Doctors recommending lenses... good or bad?

[Lady Nicole]

Here's a scenario I ran into recently-

A patient comes in complaining that he feels dizzy in his new glasses, worn for about two weeks. He's wearing flat top bifocals, new prescription has a moderate amount of cyl that the patient has never been prescribed before. I look in the chart, history of glasses goes back a few years. The gentleman has always been fitted in bifocals, plastic, no tints. Same as what he has now. The only difference is the cyl. Patient complains that he feels ok wearing the glasses while sitting, but gets dizzy when he stands or walks in them. He also complains that he can not see his computer. I look at the original Rx, and the doctor does note recommendation for progressives.

In the back of my mind I'm thinking, if this man is already struggling with the new cyl, he's going to be miserable in a PAL, especially since he's a previous bifocal wearer. But the man says, "I want a progressive so I can see my computer, and that's what my doctor told me I should have."

We discuss his new Rx briefly and the patient insists that he wants a recheck. I schedule him with the doctor for the next day. After the appointment, doctor comes and says to me, right in front of the patient, "there's nothing wrong with this prescription, and I want to know why he wasn't fit with progressives".



At that point, with the patient standing there hearing every word, I can't exactly tell the doctor I think he's wrong. Nor do I think it's appropriate to elaborate on how the gentleman is a non-adapt waiting to happen. So we (the opticians) apologized for our error and told the man we'd be happy to re-fit him with progressive lenses. Just like the doctor ordered.

My question is, how helpful is it when doctors do an optician's work while in the exam room? I've had patients brought out to me more than once already asking for specific lens brands and materials that "the doctor said would be good for me". In some cases that's great. In other cases, like the one above, it's a redo waiting to happen. The problem I find is that I'm put in the uncomfortable position of having to either disagree with the doctor in his infinite wisdom, or just be a glasses fitting drone who doesn't do anything but take measurements and collect money.

I'm interested to hear other people's opinions on this. What are your thoughts?

[fvc2020]

Hello

I actually work with my doctor as a partner with recommendations. She won't over extend herself though. My questions to you is this. Are you communicating with your doc? What made your doc make this recommedation to this patient? Did you pre judge your patient and just assume they didn't want a change and weren't ready for a change? I'm not judging, just trying figure out the lines of communication in your office. Normally(hopefully)you both should be on the same page, and if not you should be talking about it before the recheck. Express your thoughts before the rechecks. He should not being going into that recheck blind and then blindsiding you when he comes out with the patient and making you look and feel dumb. Like I said I just want to see the flow of how your office works....

christina

[Framebender]

Isn't this the same Dr that had you remake a 2 year old bifocal for seg height?!? Even if it is their name on the door there is such a thing as respect. I'd remake it in a progressive, not upcharge the patient until I'm sure they work, and then when they puke, smile sweetly and ask the Dr what the next move is!

I'm betting its the cyl too, but your jerk of a Dr needs to learn their lesson the hard way. If their cost of goods goes up because you follow their recommendation rather than what you know is best, then who can blame you for doing what your told?!?

In the meantime I'd break out the old resume, put the word out with the reps and get the flock out of Dodge!! They are never going to respect what it is you do!! I'm betting that there are other positions in your area where you will get treated as an optical professional!!

[For-Life]

I have spoken against this many times before. The problem here lies that when a patient hears the OD recommend something that patient takes it as part of the prescription.

For instance, I had one guy in the office. He was wearing PAL's, and loved them. He went to an OD, who does not dispense, and the OD told him that his current PAL's are a big no-no, and the what he should have is tri-focals; however, he should switch to bifocals first to make the adaption easy.

So the patient comes in tells us that his doctor prescribed bifocals. I asked him if he has had any troubles with his PAL's, he says no, and that they are the best pair of glasses he currently has. But it still took me about 20 minutes to convince him that since we fit glasses 365 days a year we know what we are talking about. He took the doctor's advice as gold, because the OD is called a DOCTOR.

There is a conflict of interest there. Because the OD is a doctor the patient thinks that doctors know everything. But the best OD probably has nothing on the best Optician as far a glasses goes (not prescription), because that is all the Optician does. It is the same reason why us Opticians cannot take the patient into the back room and double check each RX and question the OD.

[Ory]

I think there's a balance between explaining what a patient should have and overstepping your knowledge base. It's pretty clear that some people would be best served with an AR coat, or a progressive, or a polarized lens. That's something that I have no trouble recommending when it's appropriate. I also tell people what all their options are (or most at least).

