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Thread: Faxing Rx's

  1. #76
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    I work with a lot of "indigent" patients that by far give consistent missleading responses during refraction. I don't understand why, or how, but it happens to me all the time - and to the extreme such that some would take on an extra 2 diopters of additional unnecessary cylinder if I didn't know any better.:hammer:

  2. #77
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    Quote Originally Posted by For-Life View Post
    Keep in mind Excalibur, and I have never seen you so I do not know how you do it, but some doctors just try to rush the patient through the process. They flip the lenses so quickly that they confuse them. So it goes both ways.
    Fair enough. When I do see a patient to reconfirm an rx, 90% of the time it was due to improper manufacturing of the appliance and not an rx that needed adjusting.

  3. #78
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    Quote Originally Posted by Excalibur View Post
    Doctor: "Mrs Jones, please look at the letter on the chart and tell me is it clearer with lens 1 or lens 2"

    Patient: "Lens 1"

    Doctor: "and which lens is clearer, lens 1 or lens 2" etc etc etc. Patient is poor at judging, and makes an error in judgment when determining lens powers during refraction.

    Doctor notes down refractive findings and information is written correctly on rx. Patient takes rx to optical, and has problems with her new rx. Rx is made to spec, but pt cannot see because she gave the doctor the wrong 'answers'. This is by FAR the most common scenario in my practice.... so how is the doctor to blame if the pt has ****ty judgment skills and leads the practitioner astray?
    No Red-Green (duochrome) test? Better, or just smaller and darker? You've got all these years of training and this is Far the most common problem? Well one way to solve it... get an EYELOGIC instrument:D

  4. #79
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    Quote Originally Posted by tmorse View Post
    No Red-Green (duochrome) test? Better, or just smaller and darker? You've got all these years of training and this is Far the most common problem? Well one way to solve it... get an EYELOGIC instrument:D
    My previous post was a very simplistic explanation of the questioning approach during a refraction. As you know, a significant proportion of the refraction is based on subjective information and as such depends on a patient's accuracy of response. An Eyelogic system or even a R/G balance still requires a subjective response and in the case of a patient with poor judgement can lead to flawed data.

  5. #80
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    Quote Originally Posted by Excalibur View Post
    Fair enough. When I do see a patient to reconfirm an rx, 90% of the time it was due to improper manufacturing of the appliance and not an rx that needed adjusting.
    That is amazing. 90% of the time it's manufacturing error. WOW!

    Let's see:
    1. there is prescriber error
    2. there is patient error (as you explained earlier)
    3. there is fitting error (measurements, frame, lens choice, BC, material, etc.)
    4. there is the error of unmet expectations (verbalized or not)
    5. there is lab/manufacturing error (which is checked twice before the patients sees it and twice again before the patient is sent back to the prescriber for a recheck)
    6. and maybe some rare ones like transcription errors

    Hard to believe that the eyewear was manufactured incorrectly 90% of the time after 4 checks. My own stats indicate that this is not the case. I'm not saying that the prescriber is wrong of the time 90%. I blame most Rx changes on confusing patient responses.

    Here is an interesting thought that Chip brought up about human nature.
    http://www.optiboard.com/forums/showthread.php?t=29926

  6. #81
    ATO Member HarryChiling's Avatar
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    You know it was actually an optometrists that said this, "Opticiasn on Optiboard are not your average optician" The problem was I was thinking of opticiasn as the ones I read up on here and I like to think this is how all opticians think, but sadly we are the minority.

    Couldn't it be just as possible that the optometrists here are not your average optometrists?

    Food for thought, maybe optometrists here are disgusted with the average optician, and maybe I am disgusted with the average optometrist. At least here we're better than good at what we do.

    BTW I don't find that 90% of remakes are due to fabrication error, I usually find that 50% of what is considered fabrication error is well within ANSI, but someone either doesn't know better or uses that as an excuse to cover a segment, PD, lens, or prescription change. Be gratefull the manufacturer often doesn't nit pick and charge for the errors many pass off as the labs error or manufacturer error.

