If a patient comes into your office with an RX that states a specific Lens style, color, or material are you required to fill the RX as written? now, what if that has a PD specified, and you measure differently? i know there have been some posts before and there are great answers around "could do" and should do", but I would like to know if anyone has a clear example of actual legal requirements around filling alternate products and or measurements. Thanks all.
I'd certainly find out what the doctors reasoning for making them a requirement. If its just a box on the script that he/she automagically checks, then they shouldn't be binding, but as always, double check.
If a doctor specifies PD, BC, Material, I try to verify reason, and if it makes sense (which it usually does) I will fill as written. As far as lens brand/style, I see at as being similar to a medical rx. Doctor prescribes name brand pills, but it's ok to fill with generic brand unless otherwise noted. It's all about the conversation with the patient, find out what they spoke with Doctor about, why the Doctor is suggesting these items, and if they make sense, do it. If not, uncover their needs and reccomend what you feel would be best.
Patient, ".. Doctor says I have a subscription for stigmata.. Can you fill that?"
Me, "..Um.. "
My bosses (I work for a two doctor private practice) have a tendency to like to match BCs and lens materials and also recommend A/R if the person is accustomed to these things and have had issues with their Rx being filled at the turn & burn optical marts. If a patient is walking without visiting our dispensary then the ODs feel like they provided the dispensing optician (or more often than not, frame stylist) with a few tools for a successful fit. This is my theory and if this is what you are seeing I would respect it within reason. If your spidey sense is going off then by all means, double check. You know what they say when you assume things.... ;)
"Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki
Good Question! I recently had an outside rx come in with Dr.'s handwritten instructions Varilux, Crizal NO SUBSITUTIONS!!! in very bold writing. Looked like he was angry to not be able to close the sale.
Each state has its own requirements for the filling of optical prescriptions. If you're not a Licensed Optician or in a state where Opticians are not required to be licensed, you probably don't have any regulations to follow, so you can fill it any way you want since opticianry is not a regulated profession in your state. Optometry or Medicine (Ophthalmology) can't regulate a profession that does not exist according to that state's law. If you are in a licensed state for Opticians or a Licensed Optician yourself, I would ask for a declaratory statement from your Board of Opticianry regarding this issue. I believe it is a valid issue and should be addressed. If the Board of Opticianry declines to rule, I would present it to the Board of Optometry (if it was an Optometrist that wrote the Rx) and ask for a declaratory statement. I doubt the Board of Medicine would even acknowledge your request since they have bigger fish to fry. In my opinion, doctors should NOT write a prescription for a product that obliges the patient to buy from a particular provider (optical, pharmacy, etc.), whether it be contact lenses, glasses, medications, etc. This is what led the Federal Trade Commission (FTC) to enact the Eyeglass Rules and Fairness to Contact Lens Consumers Act. According to the FTC Eyeglass Rules, "The prescription shall contain all of the information necessary to permit the buyer to obtain the necessary ophthalmic goods from the seller of his choice." Federal Law trumps state law in this matter and anybody would be dumb to even pursue this, but if it did make it to a court room or in a legal situation, that would be my line of defense.Originally Posted by gvincent8
Having said that, if the Dr. specifies all that information on the Rx, I would first ask the patient about his/her conversation with the Dr. to find out more info, did the pt. have specific needs, make special requests that would make the Dr. "prescribe" certain specific products. There may be a legitimate reason why he/she specified that. If the patient doesn't give me a logical reason why the Dr. might specify those things, I would then contact the Dr. and ask for more clarification. If they don't give me a legitimate reason (other than pt. was going to leave with Rx & buy elsewhere), then I would use my professional judgment and do what I thought was best for the patient and the situation. Hope this helps!
Matching BC's and materials may not be a valid practice anymore with the new free form lenses on the market today. My # 1 request would be that ALL Rx's have the patient's BCVA on the Rx. That would help the dispenser more than specifying a BC, PD or lens material.
I find that there is usually a reason why things are specified and follow it. When I see stuff like that it is like a red flag that the patient has had problems in the past.
I would check it all out and then do what I believe is best.
Good question, as many have already mentioned on this thread, calling the doc, red flag, trying to sell specific product. Some states require an IPD value on the RX. Each state has their own definition of an optician, requirements to become one along the duties and tasks they are assigned to perform. I have never heard of an OD being allowed to prescribe specific brands of lenses only recommendations. As to legal actions that can or may be taken, that sounds like something for your state association or department of health to address.
