Remake because.........

[Ryan]

Pat. came in on Tues, picked up his titanium drill mounts, with Definity and AR coating, loves new lenses. Comes back in to have adusted on wed. Still loves them and sees great. On friday comes back in with new RX and its a Dr's change . Check this out:

(2 weeks ago)
Old rx: -0.25 -0.50 100
-1.00 sph

add +1.00

(today)
New rx: -0.25 -0.25 100
-0.75 sph

+1.00 add

also with a note: change material from polycarb to cr-39 (drill mount) and lower seg height. (we remeasured seg and it was dead on)




Patient was rude when he realized we had to :finger: send them back in to the Lab. Said he has to have glasses to see, can get them in 1 hr. elsewhere, blah blah blah blah blah. Wow, that Dr's change will help him see soo much better. Whatever. Situations like this frustrates me to no end.

Happy Memorial Day!!

[For-Life]

Then you have to swallow half the cost. Tell him to go yell at the doctor.

[karen]

Ryan, what is J & J's redo policy?? (just curious)

[mowmow]

..

[mowmow]

Preface: No Disrespect Intented
Definity Schminity..........you should have fit him into a poly adaptar, vip or whatever.
Wake up !!!!!!!!! Dispite all your good intentions, look at the net result and your lab bills. Fact of the matter; < 5% of the people are really & truely intersted in "state of the art" lenses like J & J definity..., In reality what actually matters to most people is how fast and how cheap. If you honestly believe I'm incorrect than suck it up and don't complain. I often wonder if those people who come in asking for the "cheapest frames you have" go into the shoe store asking the same question.
__________________________________________
"You take Sally and I'll take Sue there ain't no difference between the two"
Jackson Browne

[Ryan]

Considering the fact he is currently wearing a Essilor Natural that he currently hates, he wanted the best available. And also considering the fact we have fit about 60-70 Definity's in about 3 months with NO REMAKES FOR ANYTHING, I figured with his low add power of +1.00, a Definity would be a good choice. I don't think the answer is an Adaptar! If that's the case, then why don't we all dispense the Adaptar in a $2 frames? The point of my post is the frustration with the Dr. and the patient being rude to us, NOT to bash the lens we sold him.:finger: I

[Ryan]

Preface: No Disrespect Intented
Definity Schminity..........you should have fit him into a poly adaptar, vip or whatever.
In reality what actually matters to most people is how fast and how cheap. If you honestly believe I'm incorrect than suck it up and don't complain.

I don't know how you run your office , but at my shop most of our stuff we sell has Crizal Alize, Varilux, Definity, all top quality stuff. We happen to be inside a mall with an Eyemasters AND a LensCrafters AND a Sears Optical, AND a JC Penney Optical located each a few hundred feet away, AND a Pearle Vision outside the mall ,and we do very well. These places offer 1 hour service and even 2 for $99 bait and switch deals, but my experience is the public knows that these offers are too good to be true. Maybe the Buy one Get one deals do well in your office , but I take my profession seriously and educate the patients on what they are getting, not just to blindly fit every patient in a cheap no line with a cheap frame. Why not fit everyone in an executive? Wide reading, and wide intermediate in the trifocal, but thats not what people want. If people want 2 for $99, then go and get what you pay for, but not in my store.

[mowmow]

Are you sure you measured him correctly?

[mowmow]

Ryan,

We don't do buy one get ones and we also don't eat definity lenses. The point I was
trying to make is that just because you have one bounce on you don't go blaming the O.D.

Speaking as an O.D. when someone comes back for a recheck for whatever reason and
you find some micro change in a complaining patient about the only thing you can do is
say go try this. In reality as proved by this patient there is a small subgroup of patients that are never 100% happy with any PAL be it definity or Natural.

By the way, I have no doubt you do quite well at your location...and L.C. probably
does 2.4 M selling Naturals or whatever with R.F. all day long!!!!!!!!!!!!

[karen]

Speaking as an O.D. when someone comes back for a recheck for whatever reason and
you find some micro change in a complaining patient about the only thing you can do is
say go try this.

Dr.- do you think that small of a change will dramatically effect accuity? Do you think 3 pieces should be done in poly?

Ryan- can you trial frame the patient in the new RX before you do it??

[mowmow]

Karen,

To answer your question..no, I don't honestly think that slight of a change
would make a difference to most people. Especially the right eye. But it also depends on why he wasn't happy. If he went back complaining about a slight
blur OS then perhaps the refraction was off and that extra -.25 really helps. I can only assume that since the modified Rx did not change in the add, that this person was unhappy with the distance vision. Time will tell. If this redo is problem free than in this case the refraction was at fault. Bear in mind that subjective refractions are exactly that. Ten different Doc's would spit out ten slightly different scripts. If the redo flops maybe PAL's aren't the best visual option for this patient. I like Definity, Varilux, Adapter, Kodak Precise as well as Zeiss PALs. But you need to remember that when PAL's fail there's always flat tops. Conversely people that do well in progressives
then to do well in most any of the modern designs.


