Dr RX

[HarryChiling]

I am recalling a story that went something like this,
Doctor has a patient, rancher, prescribes glasses makes not recommendation of materials, gets cr-39, patients rodeos for a favorite pastime, eye gets injured, rancher sues doctor not optician for neglect to inform....Rancher wins

Did the doctor sell the glasses too?

I understand but there are hippa regulations to about disclosure of info and the necessity to have it. If I start writing VA or blind OS , AMD OD...IS it truly necessary for the optician to have a diagnosis when the instruction for materials etc is written on the RX? And what if the marginal optician says"No you dont need any power in that eye because it says you have AMD" Then who is it fault for hippa violations the optician or the OD for writing irrelevant info on the RX to the ordering and dispensing of glasses?
I guess then it boils down to who has the better lawyers! The lawyers always win...

I see your point, visual acuity would be relevent though and shouldn't be a violation. That has always been a pet peeve of mine when I get someone with VA less than 20/20

[steff]

My turn.

I will, occasionally write something other than numbers on my prescriptions :) Usually I do it because teh patient has come in telling me that that is what they want, or because we have had a LONG discussion about lens options for them. I've also specified progressive design on prescriptions (esp when teh patient says - I want exactly the same design of lens as I had last time).

I do it, not because I think I'm going to get sued, but because I think it makes it easier for the dispenser (saves time), and because it saves the patient saying the same thing all over again...

Do I mind if someone changes it? No, not really, but if there's a problem, and they come back and see me, and it's because the instructions haven't been followed... then it's not my problem.

steff

[OHPNTZ]

As an optometrist, I am more concerned about documenting my own charts with VA or rationale behind the refraction and/or lens selection. As mentioned before in previous posts , if I specify Poly...there is a specific reason.

For the over-refraction with minus lenses (or plus lenses), where do you draw the line as opticians? What if the patient is a latent hyperope, and I am pushing maximum plus? What if the patient has a high AC/A ratio, and I am pushing more plus or minus for a desired effect based on phoria measurements? What if the patient requests a slight monovision situation n their specs?

[steff]

Why not just pick up the phone and ask? If I get a letter requesting a specific test from an OMD, and I don't agree, or don't understand, I'll just pick up the phone and ask them... If a dispenser does the same, I don't mind at all... I'll explain the rationale, or if they have a better idea I'll change the rx...

I think with good dialogue between all the professions, everyone wins.

steff

[chip anderson]

Steff:
One of the reason's we don't "just pick up the phone and ask?" is it's hard enough to get a patient out of the doctor's office an into our own today. Now we have the patient in our office and he wants an answer now.
Unfortuantely, nowdays if we call the doctor's office he is likely to be out and one of his other locations, the records will be at the location we called.

Years ago if I called an OMD and he wasn't doing surgery, I got put through now. Today some offices have up to 60 women working there, you have to work your way through five of them just to find out if the doctor is in. I have called doctors office's lately described the patient's problem (sudden loss of vision, or similar, I don't call and just tell them Sally is in from out of town and wants a refraction) at 1:00 P.M. ended up finding the doctor at home after 6:00 P.M. Why the girls aren't trained or bright enough to say: "Send him right over, we'll work him in." Or we are swamped find another doctor, I don't know but it's today's situation.


It just isn't as easy as it used to be and it surely isn't fast enough to get an answer fast enough to satisfy the patient.


Chip

[steff]

Ouch. That must make it hard for you. I guess we are lucky enough to have a good relationship with our local ophthals... and they seem to have really well trained receptionists. If I pick up the phone to get a patient in quickly, the only time I haven't been able to is when the dr is on holiday... most ophthals here will also give you their mobile number, so you can get them if you really need them.

steff

[npdr]

Please use the correct acronym/abbreviation "HIPAA" Source: http://www.hhs.gov/ocr/hipaa/

[npdr]

There are many instances where the best vision refraction is never written as the final lens prescription. I'm afraid whenever I did try to explain to our local opticians, they still objected or didn't understand. I have stopped doing so. In addition, I find it hard to tolerate opticians saying that there is a dramatic change in axis when two prescriptions are identical when transposed. In other words, I might write it in minus cylinder during one day and I will write it in plus cylinder another day. I refuse to talk to opticians or take a call from an optician who fails to understand transposition of minus and plus cylinder forms of prescription. Without such a basis of knowledge, I doubt very much their other powers of observation or logic.

By the way, I'm a non-dispensing optometrist generating 50-70 written prescriptions per week. There is not a dispenser within 1 mile of me. In other words, I'm not in a side-by-side operation.

[Stonegoat]

I think if the optician wants to modify the original Rx to suite a need...go for it. So Chip, go ahead and add the plus 0.4 D to your painters glasses. If you're knowledgable you will do fine...if not...enjoy the remakes. DO NOT try and adjust the Rx as per it's prescribed intent, because there may be many factors of which you are unaware..and changing things will be a pain in the *** for everybody.

