Patients who change their own Rx
There are some customers we get that bring their dr's Rx and want us to make the glasses weaker than what the Rx is beacuse they are tyring to "train" their eyes I've had a few of these type all the sudden I mean no matter what you say they in their on little la la land...i just wanted to rant also want to know what you guys think?
If the patieht has an O.D., MD, or DO behind his name, have him sign it and do it. Otherwise tell him to find someone who does have these initials after his name and get them to sign off, otherwise no deal.
Chip
You CANNOT alter the Rx without calling the Dr.Originally Posted by chip anderson
we dont its just that its very hard to serve these sorta customers who seem to think they know everything about glasses and their eyes
A few of our patients like to self-prescribe. The answer is no. An office visit to check the Rx is offered. Oherwise it's no.
We don't get it with spectacle prescriptions, thankfully, but it happens all the time with CL patients. They want something other than what was prescribed, and then get shirty when they don't get it. I actually had one argue that she should be able to get whatever contacts she wanted because she was the customer.
Roach5: You cannot alter the Rx without calling the doctor. But if the patient is an MD, an OD or a DO he can write his own Rx and you can fill it any way he writes it. Right or wrong they have this legal priviledge.
MD's and DO's can write Rx's for any legal prescription. O.D.'s can write Rx's for an spectacle Rx and in some places they can write Rx's for some drugs.
No point pointing out or argueing that the DO or OMD might not be an eye specialist. No point in telling an OD he shouldn't prescribe for himself. The best you gonna do is git a lot of people ****** off and maybe a pat on the back from your office manager or the doctor that wrote the origional Rx and loose a sale. Otherwise you will accomplish absolutely nothing by persueing any opposition in these circumstances.
Chp
Of course you can! Think about it:
Because everyone's vision is fluid, the *original* Rx is simply that refractionist's determination of the eye's focus at a particular point in time.
The "Rx" changes of course, over time, as the client's vision changes. So, comparatively, the "original" Rx may be *wrong* (your term, not mine. I prefer "optimum"), to some increasing degree over time.
Sheesh! When are we gonna wise up about this?
What happens when a client's eyewear breaks, is lost, or they're uncomfortable with it, and they go back to wearing their "old" Rx until their next insurance (ugh!) is up?
Except for the societal consequences during driving, I cannot see the great harm is wearing whatever "Rx" you want to. And, as far as my research on DMV regulations and state's rights, we have, even within just the borders of the USA, no consensus on the importance of best vision for driving...especially at night! For instance, in NY alone, typical DMV vision *screenings* (not vision testings, and certainly not full eye examinations) only require vision validation once every 8 years!
IMHO, all traffic stops should include:
1. License, registration, & insurance validation
2. Evaluation and appraisal of driver, passengers and vehicle
3. Breathalyzer (if warranted)
4. *Visualizer* (portable acuity/focus tester - definitely, technologically-possible at this time)
Your thoughts?
Barry
(PS - Yes, I'm trying to provoke a response!)
Last edited by Barry Santini; 02-21-2009 at 07:55 AM.
Hey wait a second! I'm from La La Land! We do things a little differently here ;-)
~Crazy :cheers:
Yes , in Ohio I can legally duplicate a pt's wearing Rx with no time limit but if I alter the Rx, which might greatly benefit the pt. ,he won't complain but I would get fired by my boss and fined by our state licensing board.
I would very much like to hear from you OD's and OMD's on this subject.
If a patient comes in with a "standard Rx" and desires:
a: Glasses to focus shorter to say, fix watches.
b: Glasses to view a particular work station at an unusual close distance such as an overhead display or something at 8' and 6'6" high.
c: An artist that wants to view an easel with offset prism/add but be out of the way for distance in the opposite direction.
d: A painter or mechanic that needs to see overhead at a distance different from his near/distance range.
e: Piano organ player with special distance/ intermediate/ near ranges to see the music, keyboard/ director.
Is it not within the relm of opticianry to modify the Rx to for these accommodate
needs without prescriber consultation?
Chip
Last edited by chip anderson; 02-21-2009 at 10:28 AM. Reason: had to go to WP12 to spell something
Why's everyone driving business away?
Ask them to write an Rx on thier Rx pad, mention thier important signiture and how almighty they are and fill it.
Clarify remakes are at 100% of original price, then offer them a discount because you're such a nice person when they come in for the remake that will probably cost you 50% of the original price.
You make money twice and have a local Doctor that thinks you're great.
The original poster did not clarify if this was for distance or reading correction. In most states you are not actually changing the RX if you adjust the lenses using the original RX for another purpose (ie Computer use) as long as the parameters are based on the original RX. We essentially do this everytime someone orders an Office Progressive don't we? There is no official "reading" distance its just based on tradition, so if if the doctor perscribes +2.50 but the patient doesn't like to read that close, there is nothing illegal (in most states) of adjusting the add for a prefered distance.