You have to listen to your patients carefully. Ryan stated he hated his essilor
naturals but never said why. Whenever you're dealing with people who are unhappy you need to dig deeper. Why didn't he like them...did he have a similar problem with them? If someone answers honestly you can often get to the root of the problem. This is possibly a patient that might never be really happy in any PAL's. The trap is putting the cart before the horse and thinking it's the brand of lens and then getting frustrasted because they bomb out of a lens that you think is fail safe.

As for drill mounts yes I think they need to be poly or trivex. I think poly is
often a scapegoat and gets a bad rap. We you alot of poly lenses and very
rarely have trouble with it.

[Cowboy]

There are a few issues to view here.

1. Agreeing with MowMow, digging deeper to the patients' issue would be more productive before remaking the lens. What good would it be to simply order the new Rx in costly lenses and then have him come back in two weeks with another adjusted rx.
2. If replacing the eyeglasses is absolute, why not contact the Doc that Rx'd and work out a stronger plan of action for the mutual patient. Perhaps the Doc isn't privey (sickening thought) to the materials of today that would be a better choice for drill mounts i.e., trivex, high index, etc. Why did the Doc suggest cr-39 over poly?(mowmow was right, poly is far to often the escape goat).
3. Lastly, having less to do with orig. topic, but relevant: it is far to common that we (anyone in optical profession) tend to pass the buck. The Doc says we made them wrong, or the optician says the Doc refracted wrong, etc, etc. What we have less of is communication. We are concerned about costs and revenues, but what we don't realize is that we can save on the costs and keep more revenue if we communicate. MowMow, your first post was angry and blamed it on lens choice, but later changed your tune to be more helpful - because you communicated with other professionals on this board that helped you see a different side. Ryan, your aggrevations were with the patients' rudeness - cost of doing business, however, was the root of the aggrevation the underlying thought of Cost? If you would have done the above suggested, perhaps your frustration may have turned to resolution and your patient would have been more appreciative and more likely to return to you in the future and even refer you to friends and family. Don't get me wrong, I most certainly do not mean to preach, especially since I was not in your circumstance, but, if we all really think about what I have just said, can we not see the truth to it?

[Cowboy]

Had another thought to Ryan's patient. Karen suggested trial framing him, but with only a .25ou diopter change, how about a vertex distance change. What about retroscoptic tilt? Slight face form? Don't let the patients rudeness get in the way of judgement.

:cheers:
Cowboy

[hcjilson]

but I would change your company policy to say: Dr's changes of +or- .25D will be billed to the refracting doctor.

hj

It seems obvious in this case, that whomever changed the Rx did so in a sucessful effort to reduce your margin.

[Texas Ranger]

Ryan, I'm assuming that it wasn't one of the docs in your office? the rx change was for a +.25 cyl on the rt eye and a +.25 sph on the left, and amount that you'd think an emerging presbyope could accomodate for with ease; so, why was the pt. rude? the prescribing doc pretty much told him you made them in an expensive poly ar lens, you know he spent a lot of money, right? the prescribing doc probably was a bit jealous that the pt didn't get the specs from his shop? so, he "found fault" with your work. understanding this helps you to know that you did the best you could, but I think the pt needs to understand this too. i'm sure that definity will remake the rx for you, but I think the pt will have more of a problem being under minused a .25 than he was having with the first rx, and I'd advise him of that; or, you might ask him if he'd let Dr. F. put him in the phoropter for a "second opinion"? just a thought...

[Chris Ryser]

If people want 2 for $99, then go and get what you pay for, but not in my store.

I think Ryan just hit the nail on the head. Maybe all of you should use it.:cheers:

[Joann Raytar]

Ryan, out of curiosity, do you know how the patient wears their glasses? All day long including driving or just around the office? Any clue what made the patient suddenly uncomfortable with the glasses or was the patient too heated to communicate with you?

[drk]

As another OD weighing in, I think I have a solution for this for the next time. If a patient drops that kind of a bomb on you, I think it's fair to tell the patient that it is a very small change, and that you want to be sure such a small change will improve their complaint.

Now, I wouldn't bother with the trial lens stuff, because that just opens a new can of worms, and tempts you to re-refract the patient, and confuse the patient as to who's role is what.

I would get on the phone to the prescribing doc, and if he/she didn't have a mutually respectful conversation with you, I wouldn't fill their Rx's anymore. Ask the OD to have the patient back a third time, and confirm that the second refraction is consistent. Holy smokes, a quarter diopter of sphere, cyl or a small axis change can occur EASILY between two sittings! How do you know which one is correct? Let the OD do some of the legwork on the remake and be darn sure it's right before asking you to "take another crack at it". Then, after all that, explain to the patient your "one time within 30 days" remake policy and you're the good guy all around!