[For-Life]

I think if the optician wants to modify the original Rx to suite a need...go for it. So Chip, go ahead and add the plus 0.4 D to your painters glasses. If you're knowledgable you will do fine...if not...enjoy the remakes. DO NOT try and adjust the Rx as per it's prescribed intent, because there may be many factors of which you are unaware..and changing things will be a pain in the *** for everybody.

I do agree with that. Opticians are not prescribers, and if we add 0.25 phone the doctor and let them know. Most are rather open to it.

[Barry Santini]

For the over-refraction with minus lenses (or plus lenses), where do you draw the line as opticians? What if the patient is a latent hyperope, and I am pushing maximum plus? What if the patient has a high AC/A ratio, and I am pushing more plus or minus for a desired effect based on phoria measurements? What if the patient requests a slight monovision situation n their specs?

*Very* good points...and this exactly points out why today's "Rx format, parameters and overall information' is insufficently robust enough to communicate all that is necessary for a *competant* dispensing optician to understand what is going on. This is why I want separate Rxs for intended uses.

Barry

[Barry Santini]

I do agree with that. Opticians are not prescribers, and if we add 0.25 phone the doctor and let them know. Most are rather open to it.

And ditto for the refractionists who "cut back' the client's myopia 'cause they spend 90% of their time indoors. a simple comment, or phone call, is all that is necessary.

Unless we agree to revisit this whole refraction/Rx format.

We understand today that 20/20 doesn't cut it any longer as a sufficiently-comprehensive enough indicator of client's overall vision. So why can't we acknowledge that the whole Rx format issue is outdated as well?

Thoughts?

Barry

[npdr]

And ditto for the refractionists who "cut back' the client's myopia 'cause they spend 90% of their time indoors. a simple comment, or phone call, is all that is necessary.

Unless we agree to revisit this whole refraction/Rx format.

We understand today that 20/20 doesn't cut it any longer as a sufficiently-comprehensive enough indicator of client's overall vision. So why can't we acknowledge that the whole Rx format issue is outdated as well?

Thoughts?

Barry

Barry,

I think it is beyond the function of the optician dispenser to question the Rx. I concur, though, that "indication" for the Rx is helpful, just as in prescription medications.

The role of the dispenser in my opinion is to deliver an optical appliance to the user and to instruct the user in its care and use. That is all. i believe that it steps beyond the scope of the dispenser to second guess the prescriber.

[Barry Santini]

Your point is well taken. However, in *my* neck of the woods, ODs dispense, do I don't see clients from their offices very often.

I *do* see Rxs from MDs, whether they dispense or not. And in almost *all* instances, they employ *techs* to do the refractions. And their refractions are very poor indeed. Couple the now-common increased co-pay for "writing" (or performing) the refraction, and I see sooo many clients with "newly* written Rxs that are simply bad neutralizations of their current progressives.

I spend far too much time in my day CSI'ing poor Rxs. I'm sure that this greatly influences my opinions, attitudes and dispensing approach.

Maybe *we* can work together, sometime?:)

Barry

[For-Life]

And ditto for the refractionists who "cut back' the client's myopia 'cause they spend 90% of their time indoors. a simple comment, or phone call, is all that is necessary.

Unless we agree to revisit this whole refraction/Rx format.

We understand today that 20/20 doesn't cut it any longer as a sufficiently-comprehensive enough indicator of client's overall vision. So why can't we acknowledge that the whole Rx format issue is outdated as well?

Thoughts?

Barry

Interesting, this could probably all be solved if all three partners work together to develop whose scope is it to do what. Unfortunately, it is too profit driven. The sad part is it is not even about trying to maximize your profit. It is about seeing someone else doing relatively okay and wanting to take that away from them.

[vprl]

In the state of Florida the law regarding an rx is:

1. Sphere power
2. Cylinder power if needed
3. Axis if needed
4. Add power if needed
5. prism if needed
6. Any other information necessary to accomlish the objective of the prescription

[HarryChiling]

Barry,

I think it is beyond the function of the optician dispenser to question the Rx. I concur, though, that "indication" for the Rx is helpful, just as in prescription medications.

The role of the dispenser in my opinion is to deliver an optical appliance to the user and to instruct the user in its care and use. That is all. i believe that it steps beyond the scope of the dispenser to second guess the prescriber.

npdr,

I understand your situation is unique in that you do not dispense, however a majority of your peers do. I am willing to never question your prescriptions, on the condition that you are willing to pay the lab bill for your mistakes. I have many a remake because certain doctors in my neighborhood see patients non stop with very little gaps between. The incompetence of opticians keep getting brought up so I feel it should be right to brign up the other side of the issue which is overworked doctors. Many in my area will see patients like they work a chop shop, these Rx come into our office written on the same quality stock paper that the doctors who take their time with every patient and actually go over every scenario and inquire about the use for the script written and factor in lifestyle and patient habits. Nothing would make me more happier than to just sit back and get super accurate Rx's that I just fill and dispense, the reality of the situation is their are some who will do a good job and some that will do a mediocre job and the mediocre guy seems to see a bunch more patients than the good doctors so the dispensaries tend to get saturate with their scripts.