In these cases that Chip listed below you are not really changing the RX, you are changing the application, and its what Opticians (should) excel at.
Adjusting a distance RX is dangerous because if the patient gets in an a car accident the dispenser can be held liable, and you could be (in most states) dinged for working beyond the scope of your licence. If the patient does not like their RX I always send them back to the Dr. with possible reccomendations.
Sharpstick
Last edited by sharpstick777; 02-21-2009 at 07:12 PM.
I agree with Sharpstick. Adjusting distance Rx is dangerous and should not be done. And maybe it was already cut back.
As to the near, a good number of prescribers just give the +2.50 add and don't do any near point testing. Not good. I've no problem with someone cutting back an Add I've written, but I'm usually pretty thorough with the near and asking about working distance.
I'm an OD and expect the distance to be filled as written, and I have a few patients who actually asked for distance to be undercorrected and that's way I wrote the RX.
Driving requires 20/40, so I've no problem with undercorrecting, especially for the person who is slipping into presbyopia and flipping out at the idea of bifocals. But, that Rx is what I write on the pad.
Harry
When a patient wants a prescription that is different from the one that is written, I like to use a pharmacy analogy. If you walked into a pharmacy and said that you wanted 500mg tablets of codeine instead of the 250mg tablets that were prescribed to you, what do you think the pharmacist would say?
Many patients don't think about the fact that there is oversight and the potential for penalties if we fill Rx's improperly.
Prescriptions are part of a system that hopes to engender accountability on the practitioner's part and compliance on the patient's part. If someone wants something different, they should ask their doctor...some of us are pretty reasonable.
If they are an MD or O.D, or DO, I let them write any Rx they want with the provision that if they can't see it' thier problem.
It is within and opticians purview to change the focal lenght for specific tasks.
Chip
According to all the old opticians I apprenticed under over the years, yes. So I have and do when it is warranted. Mostly it is the Rx's that were written by the docs I work with. They don't have a problem with it. If I'm unsure of something, I ask.
Our Optometry Board says that determining a power is practicing Optometry. I was told to tell our opticians that if it wasn't written down, you can't fill it (we had an optician that always used 1/2 the add written to make computer glasses, that's what prompted the question) I had a doctor on premises 7 days a week, I never understood why they wouldn't just ask me. Then again, I never understood why they thought that the power for reading only glasses for a +1-3x180/+2.00 add OU Rx was +2.00 DS OU (you mean you have to put the cyl in also?why?) I hate non licensed states!
Do de O.D. board have anything to say bout modifying the Rx for specific tasks if de Rx be written by an M.D.?
Do your O.D. board be quoting the legal situation or just pontificating on what it would like to be able to control?
Chip
I work in an unliscensed state. There are many board certified opticians here. The ones who don't know how to figure things out have not been taught. That means someone else is not doing their job.
even-though you should not alter the rx, ask what's in the patients mind.
sometimes patients come up with very interesting theories about ocular physiology. for example, some myopes like to be under-corrected because they do excessive reading, alleviating some of the accommodation stress of the ciliary body. when it comes to the rx, it should all be discussed with their prescribing dr. the prescribing dr. is taking a lot of things into consideration when writing a specs/cl rx. and as far as i know, not even drs. can self prescribe.
Last edited by medicalretina; 03-17-2009 at 07:28 AM.
"blessed to give; grateful to receive"
I agree. I worked at a LC at the time. The young lady in question I believe worked at Chik-fil-a 2 weeks before and had completed the required video training......no......come to think of it the lady had worked at LC for 7-8 years, and when I corrected her she responded "I know doc, I was just checkin'" but I could tell she didn't have a clue.
I can't tell you how many calls I have had from any of the three O's who asked for contact lens specifications and then asked what do the numbers mean. Or how many call for the Rx (which I gave them) and then called back for the contact lens specs, appearently didn't understand the difference between specs and Rx.
And the lady who told me she had been in the business seven years and had never heard of an aphakic contact that wasn't a lenticular.
Now tell me, when an OD or OMD sends me a cone or aphakic patient to fit with rigid contacts, once I have determined base, power and diameter, etc. Is it illegal if I hold up trial lenses to determine power? The spectacle Rx (when I actually get one from the prescriber) is useless in such circumstances.
Why are we so dam* jealous of our proviences. What's wrong with just doing what's best for the patient without a lot of extra trips back to the prescriber and expense, time of the patient?
Chip
Just tell them you'll do anything they want, then fill the Rx as written.
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
Gee, I do exactly the opposite: I tell them I'll do anything they want, and then *I* fill the Rx as I see that it will best fill their needs/desires.
In essence, what's the difference between this scenario, and when your client returns to you wearing their older/previous "expired" Rx eyewear, saying "these feel/see better"?
Barry
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