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 By Neil B. Gailmard, OD, MBA, FAAO, Editor December 13, 2006 - Tip #256 
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Problem attempted... Not solved

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Additional Information

Last week's tip focused on resolving the inevitable eyeglass complaints that occur in any practice that has an optical dispensary, but there is actually a problem more damaging than a single episode of patient dissatisfaction. And that's dissatisfaction over an issue that was attempted to be resolved, but is not. This happens more than you might think and it's worth working hard to prevent.

Here is the scenario

It always seems to happen to one of your best patients who spends a lot of money in your office and brings the whole family regularly. Mr. Jones is that guy. He had his annual exam two weeks ago, picked up his new progressive Rx ($550) one week ago and he drops into your office and tells your receptionist that something does not seem right - he feels blurry. She smartly summons your optician, Mary, who takes Mr. Jones to optical. Mary recalls your last staff meeting when you spoke about the importance of patient satisfaction. You instructed all employees that they should try to handle eyeglass complaints on their own and that they are empowered to fix the problem - whatever it is. Don't worry about the cost. Mary also remembers that you seemed a little annoyed the last time she put a patient with "Rx trouble" in your schedule and you commented that these no charge visits are not good for the practice.

Staff protocol

As any good optician would do, Mary verifies the lens powers and parameters with the doctor's Rx in the file. She finds the invisible progressive lens markings and outlines the segs and major reference points with a felt pen. She checks the following:

  • Lens powers
  • Lens material as ordered
  • Quality of the optics
  • Monocular distance PD
  • Seg height
  • Base curves (compared to the patient's previous lenses)
  • Lens thickness
  • Frame fit, vertex distance and pantoscopic tilt

Mary did a commendable job and she, indeed finds one of the parameters is incorrect. She apologizes to Mr. Jones and explains that the lenses were not made correctly, but she will have them remade right away. Mr. Jones is quite nice about the whole matter and he understands that mistakes happen. He leaves the new glasses with Mary and will wear his old ones in the meantime. Mary writes up the re-order and sends it off to the lab.

Is the problem the right problem?

Let's suppose Mary found any one of the following things wrong (not all of them):

  • The PD was 2 mm off.
  • The base curve was .50 mm different than the old Rx.
  • The seg heights were made as ordered, but in checking it on the patient, Mary feels they should be 2 mm lower.
  • The cylinder was off axis in the right lens by 3 degrees.
  • The sphere power in the left eye was .25 diopter too much plus.

The question is, are we sure that the problem noted above was the real cause of Mr. Jones' complaint?

It's hard to know, but with a lot of experience and knowledge, most eye care practitioners in all three Os are pretty good at putting all the factors together and coming up with a conclusion. We know when the complaint matches the finding. Does Mary know? Are all your staff at a high enough level to really know?

I don't mean this to be a contest in ophthalmic optics; the options above are simply examples of errors that a tech could encounter that are not likely to be the true cause of a vision complaint. I suppose some of these items could be responsible for symptoms, but it's certainly not a sure thing. The PD being off on a progressive looks like a problem, but what if it was found to be 2mm off from a tech's measurement and the measurement was incorrect in the first place and the error was in the right direction? Or what if the PD error was on a single vision Rx and the power in one eye was plano?

Credibility is destroyed

My point is that a well-meaning optician could be led astray in an earnest attempt to fix a problem. No matter how it happens, I'm sure that Mr. Jones won't be so nice about it when he returns to get the new glasses and finds the blurred vision is still there. His opinion of his favorite eye care practice will surely drop like a rock. He must wonder if those people know what their doing.

Hopefully, the problem now finds its way into the doctor's exam chair, and without having to wait for an opening in the schedule that's 10 days out. But what if another staff member tries to take one more crack at fixing the problem? Maybe something like, let's change the frame because it looks a little small.

Anyway, let's assume in our case that the doctor rechecks the refraction and finds that he transposed a number incorrectly. That cylinder axis was not supposed to be 18 but 118. It happens.

What to do

I'm not saying that your staff should not troubleshoot optical problems first and solve them independently whenever possible. That's the protocol in my practice. But we have had staff meetings about "problem attempted- not solved". My staff is aware of it and often gets a second opinion from a coworker. I don't think the doctor should recheck every complaint case, but he or she should be happy to do so whenever the complaint is one that could be refractive.


Please don't take my comments about opticians or technicians as demeaning of their skills. I know many opticians who can run rings around me in troubleshooting optical problems. But I stand on the point that the title of optician is used broadly to mean one who fits glasses, and many skill levels exist in practices. Resolving a complaint on the first try may take a team approach using all the skills available.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

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