Dr RX

[steff]

Pardon???

[Christosfer]

Told you I would get dinged on this one. Always happens.



Lets debate this anonymous comment that someone did not want to own up to.

The first question is do Doctors have the right to do this? I do not think anyone is disputing it. If they did not have the right, then we would not see this. Though to have the right does not make it right. I believe it confuses patients with subjective information. I have had situations where I knew the OD was flat out wrong, but the patient believed him because it was written on the script.

Next part is obligation. I have never heard that the doctor had the obligation to do this. If anything, the doctor should have the obligation to not do this. It is the Opticians obligation to inform the patient about glasses, not the ODs.

I think the question is this; is the Optician obligated to follow the suggestion box (okay I'm jabbing)?
I have worked in a large Opthamology clinic where there was 1 doctor that insisted on writing Comfort on every script. Sometimes I would explain to the patient why I was choosing to use another lens, and sometimes I just chose another lens.
It's a suggestion box.
Here's a line for you: "I see that the doctor recommended this lens for you and that lens is just fine, but in this situation the best lens for you would be X. Are you okay with with that?"
To which they often reply with my favorite phrase, "your the expert." And I don't even wear a white lab coat. Although I do have a shiny name tag and a nice pen in my shirt pocket. :bbg:

Writing an Rx is easy, it's convincing the patient that they can see that takes real finesse.

[steff]

I think that Optoms have the 'right' to write things other than numbers on a script. However... I also believe they have the OBLIGATION to make sure that what they are writing is applicable, and correct.

IMHO, writing 'Comfort' on every progressive script is about as useless as writing 'pink frame' on every prescription! I think that optoms have the obligation to write pertinant info onto the prescription. If they write useless info, then I think that the forgo the right to have it followed.

I agree, Admiralknight, it's all about mutual communication to the benefit of the patient.

steff

[AdmiralKnight]

I'd agree with that. As I said before, I really don't have any problems with ODs writing other info than the Rx itself, but as an Optician, my first duty is to get my customer the best damned pair of glasses they've ever had, but if the suggestion/other stuff written goes against that, well, the customer wins out. Again, not trying to say the ODs are doing things to prevent their patients from getting a good pair of glasses, far from it! But we all know that people lie, and as Harry said, if they weren't planning on staying with you to get their glasses in the first place, they might not be telling you the entire truth. In the end it's up to the customer to decide what they want in a pair of glasses, and that's what I'm going to fill.

[OHPNTZ]

No, don't have insurance the store however does. They see the doctor before they are fit and when they are done they see the doctor again in our office.

Central Corneal Ulcer - If the cornea was comprimised when I was sent the patient for a fit that is the doctors fault for OK'ing a fit in the first place, other than that if they come in for follow up visits they would be checked for fit or signs of overwear.

Acanthamoeba - This is ridiculous, like somehow I dispense in an unclean enviornment I won't even dignify the acanthoameoba and it reflects poorly on your for mentioning it like somehow we are dispensing unclean products or cleaners, if they get it for real it is again more than likely a cause of a comprimised cornea than any lens or solution. We also inform them not to wear their lenses in the shower or hot tub to help avoid that.

If this question was serious then maybe you need to re evaluate your patient health assesment.

Sorry for you to jump the gun, and to get so defensive. At no point was I suggesting that you dispense in a contaminated environment. The question was entirely genuine...

I asked because I don't know if you have malpractice or not. The question was purely hypothetical. I have heard of a case first hand where a patient was fit by an OD, the patient developed a central corneal ulcer, was followed up at an ER...and the end result was the patient sued the OD because he did not explain fully the risks of wearing contact lenses.

Think it can't happen to you? Think again. What if some person that you fit acquire acanthamoeba from a hot tub or sauna. Did you explain those risks before dispensing? Please stop getting so defensive...and think outside of the box regarding these situations.

And for those who attack me, no one has answered whether you have a patient history form or not...

[Johns]

And for those who attack me, no one has answered whether you have a patient history form or not...

We have a patient history form, which also has an area for the patient to sign that request they give us any/all info. pertaining to the care they've recieved at toher facilities, so that we can incorporate it into their records.

We have another for that ALL CL wearers must read, initial wearing schedules, dangers associated with wear/overwear, proper handing techniques, and FAQs. It is signed by the wearer, and the guardian, if they are a minor. We then scan a copy of their driver's license onto the form to verify their identity.

I don't think anyone answered the question because asking whether you have a patient history form is like asking whether or not you have a front door.
:hammer:

[HarryChiling]

Sorry for you to jump the gun, and to get so defensive. At no point was I suggesting that you dispense in a contaminated environment. The question was entirely genuine...

I asked because I don't know if you have malpractice or not. The question was purely hypothetical. I have heard of a case first hand where a patient was fit by an OD, the patient developed a central corneal ulcer, was followed up at an ER...and the end result was the patient sued the OD because he did not explain fully the risks of wearing contact lenses.

Think it can't happen to you? Think again. What if some person that you fit acquire acanthamoeba from a hot tub or sauna. Did you explain those risks before dispensing? Please stop getting so defensive...and think outside of the box regarding these situations.

