Wow! Just Heard From A Patient About A Run-In With A Paternalistic Optician

[Lelarep]

I had a patient relay to me their interaction with what appears to be an optician with a paternalistic bent.

We have heard some unusual things about this group for some time, but some of it appeared to be so out there that I wasn't sure anyone took it seriously, until now.

Apparently the patient (who knows quite a big about optics, they have an engineering background) was asking as bunch of questions regarding the lens designs, the AR stacks, the optical resins, etc... they offered, and apparently the optician basically said they has discussed it enough with the patient, and if they wanted to know all of this, and then "dictate" what they wanted, they should go somewhere else. The optician went on to explain that patients are welcome to provide "some" input on the frame, and lens options, but the optician had "spend thousands of dollars and many hours" on understanding their job so ultimately the decisions regarding lens design used, AR, lens materials, etc... are exclusively theirs to make since it is "their name" on the final product.

I have to admit, I was kinda floored. I've never heard of anyone telling a patient to pound dirt because they didn't want to explain something to them. In this day and age, I don't know of any optician that is unwilling to explain about the lenses they offer, where collaboration on finding the best solution with the patient was unwelcome, and that the optician ultimately decides all aspects of what is dispensed for the patient.

For the most part, isn't opticianry about working with the patient? It's essentially unavoidable as far as I see it since they and/or their insurance are paying for the final product.

[Uilleann]

On the one hand, I've worked with numerous "engineers" who thought they knew an awful lot more than they *actually* did about ophthalmic optics, refraction, optical resin material science, etc. So I could see an optician getting quite frustrated with the patient in a scenario such as that.

On the other hand, I've also met plenty of "licensed opticians" who loved throwing their "knowledge" and "money spent", and "hours of class" etc. into a patient's face as well - when they were called to back up their big talk with actual dispensing prowess, and actually found to be sorely lacking. So I could see the patient getting quite frustrated as well.

Whatcha gonna do? *shrug*

[Lelarep]

I think I was rather surprised because I'm the exact opposite. I believe you find out from the patient how much they want explained, and how involved they want to be, you make your recommendations to the patient, and if they choose otherwise, you just make sure to document everything well. If they try to come back and say "Why did you do this!?" you can say "I explained ABC and suggested XYZ, and you decided you wanted QRS. So, that's what you got". I find one does get the occasional older patient that doesn't want to deal with any part of the process and will say "I don't want to hear it, do your job!" and that's when you make all the decisions regarding what to do, and the patient can eat it if they don't like the outcome.

I just can't imagine actively telling a patient "You're asking too many questions regarding your lenses, and asking to have too much input on the decisions regarding what you are paying for! Go somewhere else!"

[Quince]

That is literally the opposite of what I do.

My job is to educate the patient and let them make informed decisions. Often times, I will give my recommendations but will always tell them that it is ultimately their decision. If they want an upgrade I don't condone, I explain my reasoning then still let them have the final say.

The weirdest one I ran into was a guy who wanted to have us put a sunglass tint on a Transitions lens. This was when I was fresh off the street, working at a discount shop. He eventually walked out because the manager intervened and refused.

To be fair, if people want to be informed on science beyond my level, I am honest about it. I'll tell you what I know, but don't claim to be educated on things I am not. In this case, I offer to get them more info from whatever manufacturer or rep. I never spent thousands on a formal education (like the majority who work in unlicensed states) but have certainly put my time in. If an optician doesn't feel comfortable putting their name on an order they should notate the reasons why at the point of sale and have the patient initial that they understand something isn't recommended. That's what we do when someone refuses a chip resistant lens material for grooves.

[lensmanmd]

Engineers are my favorite! No, I’m not joking. I have an engineering background, so I can relate.

This paternalistic “optician” is basically a dumba$$. What’s so wrong with, “Great question. Let me reach out to XXX and get back to you”? Even I know that I don’t have all the answers, though I have decades of knowledge.

[dima]

Also talking with engineers, if everyone is respectful... can made possible sell high value (high price) products also.
You say to them is not a great deal a SV FF lenses for a -1 but they want try it......so.

Also talking is alaways a good things, we can learn by other people and job

[Barry Santini]

I would be OK with this scenario, and have made the eyewear in accordance with the buyer’s dictates and recipe.

But like prescribers, when the eyewear doesn't unfold as planned, they want me to “remake.”

Q: What would you do?

[Jason H]

I'd want to hear the optician's side before I judged him. Engineers can be trying.

[AngeHamm]

I'd want to hear the optician's side before I judged him. Engineers can be trying.

My thoughts exactly. I've had engineer patients I look forward to seeing every year, and some that I'd like to drop-kick into the parking lot.

[Lelarep]

I would be OK with this scenario, and have made the eyewear in accordance with the buyer’s dictates and recipe.

But like prescribers, when the eyewear doesn't unfold as planned, they want me to “remake.”

Q: What would you do?

On this, some people would consider me a "buttcrack". If someone wants something a certain way, despite being told that it was not an optimal solution, and they demand it, I would document it, and have the patient sign it. I would then do it the way they wanted. If they subsequently wanted a "remake", and the issue was due to their demands, I'd tell them, "You wanted them that way, you got them that way. If you are unhappy with your choices, we can remake them with the advice provided by staff, but it will be {@whatever cost would be to do the job again, it would not be submitted as a "remake", even if the lab offers remakes for free since we all know the costs of remakes shows up in other places. It would be submitted as a new job} because the fault does not lie with the materials, or the fabrication, but with the choices that you made, against advice to the contrary." I would also explain that it is being done at cost, as a courtesy, so no money is being made on the transaction. That way they understand that this is just to cover the cost of actually making the new lenses, not for profit, and not as a way to shame or gouge them.

I feel my approach is a good way to "thread the needle" of the middle path between being a "hardbutt" and being a pushover. I am sure some will disagree.

[mervinek]

That is literally the opposite of what I do.

My job is to educate the patient and let them make informed decisions. Often times, I will give my recommendations but will always tell them that it is ultimately their decision. If they want an upgrade I don't condone, I explain my reasoning then still let them have the final say.

+1 Exactly. This is what I do too!

[Robert Martellaro]

Engineers are my favorite! No, I’m not joking. I have an engineering background, so I can relate.

Hear, Hear. When the questions go astray and the clock is ticking, I point out what they don't know to get them back on track. If that doesn't work, I break out the bottle from the bottommost drawer of the dispensing table.

Cheers,

Robert

[NAICITPO]

It seems like that kind of opticianry is dead. People don't want to be talked down to, they want to be a part of the conversation. It is our job to make optics relatable to everyone.

What Lelarep is stating seems like a good approach to dealing with people who want to dictate the lenses they get and disregard input from people who have spent a lot of time making glasses. And I can certainly understand telling an engineer to pound sand, I have wanted to do that many times before but I never EVER would. If an engineer wants to get into the weeds about optics and I run out of answers I have pulled up white pages on the products and read it to them to answer their questions. I am not above saying, "I don't know but I would be happy to do some research for you." even if it is on the spot.