Rx. What I find interesting in this thread is that no Dr.s have chimed in, what say you??

[HarryC]

Materials and lens types, and brands that are written on an Rx are suggestions, they are NOT part of the Rx.

That is open to debate. A doctor could easily say that it is.
I once saw a 60 minutes report on eyeglasses that was about incorrectly filled rx's. They took a prescription to LensCrafters that was for FT28's. The "customer" convinced the optician to sell him FT35's and the reporter pounced on him. Of course the optician said that listing a ft28 on the rx was merely a suggestion, but the board of health strongly disagreed when they were interviewed.

[HarryC]

I have mixed emotions about this, I agree that usually things like Crizal, FDA Safety, etc are recommendations. I have no problem with that, but I was always tought that we can interpret the Rx to make SV, Mid-range, specialty distances, etc. off of the Rx. What I find interesting in this thread is that no Dr.s have chimed in, what say you??

Doctors that specify products on their rx's usually have a dispensary that sell those products.

Even though my customer got upset because I had to give him poly, you could easily have a customer who can get upset that the doctors instructions were not followed, hence the lawsuit begins.

[CME4SPECS]

Harry, I clearly understand your point. So, Dr Z writes an rx for Z pal in polyvex. You don't carry Z pal, in polyvex material because it's Dr Z's special house brand that you or no one else can get. What are you going to give the patient?