    I have right now a job in my stack that came back from their doctor as the seg heights were too high, then the doctor wrote down a seg height (which was the same as what we made it) and then changed the Rx. :hammer: It's a turd move that happens all the time, but I do understand it the patient has this prescription in hand and often will read it.
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  7. #82
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    Don't all that "trainin" teach one how evaluate patient interpretation error?

    Can neurosurgeons blame thier brain surgery failures (open skull, patient contious relating experiences as probes inserted as "the patient told me the wrong things?"

    If so, how accurate art those refractions (at $1000.00 a pop) done on patients with total anesthesia? How accurate are those that interpret brain waves as lenses are placed in front of the eye?

    Chip

    :finger:

  8. #83
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    Quote Originally Posted by chip anderson View Post
    Not "Errors" re-evaluation of the patient's condition and need.
    err... right.

  9. #84
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    Quote Originally Posted by HarryChiling View Post
    You know it was actually an optometrists that said this, "Opticiasn on Optiboard are not your average optician" The problem was I was thinking of opticiasn as the ones I read up on here and I like to think this is how all opticians think, but sadly we are the minority.

    Couldn't it be just as possible that the optometrists here are not your average optometrists?

    Food for thought, maybe optometrists here are disgusted with the average optician, and maybe I am disgusted with the average optometrist. At least here we're better than good at what we do.
    I think this is a great point. It's a good thing to keep in mind when any thread start degenerating into personal attacks against each other.

  10. #85
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    I have no problem faxing a CL or Spec rx to another practice, by request.
    I will not fax expired RX.

    My understanding is , if an MD or OD has one exam charge and does not
    have an add on charge for the contact lens fitting,, than he /or she is not
    legally bound to give the patient a written CL rx.
    If the Doctor charges for an exam and extra charge for the CL fitting fee,
    Than the patient is legally entitled to a written copy to be kept by them
    and filled anywhere they chose...... some doctors request one followup
    after a week, to make sure everything is well, before finalizing the rx.

    On Glasses, if a patient says it has been 4 years since there last exam
    but say "i can see just fine with these" i will usually insist they get
    a new exam, either by the doctor in our practice, or any practicioner they
    choose... If the 2 year rx is under 4 years old , i will duplicate the glasses
    but request the patient sign a waiver stateing " I have been strongly
    advised that my glasses rx has expired and have been told it is recommended
    to get another exam,,,, I have declined to comply since it is my
    belief my prescription eyeglasses are providing the same acuity as
    when first dispensed.

    Im not saying this would totally avoid any and all liablity, but its better
    than nothing.

    Rick

  11. #86
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    Quote Originally Posted by chip anderson View Post
    It was also very, very Illegal Kid.

    When I worked for US Vision we had a similar promotion and nothing illegall about it. It was simply a rebate for the amount of an exam (up to a maximum) applied toward the purchase of glasses. It did not require and exam from the doctor next door. No different than a dollar off promotion except that it promoted getting an exam.

  12. #87
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    K numbers:

    As many times as we have published Eyeglass I here and you can't see anything illegal about this. Nothing about the practioner may not discount or reduce his fees on conditon of purchase of eyeglasses?

    Chip

  13. #88
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    Maybe we ought to debate US law somewhere other than the Canadian Discussion Forum.
    RT

  14. #89
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    Quote Originally Posted by RT View Post
    Maybe we ought to debate US law somewhere other than the Canadian Discussion Forum.

    sorry, but I have to respond to this


    Quote Originally Posted by chip anderson View Post
    K numbers:

    As many times as we have published Eyeglass I here and you can't see anything illegal about this. Nothing about the practioner may not discount or reduce his fees on conditon of purchase of eyeglasses?

