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Thread: Ethics in today's opticianry...

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Ethics in today's opticianry...

    We all see it.

    An increase of a 0.25 in the sphere and decrease 0.25 in the cyl.

    Management insists we make the sale to the fixed income widow.

    Should we?

    I'm inclined these days to say while there is a change it is minimal and if "you want the best vision possible" you can update the lenses and then get in trouble when I say it may not be noticeable.

    While I understand management has bills and payroll to cover I also believe in karma and trying to live by the Golden Rule. Especially as my Judgement Day gets closer;)

    Can our business still afford this kind of honesty?

    What do you do?

  2. #2
    Master OptiBoarder
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    I refuse to work in a place like that. If I believe an rx is not noticeable, I will tell the patient that. It is their decision to make if they still want to place an order. I worked with a guy that was so proud to sell 1.74 to someone with a -0.50 Rx. Made me sick. That's not what being a good optician is. Maybe you'll make ONE quick sale, but that patient will not come back....and they'll tell all their friends. Yup Karma.

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    Master OptiBoarder optical24/7's Avatar
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    I had tons of AMD and cataracts advancing. Loose trial lenses are your friend. Let the patients see for themselves if it makes a difference.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by optical24/7 View Post
    I had tons of AMD and cataracts advancing. Loose trial lenses are your friend. Let the patients see for themselves if it makes a difference.
    But the pressure to not do this (as the refractionist should have!) is still there.

    And I'm almost always working with a dilated pupil.

  5. #5
    Master OptiBoarder
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    Stinks to be in that situation. Either you do what you feel is right and be a good optician or you bow down and become one of them. I would just do what I felt is best. If they yell at me or fire me... so be it.

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    Master OptiBoarder OptiBoard Silver Supporter lensmanmd's Avatar
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    Quote Originally Posted by Uncle Fester View Post
    We all see it.

    An increase of a 0.25 in the sphere and decrease 0.25 in the cyl.

    Management insists we make the sale to the fixed income widow.

    Should we?

    I'm inclined these days to say while there is a change it is minimal and if "you want the best vision possible" you can update the lenses and then get in trouble when I say it may not be noticeable.

    While I understand management has bills and payroll to cover I also believe in karma and trying to live by the Golden Rule. Especially as my Judgement Day gets closer;)

    Can our business still afford this kind of honesty?

    What do you do?
    Eshilux and Marchon/VSP, plus the new breed of McTometrists. The era of true opticianary are, sadly, gone.
    I bend light. That is what I do.

  7. #7
    OptiBoardaholic
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    I'll be blunt I'll be say the new rx will make things a bit clearer but you can get away with wearing what you have (or some version of that).

  8. #8
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Small number changes rarely matter.
    Except when they do.

    B

  9. #9
    What's up? drk's Avatar
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    I think the prescriber has this responsibility. You are not obligated to make such decisions. You are there to fill Rxs as best possible. If the patient asks "is there a big change?" the answer should be "what did the doctor say"? And if the answer is "he didn't say" then you say "I just fill the prescriptions, I don't write them. Ask the doctor."

    The reason I say that is because, in this case, it's pretty obvious that it makes little difference, but Barry's right...I've done remakes over a 1/4 diopter many times.

    What if it's a 1/2 D but the patient is amblyopic in that eye? Or has AMD? Who knows? The doctor should.

    Now, I need to ream out a huge percentage of the prescribing population for not taking the responsibility! You should not have to be put in such a situation.

  10. #10
    Master OptiBoarder OptiBoard Silver Supporter
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    Quote Originally Posted by optical24/7 View Post
    I had tons of AMD and cataracts advancing. Loose trial lenses are your friend. Let the patients see for themselves if it makes a difference.
    Yes sir. And once that's established, look at all of the other factors that contribute to the decision making process when deciding whether new eyeglasses are indicated; i.e., age of the frame, condition of the frame and lenses, spare pair availability, dependance on visual correction for everyday activities, etc.

    Hope this helps,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  11. #11
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    Quote Originally Posted by drk View Post
    I think the prescriber has this responsibility. You are not obligated to make such decisions. You are there to fill Rxs as best possible. If the patient asks "is there a big change?" the answer should be "what did the doctor say"? And if the answer is "he didn't say" then you say "I just fill the prescriptions, I don't write them. Ask the doctor."

    The reason I say that is because, in this case, it's pretty obvious that it makes little difference, but Barry's right...I've done remakes over a 1/4 diopter many times.

    What if it's a 1/2 D but the patient is amblyopic in that eye? Or has AMD? Who knows? The doctor should.