And for those who attack me, no one has answered whether you have a patient history form or not...

I'll give you a minute to read the post you quoted from me and then pick up your face. :D Not getting defensive at all, it's just the same thing over and over your question implies incompetence and even when I took the time to speculate you response and address it before you ask it, you still didn't read my post, because more than likely you think I am incompetent. This is usually where I would start making enuendo's as to your smarts, but let's forgo that and just get to the nitty gritty, you don't respect opticians and their abilities, got it, thanks.

I think that Optoms have the 'right' to write things other than numbers on a script. However... I also believe they have the OBLIGATION to make sure that what they are writing is applicable, and correct.

IMHO, writing 'Comfort' on every progressive script is about as useless as writing 'pink frame' on every prescription! I think that optoms have the obligation to write pertinant info onto the prescription. If they write useless info, then I think that the forgo the right to have it followed.

I agree, Admiralknight, it's all about mutual communication to the benefit of the patient.

steff

Thanks, that's a very acceptable comment on the subject, I like to get scripts with pertinent info and welcome them. I think sometimes the line can be crossed on what's pertinent and what's not. I think that's what the discussion here is about. By the way steff, you haven't come off as rude or insulting, I have enjoyed your points of view.

[OHPNTZ]

Harry,

I have no idea what your abilities are... I have no idea what you can and cannot do... Can you put fluoroscein on the eye? I don't know... How about proparacaine? I don't know that either...

Do you have patient history form? I don't know that. Have I, or anyone I know, been fitted by an optician for contacts? No.

So I ask these questions, and you take an aggressive tone, and assume I know what you do, or are even licensed to do...

Have I put you down? No...

I asked the optician that I work with if he has malpractice insurance, and he didn't know how he would be covered in the event of a lawsuit... Does he have a patient history sheet? No. He asks me, or refers to our offices health history sheet, which is rather poor in it's scope and breadth...

So I ask these questions and you go on the defensive...then you act like the all knowing...

Thanks for your replies...

[chip anderson]

Ophntz:

Many years ago one thing was universal in being the first thing we were taught in contact lens fitting: "Never use a local ansesthetic with contact lenses." For some reason today's fitters fit contact lenses so poorly that they are trained to use same during evaluation and during patient instruction. It still should never be used while a contact is in the eye or when a contact is going to be inserted in the eye.

Chip

[OHPNTZ]

Chip,

I could see using it for a first time RGP wearer to aid with initial comfort...this also appears in some textbooks.

I would argue that some of my patients end up be fit or refit after their exam, and their eyes may still be numb from the fluress for Goldmann applanation tonometry.

[chip anderson]

Aid initial comfort or mask discomfort and possible corneal injury? That's why we were taught not to use it. Not to mention the possibility that if the patient is being allowed to leave with the lenses on, or left alone for "practice insertion removal" he's liable to rub his eyes. He won't feel anything at least until the drops wear off.
Lots of things in text are wrong. How many "experts" have you listened to that at the conclusion of the talk, you realized they were clueless but wanted to feel important talking at a "meeting?"
How many "discoveries" have you had presented that you had foreknowledge of from texts written decades before the dingy presenting his discovery was in diapers?

Chip

[OHPNTZ]

Chip,

Great article regarding our discussion: http://www.optometry.co.uk/articles/...net1990730.pdf



I don't think I would argue with Bennett on this one...

[chip anderson]

This kind of typical of the type of "litterature" I was referenceing. The type that sounds like the author has just discovered rigid lenses and feels that rest of his section of the profession should get on board.
I won't bother to pick all the parts of this article to pieces but a man that thinks "edge thickness is the most important thing for verification" is not at the top of his game.
Notice the man had a 12% failure rated in the first month of wear amoung a selected control group (this type of group is usually better than most at doing what they are told).

Chip

[HarryChiling]

Can't use and anaesthetic drops, or I should say not supposed to unless my doctor asks me to. I would definately agree with Chip as far as fitting and drops go and the study didn't give any real data about the study other than out of 80 people 40 anaesthetic / 40 placebo 10 dropped out and 8 of those 10 were from the placebo group, that's nt really an exhaustive study on the subject and I would be curious to know if the wearers were repped as to their expectations.

[Pell]

Only if the surgery is completely elective, there are several other choices, and may not be the best person to make that decision.

The thing is, it is perceived by many patients that what is written on the script and what is mentioned in the exam room is not a suggestion but a prescription. Prescriptions mean to must must not could.

Agreed, mostly. Couple things to add:
1) If docs enter the realm of recommending lens specs, the doc should both write why (chart notes) and tell the patient. This way you do not directly conflict with the "doctor's orders." e.g. 'poly for low vision OS' Then you know you could switch to Trivex without a complaint.
2) Doctors rarely know availability. e.g. recommending an aspheric FT35 in 1.67 high index. Then, when you find out it doesn't exist, everybody looks incompetent.
3) Only if 'no substitutions' is printed on the Rx would I worry about it.

Overall, patients purchase an exam and refraction. We, as opticians, fill the prescriptions to the best of our ability and judgement within the boundries of the law and the desires of the consumer, aka patient.