    Chip
    The independant practioner is not discounting or reducing his fees on conditon of purchase of eyeglasses. The optical shop is giving a discount up to the amount of the exam fee on a pair of glasses EVEN IF THE EXAM OCCURED ELSEWHERE. The practioner is not benefiting from the sale of the glasses or reducing his fees and no one is breaking eyeglass I or any laws it is just a sale gimmick.

    and again sorry for debating US law on the Canadian Forum.

  15. #90
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    Edited to be nice. :D
    Last edited by kidsparrow; 07-11-2008 at 01:51 PM.

  16. #91
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    Quote Originally Posted by HarryChiling View Post
    Food for thought, maybe optometrists here are disgusted with the average optician, and maybe I am disgusted with the average optometrist. At least here we're better than good at what we do.
    Not me.

    I have a huge respect for dedicated opticians - particularly those that are licensed. I've learned a great deal here thanks to all of you and I appreciate the excellent advice I've frequently received. I hope it works the other way around. We have much to offer each other.

    Can't we all just get along......:D

  17. #92
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    Quote Originally Posted by optical maven View Post
    I always give the patient a copy of their Rx at the time of the exam and fax Rx's as requested. If the Rx is more than 2 years old I charge a fee to rewrite the Rx and ask the person to pick up the paper. I've had people pick up Rx's that are over 5 years old. Are opticians filling these?

    You bet they are, I've seen it. ( Not me) They make the patient sign their name saying that the optician is not responsible for any issues with the rx.

  18. #93
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    Quote Originally Posted by va_optikal View Post
    You bet they are, I've seen it. ( Not me) They make the patient sign their name saying that the optician is not responsible for any issues with the rx.
    I won't if there's an expiry date on the rx, if not, sure. I don't see anything wrong with it, ESPECIALLY if the doctor's are still giving them out, and charging, 5 years after the exam. Why else would the patient want a copy of their rx if not to get glasses made?

  19. #94
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    I used to ask my staff to call a patient's CL fitter (with patient's consent) to obtain the last CL parameters used to provide continuity of care and aid in refitting that needed to be done. The overwhelming majority of stores said 'we will not give you that information'. If I was to withhold a patient's rx/information after consent was given by the patient, I would be taken to task by my regulatory body.

  20. #95
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    But wouldn't that be your responsibility as the patient's new provider of the lenses?

    As far as type of lens, etc., I'm always amazed that people have no idea what lens they're sticking in their eye every day.

  21. #96
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    Quote Originally Posted by Excalibur View Post
    I used to ask my staff to call a patient's CL fitter (with patient's consent) to obtain the last CL parameters used to provide continuity of care and aid in refitting that needed to be done. The overwhelming majority of stores said 'we will not give you that information'. If I was to withhold a patient's rx/information after consent was given by the patient, I would be taken to task by my regulatory body.
    The CL fitter's knowledge, expertise, experience, 'work' in selecting final lens parameters is, in my view, proprietory.

    So if, as you say, a refitting 'needed to be done' then simply "DO YOU OWN WORK". This was the response I received from a famous Vancouver pediatric Ophthalmologist many years ago when I asked for a young girl's soft lens parameters.

    And, 'since a refitting needed to be done', the young girl was put into RGP's, which she and her parent adored.

  22. #97
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    Quote Originally Posted by tmorse View Post
    The CL fitter's knowledge, expertise, experience, 'work' in selecting final lens parameters is, in my view, proprietory.

    So if, as you say, a refitting 'needed to be done' then simply "DO YOU OWN WORK". This was the response I received from a famous Vancouver pediatric Ophthalmologist many years ago when I asked for a young girl's soft lens parameters.

    And, 'since a refitting needed to be done', the young girl was put into RGP's, which she and her parent adored.
    thats an interesting position considering all the *****ing and moaning about OD's you've accused of doing the same.

  23. #98
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    Quote Originally Posted by Oedema View Post
    thats an interesting position considering all the *****ing and moaning about OD's you've accused of doing the same.
    Explain please.

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