In the original example, did your OD know that you suspected cyl adaptation problems? You'd really be amazed how many people tell me things are ok because they don't want to seem like a bad patient, while they just told my staff what the real problem is.

Perhaps you do need to sit down with the doc and hash out what is your responsibility and what is his. You may also want to have some kind of signal where you can pull him aside and ask what he is thinking.

I'm not saying all ODs are perfect but there's always 2 sides to every story.

[loncoa]

In our practice the ODs make recommendations based on their conversations with the patient which we sometimes follow and sometimes don't. They don't really give them to the patient. They give them to the dispenser they're handing off to. That way they don't overstep, and if we learn things about the patient which contraindicate then it's not a problem. So it is down to the doctor to do the right thing. Any time a doctor gives a patient a false impression about their rx isn't great. It needs to be clarified. What the dispensers do is then tell the patient they will talk to the doctor and ask if this is prescribed or recommended. That should clear it up. Might irritate the OD if he's trying to sell something though. This is just what we do here, I'm not saying it'll work for you.

[Johns]

I'm not saying all ODs are perfect but there's always 2 sides to every story.

Are you saying that "MOST" are perfect?

"SOME" are perfect ?

Just speaking from the ODs I know, I'd say that most are good, some are excellent, but "NONE" of them are perfect.


I agreee that there are two sides to every story (at least), and I think that the OD that Lady Nicole speaks of should be looking at all sides.

[Ory]

Are you saying that "MOST" are perfect?

"SOME" are perfect ?

Just speaking from the ODs I know, I'd say that most are good, some are excellent, but "NONE" of them are perfect.

Errr.....Let me rephrase that. What I'm trying to say is that Lady Nicole's doc may be wrong, he may be right. We don't know all the details of this story. I've found around here that any post that expresses support for ODs over opticians is likely to result in rather negative comments very quickly, so I was trying to limit that.

Give me a break, I'm not perfect.......;)

[Johns]

I've found around here that any post that expresses support for ODs over opticians is likely to result in rather negative comments very quickly, so I was trying to limit that.

I don't think this is an issue of OD bashing. Regardless of whether it was an OD, an MD, or a refracting optician, they shouldn't be so narrowminded as to not take into consideration the reccomendation of the person (not necessarily an optician) that fit the glasses. If they have that little respect, or have that little confidence in their staff, they should replace them, or do it themselves.

[chip anderson]

I have known opthalmologist who were so concientious that when a patient complained about not seeing well enough through the scope on his hunting rifle, he had them haul it up to his sixth floor offcie and refracted them sighting out the window with it. Same when the complaint was about vision with a microscope. Haven't known any O.D.'s well enough to know if they would do the same but some probably would.

For such men, you can damn well bet that I will at the very least listen to any suggestions about lenses, or most anything else. If the doctor runs them in and out at a rate of four per fifteen minite interval, his advise doesn't hold as much weight, no matter how good he thinks he is.

You have to concider the source on all advise, whether it comes from a surgeon, Rush Limbaugh, or Hillary Clinton.

Chip

[Lee Prewitt]

I think that this issue is one that is very complex in the context of posting. I know that I did not always follow my OD recommendations and that I asked the patient what they wanted. Always before sending a patient back for a recheck, have a conference with the Dr. first. Discuss the issue and possible solutions. You would be surprised how much chair time can be saved.


My 2 cents.

[Bev Heishman]

We had a similar situation. Progressives were prescribed although an emmetrope previously wearing Ft -35 and readers. They were demonstrated with a Varilux demo kit and they simply could not get the gist of the way to use them. Chief complaint was that they could no longer see the dash board with the bifocals at night. The patient decided they weren't for them.

On return to the OD, the doctor argued that the Rx was filled incorrectly,although, the patient was informed and made a decision. Main problem that eroded our credibility was that he told the patient this info without asking the circumstances......My decision, as manager and senior optician to my staff, no matter what may have transpired ...if it is not documented in writing....it did not happen.

Very frustrating for me,as this patient is not an ideal candidate for these type of lenses and had a +2.25 add. These were dispensed as ordered the second time for no charge between the FT and the progressive. Guess what? The patient is having much difficulty seeing. This makes us (optical) look like ....! and the OD refuses to see them again.

[chip anderson]

BEV: ANY PRESBYOPE WITH AN ADD Of TWO OR MORE NEEDS A TRIFOCAL.

