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It's no secret that I am a strong believer in the power of patient satisfaction in
practice building. To that end, I seek out and study situations, in my own practice
and in optometric practices in general, which have the potential to make patients
unhappy. Managing these tough situations properly is a big step toward success in
practice. Handling a request for a contact lens prescription, especially when the Rx
is expired, is the mother lode of such situations. This happens frequently in optometric
practices today, and we need to step back and evaluate our policies.
It's easy to get caught up in defending our rights under the new Fairness to Contact Lens
Consumers Act (FCLCA), and in watching the competition like a hawk to make sure they play
by the rules. Admittedly, they don't always play by the rules, but my best advice is to
focus on the patient more than the contact lens seller. It seems to me that many ODs are
so interested in being right, that they forget the more important task of satisfying the
patient's wants and needs. Do that well enough and no one will ever leave you! Spend
your time trying to figure out a way to deny the request from a mail order company or
discount chain store, and you will alienate the patient and he'll go elsewhere not just
for materials, but for professional care as well. And he'll take his family with him.
When a patient calls your office, or when a contact lens vendor contacts you on the
patient's behalf, your patient has a need. How well do you really handle that need?
Put yourself in the patient's shoes
Let's develop an analogy that puts you in a similar situation. Suppose you take a
medication for gastric reflux disease called Nexium. It works great for you and you've
taken it successfully for years. You see your physician regularly, but maybe not quite
as often as you should. You order your medication from a mail order pharmacy in
conjunction with your health insurance plan. Knowing you have another unopened bottle
of pills, you take the last pill in a bottle. The next day, however, you discover that
spare bottle was old and empty and you are out of pills.
You call your physician, and speak to a rude receptionist who seems busy and uninterested
as you tell her your plight. She says she'll have to pull your chart and someone will
call you back. As heartburn develops (in more ways than one), a nurse from the office
finally calls you back and tells you that you are past due for an exam with the doctor
and you need a blood test to check your liver profile (she reminds you that the drug
does have serious side effects). They offer you an appointment a week from Friday.
You explain that you need the medication now. You're willing to have the needed exam,
but you remind the nurse that you are feeling fine and you just need some more pills.
You aren't sick - you just need a refill! You get the picture.
At this point, the medical office might do various things to help you out - or you might
be munching Rolaids for the next ten days waiting for your appointment.
What would you expect the doctor's office to do? You'd probably be happy with any of the
Now, let's put a slight twist on our scenario. Suppose you contact your pharmacy for
more pills, instead of the doctor's office. For realism, pretend it's either the mail
order pharmacy or the pharmacy in one of the big discount stores. The pharmacy
technician says you are out of refills, but she will contact your doctor and have the
Nexium Rx renewed for you. You say fine and you wait. Behind the scenes, the pharmacy
contacts the doctor's office by fax or leaves a message on the office answering machine
(doctors often have strange hours). The nurse eventually looks at your chart and sees
the Rx is expired because you are past due for an exam. The medical office faxes the
Rx form back to the pharmacy stating that the Rx is invalid. Or perhaps the office just
ignores the form altogether. Eventually, the pharmacy contacts you and informs you that
the doctor will not approve the refill request.
- Offer you a 2-week supply of free sample pills to get you by until your appointment.
- Offer you an immediate Rx for a 30-day supply of pills that you could take to the
local pharmacy and have filled, even though the Rx is technically expired, taking your
word that you will schedule an appointment with the doctor and have the blood test.
- Offer you an appointment at 2pm this afternoon, in which case the doctor can examine
you, order the blood test and write a new long term Rx.
This scenario is enough to evoke anger. You may even be tempted to find a new doctor.
Are you angry at the pharmacy? No, probably not. You're angry with the doctor for not
caring about your situation and for not helping you out.
So, what should you do in your practice?
The lesson to learn is to help your patient out, as quickly as possible. Today. Do so
and you're a hero, fail to help and you're a jerk. Don't assume the patient is just out
to trick you or avoid care or stockpile lenses. Don't be offended if the patient wants
to buy lenses elsewhere. Be realistic about the health risk of supplying more lenses
until the patient can get in for the exam (it's minimal). Don't worry if the patient
obtains a few more lenses than the exact quantity he or she needs to reach a specific
date on the calendar. Assume the patient still wants you as his eye doctor and is
willing to come in for the follow-up visit until proven otherwise. Sending a signal
that you don't trust him, or that you doubt his word, is a certain way to create bad
Consider offering a grace period on the expiration of CL Rxs, say for 3 or 6 months.
During that time, your staff will know that you'll allow a refill of the smallest
available quantity of disposable lenses, as long as the patient commits to scheduling an
exam. A grace period policy will reduce the stress on your staff immediately, and
patients will love the fact that you helped them out of a jam.
By all means, have your staff call the patient as soon as you get a request for an Rx
that has expired. Explain the situation and offer ways you can help. Your patient is
due for an exam and you may be able to convert the patient back to your office for lens
sales, especially if you have them in stock and you make it convenient.
What are your options?
Misuse of free samples
- Dispense a trial pair of lenses to get the patient by until his next visit. See the
section below for why this is not the best option.
- Write an Rx for the minimum quantity of lenses available (frequently a 6-pack for
each eye). This is an excellent image builder because it says you're interested in the
patient first and foremost. You gave the patient what they wanted and needed. You also
gave the patient adequate time to schedule the eye exam with no pressure. Don't forget,
there is an unspoken financial burden in scheduling an eye exam and CL evaluation. Some
patients may not have budgeted properly for that, but don't want to say it. This policy
lets them save face gracefully. Angry confrontations that don't make sense often occur
because there is a hidden reason.
- Accommodate the patient for an eye exam very quickly and issue an Rx for a full year
Rx. This obviously depends on the availability of the patient and the doctor, however.
While the free sample route seems like an easy answer to the problem, and many
optometrists do this, it's really not a good answer. Free samples are made available by
the manufacturer as an aid for fitting the lens, or in drugs as an aid in starting a new
prescription. They are not intended to be a convenient method to help people who run out
of the product. Abusing samples in this way only drives up the cost of the product, and
since trial allocations are determined by ratios based on product sales, overuse could
lead a practitioner to run short on his or her bank of trials, and not have enough for
fitting purposes. A better answer is to write a short term Rx for a drug or a lens and
let the patient buy the needed product, if they also schedule the exam.
Our heritage with contact lenses may actually make optometrists behave in a way that
seems irrational to those who don't understand it. Many ODs felt like the supply of
contact lenses was integrally connected to the professional care, and as such did not
want to release the prescription for the patient's own welfare. Back when contacts were
custom made, that was true. In fact, before the FCLCA, a large percentage of ODs refused
to release CL Rxs (which is actually why the FCLCA exists). Many ODs feel that mail
order suppliers and big box discounters are the enemy - and any cooperation with them is
personal and painful. We need to get over these feelings, because times have changed,
and patients don't get it or care about it.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
A Proud Supporter of
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.
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