    Now, I need to ream out a huge percentage of the prescribing population for not taking the responsibility! You should not have to be put in such a situation.
    yes you are right..Its not your responsibility.

  12. #12
    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    The central issue I have with only “fulfilling the Rx as written”, without a consult (which includes asking “What did the prescriber say?”) is that when the glasses must undergo troubleshooting and revisement, if this is directly traceable to the given Rx, then the prescriber should pay for all time and materials.

    If the prescriber wants to be free of this financial responsibility, then they must accept the fact that they are no longer the sole professional in charge of this eyewear treatment plan.

    Discussion.

    B

  13. #13
    What's up? drk's Avatar
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    Well, you're not going to like my answer.

    I do agree that SOMEONE should be responsible for "doctor's changes". It doesn't seem right that it should be the dispenser. Nor the lab. The problem originated with the patient/prescriber interaction, and the patient/prescriber REALLY should be responsible.

    But having said that, there's not enough margin in that for the prescriber. Look at that scenario from my viewpoint: Patient gets eye care from me for $99...fragments it and goes to optical XYZ (usually because it's "cheaper") and I'm supposed to remake their $199 lens? I'd have to raise my exam fee to cover such losses, and you KNOW that's not happening.

    So the labs and the dispensers have to build in that margin into the manufacture. It's not necessarily fair but it's tradition.


    I WILL SAY that when the (true) "practice of optometry" happens, there's seamless integration so the prescriber gets really, really careful about writing prescriptions. It's the refracting techs at ophthalmology that don't have the training or the incentive to do a precise job/wise prescribing.
    Last edited by drk; 08-30-2022 at 07:31 AM.

  14. #14
    What's up? drk's Avatar
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    I don't think "acceptance" is a problem. An optometrist has to understand, though, that the patient has chosen to fragment care so the patient has forced the issue, and therefore the OD is now on an eye care team of the patient's choosing.

    How do you like them apples? I don't. If Joe Cheapo wants me to fix his problems, but then won't let me finish the job, and invites someone else in the equation (who may be wonderful or dog-crap), am I now obligated to be part of this threesome?

    You know how you feel, Barry, when a patient shows up with an Rx from that schlock OD...you can refuse to fill it! ("No, we have had lots of problems with that office...sorry".) How do I get to refuse? "No, you can't take your Rx out, because there are too many crap opticians in town, and I don't want to have to deal with them"?

    This is exactly what I'm facing when morons go to a high-end optometrist (me) and then want to build their own glasses online! (Even worse than a crap optician!) Am I supposed to put up with that?

    Do you see why a lot of ODs would be frustrated and just take the position that "If you take your prescription and have it filled elsewhere, I'm out of the equation"?

    In truth, I don't want or need that kind of patient. Let me do the job, or let someone else do the job, but don't put me in the middle!

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    "An increase of a 0.25 in the sphere and decrease 0.25 in the cyl.

    Management insists we make the sale to the fixed income widow.

    Should we?"

    Just a reminder for those skimming the thread.

    I must say it is turning into an interesting thread.

    Thanks for the replies.

  16. #16
    What's up? drk's Avatar
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    Fes, you are creating a problem that doesn't exist.

    A manager cannot insist that "you make the sale". That's not possible.

    What the manager wants is for you to TRY to make the sale. So, try.

    But there are much easier ways to make a sale than flimsy power changes. Show the new stuff. Show the different stuff.

    What's more, your hypothetical manager isn't as smart as you are...never was, never will be. Show the manager how you can increase sales incrementally, but offering better quality frames and lenses, not by lying and abusing.

    Show "relationship opticianry" not "transactional opticianry".

    Heck, you'll have the manager's job in a year!
    Last edited by drk; 08-30-2022 at 09:05 AM.

  17. #17
    Master OptiBoarder
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    Quote Originally Posted by drk View Post
    Show the new stuff. Show the different stuff.

    What's more, your hypothetical manager isn't as smart as you are...never was, never will be. Show the manager how you can increase sales incrementally, but offering better quality frames and lenses, not by lying and abusing.

    Show "relationship opticianry" not "transactional opticianry".

    Heck, you'll have the manager's job in a year!
    +1

  18. #18
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Thanks guys.

    My "plan" was to a year from now become part time as I ease into full retirement by the time I'm 70.

    That's probably changing.

    I'm stubborn when told I have to do things differently and know I have options if my ethical decisions become too great a conflict with what I predict and fear is coming.

    So we'll see what happens over the next couple of months.

    C'est la vie.
    Last edited by Uncle Fester; 08-30-2022 at 10:22 AM.

  19. #19
    OptiWizard
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    Quote Originally Posted by Uncle Fester View Post
    We all see it.