Last edited by Paul Smith LDO; 02-25-2014 at 08:33 PM.
You are preaching to the choir on that one. I've gently explained freeform and how BC is chosen for these lenses before but, at the end of the day, my name isn't on the door. I can be a stubborn "know-it-all" or I can play ball and follow Drs orders. They usually are pretty hands off and let me make my own decisions so when they make a specific request they get nothing but "yes sir, yes ma'am" from me. :)
"Strictly speaking, there are no enlightened beings; only enlightened activity." -Shunryu Suzuki
Oh lord will I ever second that motion! With both hands!! I work in a MD's office and have so many times sat in front of a patient who has other health issues that affect their vision and they do not understand that or are in denial and they damn sure are not going to share that information with you. They are 70 years old and want to see like they are 17 and just don't understand why they cant. Now if they brought that Rx in to me from a outside Dr I would not even have access to the exam to find out they take blood pressure meds or that they are diabetic or they have optic nerve damage for whatever reason or that they are just one week post-op cataract Sx. All they know is they cant see the way they expect to and they want us to sprinkle some pixie dust and make it happen for them. Looking at the Rx for the most part we have no idea why they cant see.
If Drs would just put on the Rx what the pt's "BEST EXPECTED" (not will be) Corrected Visual Acuity is. Then we all would sound much more intelligent talking to the patient as to what is and is not going on. Till then we sound like morion's saying, "here try this for two weeks and see what happens, it may get better." Patient is thinking, ya right dude, you already have my $800 and I'm not happy.
+1
+2 This would make the pt's expectations in line with what we provide. I am sure it would be a struggle to get the Dr's to provide this information on the r/x.
Writing down two little numbers on a Rx for expected VA is not asking for much at all and it would move mountains of doubt for everyone making everyones job so much more easy.
Now if they would not want to do this I would love to understand the reasoning behind it.
Hmm tough question. As an OD when I put 'notes' on my Rxs they are simply recommendations for the patient and optical. I will not force a -2.00sph presbyope to wear progressives when they simply can get DVO and remove their glasses as needed. I always do explain their options (DVO vs. progressives, advantages/disadvantages, etc.) in the exam room. I think it should be a patient's choice in that regard. When it comes to BC, material, etc. again I can recommend certain materials are better for a certain type of Rx but the optical should take care of knowing the proper BC to use for the Rx/frame style/etc. My only 'requirement' is polycarbonate lenses for anyone under the age of 18 but any OD or optician should already know to do that.
Interesting. I usually find that when specific products are Rx'd by outside doctors, it's an indication of ODs meddling in stuff about which they rarely know enough to be doing so. Before all the ODs here jump on me, of course I don't mean any of you. You're on Optiboard, you know stuff which you must admit many of your peers do not. So does my doc, and he demonstrates his knowledge by focusing on his doctoring and leaving the product design to opticians.
If docs are prescribing products as orders for their own opticians, I believe it belies mistrust of their opticians' abilities. It marginalizes them to the status of order takers. My wife, a 14-year managing and dispensing ABO optician, worked very briefly for such a doc. The only thing she was allowed to do was frame style, take segs (not even PDs, the docs supplied that from either auto or phoropter), maybe offer Transitions or sunglasses as a second, and adjust at dispense. Needless to say that practice had no respect for opticians. Might as well just have techs or front desk staff sell and dispense frames, I'm sure the doc could slap a seg height on with a marker. No reason to pay for opticians when you don't bother using them.
If they are prescribing products for opticians at other places, they are doing little more than creating inconvenience for their patients. If they Rx Physio Crizal and the patient goes to Costco and the opticians there call the office for substitution, will the doc refuse? If so they've seriously jammed up the patient, if they acquiesce they've created a fruitless inconvenience since there is no force to the Rx. The idea, we know, is that the patient does apples-to-apples price shopping, finds others can't offer the same quality or do any better on price for the same stuff, and then they come back to the doc to buy from him. But we know this seldom plays out in reality. I think more patients would be lost to such control tactics than retained.
And thanks FL-Opt for succinctly addressing the OP's question of legality, rather than professional judgment and prudence. I agree there is no clear answer to the question other than to contact any state regulatory agency and hear it from them.
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