[1968]

Can't use and anaesthetic drops, or I should say not supposed to unless my doctor asks me to. I would definately agree with Chip as far as fitting and drops go and the study didn't give any real data about the study other than out of 80 people 40 anaesthetic / 40 placebo 10 dropped out and 8 of those 10 were from the placebo group, that's nt really an exhaustive study on the subject and I would be curious to know if the wearers were repped as to their expectations.

If you want more info, here is the abstract: http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

I'm sure you could contact Dr. Bennett if you have questions regarding the protocol: http://www.umsl.edu/~optomety/faculty/bennpag.html

[HarryChiling]

If you want more info, here is the abstract: http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

I'm sure you could contact Dr. Bennett if you have questions regarding the protocol: http://www.umsl.edu/~optomety/faculty/bennpag.html

Thanks for the info.

[chip anderson]

Personally I seldom use trial rigid lenses except on cones, transplants, and otherwise mangled corneas. When I actually deliver a pair, I keep the patient two hours. The last half hour of which, I personally instruct the patient on insertion/removal and care/hygiene. By the last half hour the patient realizes that the lenses are much more comfortable than on origional insertion and usually sticks with the program. Those that will not I can usually spot (but I don't tell them this) when initial measurements are taken. Has a lot more to do with maturity and attitude than lens discomfort.

We used to keep new patients three hours during which I would observe the fit at half hour intervals and remove/re-insert the lenses each time to aquaint the patient with the ease of the process. Never needed an anesthetic except for possibly a panicy underage child who dislodged a lens and needed to be calmed down for removal.

I also never send a patient home with a suction cup (except for senile patients and then the suction cup is given to responsible caretaker). Another personal offensive opinion of mine is those that give suction cups to patients are just too lazy to instruct them until thier apprehension is abated.

Chip

[npdr]

It is unfortunate that this thread has degenerated into a contact lens fitting philosophy. The original intent, I believe, was whether prescribers should write more about their prescriptions to either avoid mistakes or to limit assumed dispenser authorization to change a prescription. I think to go afar is to minimize the gravity of the original discussion

[HarryChiling]

It is unfortunate that this thread has degenerated into a contact lens fitting philosophy. The original intent, I believe, was whether prescribers should write more about their prescriptions to either avoid mistakes or to limit assumed dispenser authorization to change a prescription. I think to go afar is to minimize the gravity of the original discussion

I think that it was pretty much agreed by all that relevent information on the script is not only important but a must, what we can't agree on is what is relevent and what is not. I personally would like to see the codition being treated for if it is relevent to the utimate lens design, I would also like to see visual acuity so that I know what the patient should see compared to what the can see. I would love to see more generic data, eg. progressive as compared to Varilux, I would also like to see less same base curve (if the Rx changes and you want to keep the lens design the same then the base curve must change, so it is not a good suggestion to write same base curve on any Rx). I also think a very important and yet often missing measure is the vertex distance the patient is being refracted at, I would like to see on every Rx above have a refracted vertex on it. Those are my opinions and I think that these measures would provide relevent data to fabricate lenses more accurately for clients.

[tmorse]

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.

An area Optometrist once wrote an Rx with the OD in -cyl and the OS in +cyl form. Before I would spend MY money on a re-do, I called him , just in case a transcribing error had occured. He answered with the same arrogant attitude..."Just transpose it!!".

I was furious. I had to waste my time with a phone call because of his lack of refractive discipline. OD phoropters are designed to be read in -cyl, and I reasonably expected all OD Rx's to be written in -cyl form only.

So, perhaps you can enlighten me. Exactly why would you choose to alternate your Rx form, -cyl to +cyl, one day to the next?

[steff]

Maybe he just did an over refraction of their current specs... he added plus cyl, and thus ended up with a plus cyl result...? Sounds bizarre to me to write one eye one way, and the other, another...

steff

[chip anderson]

I conceed that you have the "Right" to write an Rx in + or - cylinder however it's probably a much better thing to write consistantly. I have recieved Rx's written in - cylinder when I knew that the doctor never wrote in - cylinder, called an we corrected the problem without the patient having to think either of us was an idiot.
If I recieve an Rx with the sphere + on one eye and - on without the words "signs correct" after it, I call. But smart doctors will always write "signs" correct.
When I see a patient come in with a pair of +3.00's on and the new Rx is for -2.50's I call. Sure the doctor, could mean -2.50 and I haven't had one get mad yet when I asked, or couldn't read his writing.
If an Rx comes in + cylinder on the right and - cylinder on the left, I call. And yes, I have recieved Rx's that were "correct" as + cylinder on the right and - on the left.
But we all end up looking bad when mistakes are made. Even doctors make mistakes. Actually from what I used to tell my lab employees who delighted in finding my mistakes (I trained all of them): "Perfect people tend to be crusified."

Lighten up people,
We all be human and we don't gain anything by making things harder for each other.

Chip

[steff]

Absolutely agree Chip...

Where's that beer drinking smiley you guys always use?

[steff]

:cheers::cheers::cheers:
Found it