[Robert Martellaro]

Ryan,

When I see an Rx like this, the client is either wearing glasses for the first time, or had a pair for night driving but might not always wear them when driving, especially daytime driving. They're probably getting along just fine for near tasks. If I use a PAL in this case I would warn the client that they will most likely prefer to remove the glasses for near tasks, and that the night vision for driving might be a tad soft, with the initial sensation that the fitting cross is to high. (A good instance where one might cut the seg height 1mm, especially if they have large pupils). There will be some discussion of lined bifocals for functionality, but this will be ruled out for cosmetic reasons. Two pair will be ruled out due to inconvenience, although some thought will be given to PALs and reading glasses or driving glasses. Since this has all been discussed before the glasses are ordered and reviewed at the time of dispensing, the client will have realistic expectations and will be psychologically prepared for the compromises inherent with PALs, especially for this type of wear.

Robert

[Ryan]

Ryan, out of curiosity, do you know how the patient wears their glasses? All day long including driving or just around the office? Any clue what made the patient suddenly uncomfortable with the glasses or was the patient too heated to communicate with you?

He wears his glasses all day, including driving. I do not know what caused him to see the DR. again. He was just in the night before for an adjustment, and I overheard him say he still could see well and seemed overall happy. I don't know what all of the sudden made him uncomforatable with the glasses, he wasn't in the mood to calmly discuss the situation. He was too busy complaining "I didn't know places still took this long to make glasses", etc.

[drk]

He wears his glasses all day, including driving. I do not know what caused him to see the DR. again. He was just in the night before for an adjustment, and I overheard him say he still could see well and seemed overall happy. I don't know what all of the sudden made him uncomforatable with the glasses, he wasn't in the mood to calmly discuss the situation. He was too busy complaining "I didn't know places still took this long to make glasses", etc.

Maybe you should just turn the jerk loose...remake it one more time and be done with him forever. Loser!

[rinselberg]

I don't know, maybe you could refer him to the nearest LensCrafters!

[Rophod]

The biggest problem I see here is the patient was rude:finger: This is something I have a hard time with. We try very hard to be very professional and friendly in all our interactions with our patients and when the few come back and feel they have to be rude it rubs me the wrong way. We have a very patient friendly remake policy but when they are screaming for a refund for no good reason or acting in a way that makes me or my staff uncomfortable I get just refund them and get rid of them via an exit letter. I know many docs who feel the patient is always right and will refund in hopes of saving this doctor patient relationship but what kind of relationship is that? I like to go home at night feeling good about the day and the days ahead. I have no time for the few that rob me of enjoyment. Let them find someone else to abuse. Just my .02

[mowmow]

If my original post sounded arrogant it's only because of the way Ryan started this thread. He made it sound like because he sold the patient an A/R coated definity lens in a titanium drill mount they have no grounds to complain, especially since he felt that the Dr's change lacked credibility.
(That could be the topic for another thread)

The root of the problem is not the slight difference in the modified Rx. It's that Ryan failed to ask the right questions at the right time. If the patient told him he hated his prior PAL ...Major Red Flag . Your REDO spider senses
should have been tingling. If he hated the naturals and assuming they were measured and dispensed properely what made Ryan think the Definty would be better? In this case not finding out why they bombed on the last pair was just as fatal as crappy PD's and seg Hts.

There's nothing wrong with selling expensive frames and quality lenses to the appropriate patient. But doing so is not a substitute for properely accessing their visual needs, expectations and prior problems. Expensives frames and lenses will not mask anything, nor do they guarantee automatic success. In fact they demand that the dispenser be even more diligent in their efforts in order to minimized mistakes and remakes.

When I deal with patients with high REDO potential and expensive materials I'll go in slow motion. Trial frame at end of exam! (I also agree with DRK..to late for the trail frame on this one). Sometimes I'll have their lenses made and edged and inserted into their frame and then call the patient and have them try it before sending them for A/R. Pain in the butt but it will avoid a remakes 99% of the time. This does two things: #1 They appreciate your extra steps to help ensure their success and #2 They're usally to embarassed to complain after they said that they were good to go. Not that this would have prevented Ryan's dilema, but the point being once the horse is out of the barn it's a different animal, more like a bull.

Ryan should learn from this. I think this one just came in under the radar. Don't feel like this doesn't happen to us all. We had a A/R drill mount job almost bounce because it was edge polished and the woman was seeing reflections. Then she tells us the same thing happened the last 2 places she
went but she just wanted to try again. Luckily we were able to disassemble
it and go over the edges with a fining pad. Go figure.

Please post the outcome. There's always the chance it buyers remorse, especially if the final result is a refund.

[John R]

Customer is shouting the odds, then thats a sign that they know they are in the wrong (Dr told them they might have to pay for change) and have found if you go in shouting then in most cases they will get a result and get a free replacement.
Stand your ground and dont give in. Explain to him that lenses have to be custom made and cant be done just like that, sure you can get done in 1 hour when you have a in house lab, but you dont and as such things take a bit longer also you are using a product that isnt stocked by the lab adding to time taken. If after all this they still want to go else where fine, but NO refund as you made what you were asked to do. Tell him to take it up with his Dr....