Opthalmic dispensing 101. I suspect it's even in the ancient "Helpful Hints for the busy optician."

Chip

[chamilun]

wow,
a lot of anger here. it seems very dangerous that these forums can be read by anyone....

a good optometrist (or OMD) determines the Rx as part of his/her exam, and evaluates the health of the eyes as well.
I think a good eye doctor leaves the dispensing to a qualified optician. A quality optician should be able to gain confidence from their 'customer' so that they can explain that the doctor wrote the Rx but you are recommending the best lens to suit their lifestyle.

If the prescribing doctor doesnt have faith in who will be working with the patient, I think then recommendations should be made. But why does anyone here think the prescribing doctor cares about PAL vs AR vs brand, etc?? unless it affects the patient aversely.

i for one know I could care less

[loncoa]

Some OD's do care about what brand is sold because they own the whole show and they know they will make more money off one or the other. Sad but true. One does get a larger discount on their lenses if they have a higher volume. That is, when they use a lab which is owned by a particular lens company. I can't say this is a desirable situation (from the patient's point of view) but it exists.

[Andrew Weiss]

Sometimes I want the OD to suggest a lens type or option. The patient will usually take it more seriously if it comes from the doctor than if it comes from me. I am also fortunate to work in an office where the ODs have respect for the opticians and our knowledge of the eyeglass end of things. And the patients know that.

For example: if one of the ODs tells a patient that (s)he needs multifocals, I don't take that for granted. I ask the patient questions, especially if the person is a myope on the cusp of needing a reading Rx. And sometimes my recommendation is, "Wait until you're totally frustrated with your single-vision glasses because then you'll be motivated to adapt to the progressive (or flat-top sometimes)." The ODs here know that I and the other opticians here do this; they trust that we know better who's a good candidate for multifocal eyeglasses and who isn't because we're fitting and dispensing them every day. The same applies to other dispensing issues too.

In the end, I believe our patients have more trust in us, the office opticians, because they know the ODs trust us. And that makes our job a whole lot easier. I don't think I could work in a place where the doctor did not respect my expertise.

[fjpod]

Sometimes I want the OD to suggest a lens type or option. The patient will usually take it more seriously if it comes from the doctor than if it comes from me. I am also fortunate to work in an office where the ODs have respect for the opticians and our knowledge of the eyeglass end of things. And the patients know that.

For example: if one of the ODs tells a patient that (s)he needs multifocals, I don't take that for granted. I ask the patient questions, especially if the person is a myope on the cusp of needing a reading Rx. And sometimes my recommendation is, "Wait until you're totally frustrated with your single-vision glasses because then you'll be motivated to adapt to the progressive (or flat-top sometimes)." The ODs here know that I and the other opticians here do this; they trust that we know better who's a good candidate for multifocal eyeglasses and who isn't because we're fitting and dispensing them every day. The same applies to other dispensing issues too.

In the end, I believe our patients have more trust in us, the office opticians, because they know the ODs trust us. And that makes our job a whole lot easier. I don't think I could work in a place where the doctor did not respect my expertise.

Very well said.

[Johns]

Some OD's do care about what brand is sold because they own the whole show and they know they will make more money off one or the other. Sad but true.

What's the problem with that?

On the other hand, opticians don't care about making money,we just want to sell the absolute best product to the consumer, regardless of how it will affect our bottom line. Thank goodness that their are still opticians out there (Like me) that will protect and preserve the vision of consumers worldwide! (I had a paper route when I was young, and made all the money I'll ever need, so profit is of no concern to me now...)

[Framebender]

I want the Doc spinning dials to make money. Keep them in the dark and we all make money!! I've never once stepped into an exam room and told them how to spin dials or do a health check. I've never called one in front of a patient over a bad Rx. I have made one pay for his own redos, but that's it.

For some reason though the fact that the OD signs checks, or may have their name on the door, seems to entitle them to call an Optician down in front of patients and other staff. I guess my question is, why should an Optician not be afforded the same professional courtesy that they are expected to give an OD?

My wife signs the checks in our store and we chose the name on the door, but whether its an OD or another Optician, we would never say anything in front of a patient or other staff. We would just consider that really bad form.

There are some really great OD's, but there is also a large group that aren't so great. It just seems like a double standard to me!

[Johns]

We would just consider that really bad form.

Of course...We both know that it's bad form, but you'll find those w/ bad form in any industry.