    An increase of a 0.25 in the sphere and decrease 0.25 in the cyl.

    Management insists we make the sale to the fixed income widow.

    Should we?

    I'm inclined these days to say while there is a change it is minimal and if "you want the best vision possible" you can update the lenses and then get in trouble when I say it may not be noticeable.

    While I understand management has bills and payroll to cover I also believe in karma and trying to live by the Golden Rule. Especially as my Judgement Day gets closer;)

    Can our business still afford this kind of honesty?

    What do you do?
    Did the visual acuity change? I like to pull up the doc's notes and see what if that's changed. A 0.25 changes can be a line or two for some people and it could be nothing for others.

    If the acuity hasn't changed much you can still talk about new sunglasses or task specific glasses. Especially if they still have an insurance benefit to use. Having a backup pair of glasses is never a bad idea either. I think you can be honest with the customer and still demonstrate the value we have to offer them. It's a fine line, you cannot think about their budget for them but you can be honest with them. The doctors I work with are very good at selling in the exam and will come out and say Mrs. Customer needs new progressives and is considering sunglasses as well... which definitely helps A LOT and makes this not a question we got often.

  20. #20
    Rising Star Cat-Eyes's Avatar
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    Quote Originally Posted by NAICITPO View Post
    Did the visual acuity change? I like to pull up the doc's notes and see what if that's changed. A 0.25 changes can be a line or two for some people and it could be nothing for others.

    If the acuity hasn't changed much you can still talk about new sunglasses or task specific glasses. Especially if they still have an insurance benefit to use. Having a backup pair of glasses is never a bad idea either. I think you can be honest with the customer and still demonstrate the value we have to offer them. It's a fine line, you cannot think about their budget for them but you can be honest with them. The doctors I work with are very good at selling in the exam and will come out and say Mrs. Customer needs new progressives and is considering sunglasses as well... which definitely helps A LOT and makes this not a question we got often.
    I take this approach also. Many people will generally return year after year if they feel like they can trust you and will tell their friends and family too. What you may lose on that sale could bring 5 more just because you are honest imo.
    "One should either be a work of art or wear a work of art" - Oscar Wilde

  21. #21
    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by Cat-Eyes View Post
    I take this approach also. Many people will generally return year after year if they feel like they can trust you and will tell their friends and family too. What you may lose on that sale could bring 5 more just because you are honest imo.
    100%. Nothing is more important to your bottom line than patient retention, and trust is a huge part of that. Clawing every penny from every patient is exhausting and doesn't make as much money as you imagine it does.
    I'm Andrew Hamm and I approve this message.

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    Master OptiBoarder OptiBoard Silver Supporter Barry Santini's Avatar
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    Quote Originally Posted by NAICITPO View Post
    “The doctors I work with are very good at selling in the exam and will come out and say Mrs. Customer needs new progressives and is considering sunglasses as well... which definitely helps A LOT and makes this not a question we got often.
    Ugh.

  23. #23
    Master OptiBoarder AngeHamm's Avatar
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    Quote Originally Posted by NAICITPO View Post
    The doctors I work with are very good at selling in the exam and will come out and say Mrs. Customer needs new progressives and is considering sunglasses as well... which definitely helps A LOT and makes this not a question we got often.
    100%. There is no more powerful tool in optical sales than a doctor who knows how to recommend appropriate product.
    I'm Andrew Hamm and I approve this message.

  24. #24
    What's up? drk's Avatar
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    I think the thing doctors need to do is to GET INVOLVED in spectacle lens design! Why is that such a difficult concept? We do it, readily, for CL design or any other treatment plan. But NOO! Not "selling glasses"!

    Really, we're supposed to be "taking care of their vision" and that's a wholistic concept.

    Weirdly, if you are a low vision practitioner, you have to consider all activities of the patient: activities of daily living, driving, light protection, lighting, etc. That's considered good care.

    BUT NO! Don't ever do that for the rest of our patients! Derp.

  25. #25
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    I love it when the ODs know what they're talking about and can make a suggestion of what to discuss with the optician, but then lets the patient know that the optician is the one who will know best about that stuff and can discuss it more thoroughly. Like maybe the OD can say the patient should discuss computer glasses or sunglasses with the optician and the optician can take it from there. I don't like it when the ODs start to get into the lens design by saying a specific lens for a patient. It gets weird and it makes the opticians look like they don't know what they're doing.

    I also don't like "selling in the exam room." I'm not a salesperson! I'm an optician. I educate my patients and help give them the best vision I can. I don't sell. If an OD educates a patient in the exam room, it does help. But not just "selling". Ugh

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