Article Date: 12/1/2007

300 Tips: The Best of the Bunch
practice management

300 Tips: The Best of the Bunch

Which of the "Management Tip of the Week" tips had the greatest impact on practices?

NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O. Munster, Ind.

If you're already a subscriber to the "Optometric Management (OM) Tip of the Week" e-mail newsletter, you already know that I recently authored my 300th tip article. That's an idea a week for almost six years, so I'm proud that it's still going strong. To celebrate, I asked readers to submit nominations for their favorite tip and tell me how it impacted their practices. In this article, I'll review the tips you liked best. I'll also point out a few of my favorites.

Three tips received more votes by readers than any others by a wide margin. I happen to agree that these three are among the best.

Tip 222: Mydriatic drops at pretesting

This really is an oldie but a goodie; I wrote an article on this idea in the print version of OM in September 1989, and I had been using the technique for a few years prior.

The concept is to have a technician instill 2.5% phenylephrine on nearly all patients at the beginning of pretesting. Phenylephrine is a mild mydriatic that has no cycloplegic effect at all, so your technician can instill it before the refraction with no concern of obtaining inaccurate data for eyeglass- or contact-lens pre-scriptions. Furthermore, this eye drop does not inconvenience patients, and they can drive, read or return to work without the blurred vision caused by most mydriatics.

Let's be clear that phenylephrine alone does not produce the full dilation that we obtain with tropicamide, and you'll still need to add tropicamide or other agents, when you need a full view of the peripheral retina. But, most eyecare practitioners do not dilate every patient at every exam, and the use of phenylephrine generally gives you a better look at the fundus than you would have without any drops. This early instillation of phenylephrine makes several examination procedures better, including:

► the use of 78.00D or 90.00D slit-lamp fundus lenses;
► binocular indirect ophthalmoscopy with small pupil feature;
► non-mydriatic retinal photography;
► optomap;
► nerve fiber analysis.

You'll still need your clinical judgment as to when to fully dilate, but the use of phenylephrine during pretesting speeds up the action of additional drops when you add them. You must consider many details when using this technique, so please read the full article online if you wish to try it.

Tips 1 and 287: A key history question

Ironically, this was actually Tip 1, but I updated it. Management expert Jerry Hayes, O.D., once told me he thought this tip was one of the best ideas for optometric practice. The beauty is in its simplicity. Clinical technicians in my practice take a basic case history as part of our pretesting routine, and I have them ask each patient, "Are you planning to get new glasses today?" The tech notes the answer in the record, and a large percentage of patients say "yes." You can be sure that 100% of those patients order glasses that day.

I think many eyecare practitioners are so focused on symptoms and other aspects of care, that we neglect to ask this basic question. But, it really helps to know the answer up front. Before asking this question, I can only imagine how many times I struggled to decide whether a minor prescription change was significant enough for a prescription. I'm sure I've talked some people who wanted new glasses right out of it! Knowing the patient's wishes in advance makes the exam and patient consult easier, and it enables you to sell more glasses.

I'm generally against giving discounts of any kind; in fact, this is the only discount I offer in my practice.

Tip 214: How to sell multiple pairs of glasses

I tried everything in my practice to increase the number of multiple pair sales … staff training, lifestyle dispensing, recommendations at the chair and more, but nothing made much difference. Selling two complete pairs of glasses to the same person was pretty rare, and three pairs were extremely rare. Since I implemented a program that offers 50% off the second pair, multiple sales occur about twice per day on average.

Please know that I'm generally against giving discounts of any kind; in fact, this is the only discount I offer in my practice. Discounts can actually hurt your bottom line quite badly because many times the sale would have occurred anyway at the full price. But in this case, additional sales occur that would not have without the discount. And even though the margin is lower, it's still more profitable than no multiple sale.

Many offices provide 20% off on second pairs, but that's not enough of a discount to make an impact. At 50%, my staff perceives a duty to tell every patient about the policy, and merely bringing it up creates interest. This policy works best for practices that have healthy mark-ups on frames and lenses to begin with. I justify the dramatic discount to the patient because it's easier for us to process two pairs of glasses with the same prescription at the same time. Do the math on a hypothetical second pair, and examine the profit.

A few of my favorites

Here are a few of the tips that I think should make the top 10. (Read more online if these topics interest you.)

► I covered using an in-office pager in Tip 2 and from a different angle in Tip 302.

► Are you monitoring patient satisfaction? Tip 17 had an example of a simple postcard survey we give to every patient in my practice. How do you know if you don't ask?

► Technicians as scribes. I cover different aspects in Tips 113, 276 and 302. This is the greatest time saver ever; why is it underutilized in optometry?

► Recruiting and screening job applicants are tough jobs. I discuss a novel approach in Tip 159.

► Find office design in Tips 129, 232, 233 and 280.

► Hiring associate O.D.s. Tips 139, 140 and 274.

► I cover hiring an office manager in Tip 234. I believe every practice should have an office manager, even if you have only one employee. It starts you out on the right foot.

► My top 10 misconceptions in practice management. In Tip 268 and several that followed, I shared my belief that our conventional wisdom is often wrong. This tip was a bit controversial.

► Why should new and established patient-exam fees be different? Tip 285 was a sleeper, but it raises a good point that will increase your gross and net incomes.

► Words make a difference. Tip 290 provides a list of do and don't say eyecare terms for staff members (and doctors).

► Delegation is one of the most powerful tools we have in practice management. I have many thoughts on this subject, and several tips touch on it. Use the key word search feature in the tip archive to find articles on delegation or any other topic of interest.

If you're not a subscriber to the Tip of the Week, you can sign up for a free subscription at In addition, you can find a complete archive of past tips available at that same Web site. OM

Dr. Gailmard is former chief optometric editor of Optometric Management, and he currently writes the Management Tip of the Week e-newsletter. He is in private practice in Munster, Ind., and he is president of Gailmard Consulting. You may contact him at

Optometric Management, Issue: December 2007