I personally would like to VA on the Rx so that I can go over the expectations of the eyewear. I am aware that most doctors would go over that information with the patient, but 80% of what they hear is either lost or reinvented as something else they wanted to hear. It would be nice to have the VA to further explaint eh expectations and reinforce what the doctor has said. As far as HIPPA goes, when I think about it the patient is taking this script to another office and handing it to the dispenser, their is no HIPAA violation to provide the dispenser with relevent information. For the case than was brought up with ARMD if I am given that information I could recommend low vision or even provide the patient with a low vision device.

To second guess the prescriber, this is a slippery slope for opticians. For opticiasn our lively hood depends on scripts that we expect to be accurate and their again are the few who perform chop shop refraction. It is in the optometrists place to perform the refraction to the best of their ability, when this doesn't happen, it hurts the optician and is a burden. As an optician I deal with substandard refractions all the time, so even if I do everything correctly and make the best pair of glasses to fit the prescription if the patient starts off with a doo doo script they get doo doo glasses. Then the result is usually don't talk bad about the prescriber or it impacts us negatively, add to that I am stuck with a remake from that doo doo script, and the patient will often lose faith in my abilities before they lose faith in their prescriber (even if they got their prescription from the local mart free with and oil change). I personally not only second guess prescribers but I hold them accountable, if they are writing bad scripts and in some cases refuse to fill their Rx's.

[Barry Santini]

. I am willing to never question your prescriptions, on the condition that you are willing to pay the lab bill for your mistakes. .

But let's be fair, Harry. Not nearly all *remakes* are Dr. faults. The patient is much of the problem, much of the time.

Barry

[HarryChiling]

But let's be fair, Harry. Not nearly all *remakes* are Dr. faults. The patient is much of the problem, much of the time.

Barry

Absolutely true, that is why it would be nice to have more information to further evalutate the patients needs, but to just say the Rx shouldn't be questioned is a bit conceited.

[abocandy]

I will, occasionally write something other than numbers on my prescriptions :) Usually I do it because teh patient has come in telling me that that is what they want, or because we have had a LONG discussion about lens options for them. I've also specified progressive design on prescriptions (esp when teh patient says - I want exactly the same design of lens as I had last time).


As a good Optician, I ask the Patient many questions, watch there movements, are they happy with the currant pal? material? etc.
I think we are obligated to give them what they are used to if it works...
WHy fix something that is not broken (besides the RX)
If one is satisfied I will match PD, seg ht, material, lens style etc..
It's only changed if specified. I have no problem calling the Dr to verify anything I am unsure about or want to suggest.
I appreciate Doc's who will work with me rather then against me (even if they do have their own dispensary) If a patient wants Candy- it is Candy they get!!!

Thanks for this discussion everybody!

[DragonLensmanWV]

But let's be fair, Harry. Not nearly all *remakes* are Dr. faults. The patient is much of the problem, much of the time.

Barry

Too true. But also how many times has a patient come back complaining of general blurriness and then gone back to the prescriber? And how many times has the glasses come back with a note about how "off power" they are or "a bit wrong" that infuriates the patient because they think the optician incorrectly made them? And how many times do the above happen but also come back with a new Rx? We've had many like that - "Oh, the glasses are totally wrong, but here's a new Rx anyway."
Those are the doctors we stop referring to.

[Barry Santini]

client some *money*, tells them that there is little change in their Rx, and that their present lenses are fine..and the client continues, therefore, to wear the same eyewear for another 2-3 years (while, all the time, their vision remains fluid and becomes further away from the "right/accurate/proper/current" Rx)...

Well....whose "wrong" now?

1. Refractionist
2. Dispenser
3. The eyewear
4. The client

B

[Barry Santini]

Instead of "right/wrong", how 'bout "satisfactory/unsatisfactory", and we'll also include the parameter of "degree" to improve the *fuzziness* (re: precision) of our descriptions.

This will move the discussions away from implying "fault"

Yes???

barry

[HarryChiling]

Instead of "right/wrong", how 'bout "satisfactory/unsatisfactory", and we'll also include the parameter of "degree" to improve the *fuzziness* (re: precision) of our descriptions.

This will move the discussions away from implying "fault"

Yes???

barry

Barry, you should have been a politician. :cheers: I'll go satisfactory/unsatisfactory, I don't fault anyone, it would just be nice to collaborate instead of infuriate (both me and the patient).

[Barry Santini]

Barry, you should have been a politician. :cheers: I'll go satisfactory/unsatisfactory

Harry...you should be too!

Besides, satisfactory/unsatisafctory more realistically describes what it is...namely:

a new, (current) satisfactory Rx, becomes, over time, unsatisfactory. But just when does it move from being right to being wrong?

"These'll do" = satisfactory

"Sometimes I feel they're not right" = borderline satisfactory (or, conversely, borderline unsatisfactory)

"I can only wear them for a little while, before my eyes hurt/fatigue" = Unsatisfactory

??!!

Barry