Last week's Tip article explored the idea of charging patients a fee for eyeglass adjustments when they are purchased elsewhere. I received quite a few email comments from readers, many agreed with me and some did not. That's what makes optometry so great; there are many ways to be successful in practice. One colleague liked the article, but asked what he should do when a patient returns with a problem with new eyeglasses he prescribed, but they were purchased from another eye care professional or even online.
Still your patient
I view the complaining patient as a person who needs our help, even if he bought the glasses elsewhere. After all, I'm still his eye doctor and plan to be for many years to come. I accept what the patient tells me with understanding and empathy and I believe them completely (until they prove untrustworthy, which is not usually the case). I believe patients have a right to fill their eyeglass or contact lens Rx anywhere they wish. I work hard at trying to make my practice their best choice, but it is their choice.
Generally, all patients with eyeglass complaints are received by one of our opticians or technicians. This obviously depends on the size of the practice and available staff; the optometrist can certainly follow the same steps. I genuinely want to assist the patient with identifying the cause of the problem and advising them about what to do about it. I also want to do this efficiently and not provide services that were not paid for. Building some goodwill with the patient that converts to loyalty and referrals is worth some time and effort.
Here are the steps I would follow:
Listen to the complaint and think about what could cause those problems. This is important because it can lead you down the right path to identifying the problem. If the patient is angry or upset, show them that you want to help and that you are also unhappy with the issue.
Most visual complaints will require you to check the spectacle Rx and some basic lens parameters. Use extra care in handling the glasses because they are the patient's property and they were purchased from another source. Inspect the glasses in front of the patient before taking them away for lensometry or other tests. If you see any defect in the frame or lens, show it to the patient. You could say, "Were you aware that..." Using care not to scratch the lenses on your lensometer, read the lens Rx and note the optical centers. You may need to mark the optical centers and measure the PD, but not in all cases and maybe not yet.
Compare the Rx with your record. It is best to not compare the Rx as read with a written copy of the Rx or a lab invoice because those could have been written incorrectly. Let's see if the Rx is what your record indicates. Here is where you need some optical experience. The Rx may not be exactly perfect. There is a tolerance, which is often considered to be the published ANSI standards, but use your common sense. If the cylinder axis is 5 degrees off, that would be significant if the cylinder power is 2.00 D. But if the cylinder power is .25 D., I'm not so sure 5 degrees would even be noticeable. Maybe, but I'm still looking for more than that.
Depending on the complaint, you may want to evaluate the seg height of a bifocal or the major reference point of a progressive. Bifocals are easy; progressives will require you to find the invisible markings and draw the segment with a washable pen. Put the glasses on the patient and look at the seg in relation to their eye and determine if it is set properly.
This may seem like a lot of effort for glasses that were not purchased from you, but I believe this is a courtesy we should show our patients. It is not very many that need this extra time. I'm willing to check the Rx, the PD if needed and the seg height.
Complaints about frame discomfort are easy. That is really not your problem, because you did not sell this frame.
If you have found the likely cause of the problem, I write the patient's name and date on an Rx blank and write a short note with what I found. You might write the Rx you found and rewrite what was prescribed or write that the seg height is too low, etc. I give the note to the patient and advise him to return to where he got the glasses and have them remade. There is usually no problem with this because the glasses were not made correctly.
If lensometry shows the Rx to be substantially what you prescribed, the problem may lie with you. It happens and I don't get defensive or try to shift blame. Just take the next step which is to recheck the refraction. I happily do this at no charge because it is expected by the public. I know the often quoted analogy that a physician would not see a patient for a second exam at no charge just because the first drug Rx didn't work. It's different.
Be very exact about your recheck refraction. Also review the visual complaints at the time of the last exam and review the habitual Rx. You will know what to do at this point. If you find a different Rx, just explain how that can happen and confirm with hand-held trial lenses how you can fix the problem. Read on for how to proceed if you need to change the Rx.
How to be a hero
Quite often, you or your optician can be a hero in the process of working with this problem patient. At first, just listening and caring gets you some points. You come off as the true expert in visual science. You are the one that can unravel this mess of variables and help the patient get some glasses he can see with. If the Rx needs to be changed, I would write it out for the patient and add a note like "Rx change needed". I would advise the patient that most reputable optical stores will remake glasses at no charge within 30 days of purchase when there is a change needed. If there is any chance that my staff or I made an error in our exam or our records, I advise further that if the optical store will not remake the lenses at no charge, I want the patient to bring the glasses back to my office and we will remake them at no charge.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week