Article Date: 11/1/2008

Help! There's a Consumer in My Office
patient care

Help! There's a Consumer in My Office

Here's how top practitioners view and manage today's "empowered" patients.

Editorial Director


For some, all that's missing from the encounter is the theme music from "Jaws": There, lurking in reception is the Great White of patients. He's carrying information he's "researched" on He'll argue the diagnosis or compare prices. And all your experience and training, he feels, cannot refute his buddy Al's recommendation, which he delivered while sinking a birdie on the 16th hole last weekend.

Welcome to the consumer of the 21st century. The media urge him to become an active decision-maker in the healthcare process. "To be an empowered patient, you must recognize yourself as the hub of the healthcare wheel," tells us ( And when the economy weakens, he'll seek less expensive healthcare solutions. "We are hearing many comments about the slowing economy," says Milton Hom, O.D., of Azusa, Calif. "Patients are extremely reluctant to pay out-of-pocket for non-covered or high-deductible drugs."

A contrarian view?

While the knee-jerk reaction might be to dread this empowered consumer, many successful optometric practices welcome them. "I am always glad to see patients taking an interest in their own healthcare," says Andrew Gurwood, O.D., of Doylestown, Pa. "Since the number one cause of treatment failure is non-compliance, a patient taking an interest in his own wellness is making an investment that will pay dividends for both of us."

The issue for many doctors is one of education. "I have always encouraged my patients to ask questions," says Pamela Miller, O.D., Highland, Calif. "I make a concerted effort to educate my patients regardless of age, often showing them what I am seeing and explaining issues, such as cause and effect between their eyes and diseases, sports vision, computer use, prescription sun-wear, menopause, aging expectations, etc. It is my responsibility and legal obligation to lay out all viable options and make appropriate recommendations for every patient."

The self-diagnosis

Early in the examination, the doctor may find that the empowered patient offers a self diagnosis. Dianne Anderson, O.D., of Aurora, Ill., provides the example of a 45-year-old airline pilot who researched his condition on the Internet. Noting that his vision was blurry in the center of his near field, he feared he was developing age-related macular degeneration (AMD), she says.

"After his exam, I explained to him that his condition was presbyopia, and it's due to the normal aging process," says Dr. Anderson. "I assured him that he did not have AMD. After I clarified the diagnosis, he thought he had wasted my time."

Dr. Anderson explained the visit wasn't a waste, but a "learning experience." In this instance, education satisfied the patient.

Dr. Miller says that patients do have some knowledge of what they want, which is "usually relevant but not always accurate."

"It is my job to make certain that their knowledge is fact-based and geared toward their wants and needs," she says. "The words, ‘you are absolutely right’ help a lot and open the door for further explanations of pros and cons of options."

When patients disagree

But regardless of how carefully an optometrist explains the diagnosis and a treatment regimen, some patients will still disagree. "The patients who present the biggest challenge are the alternative medicine folks," says Donna A. Suter, a consultant based in Ringgold, Ga. "Or, the ones that think eye exercises or a designer, hydronated water can prevent presbyopia and feel the doctor writing a script is all about the money."

Ms. Suter provides an example. "I was shadowing a doctor when an old hippie who smoked pot came in for his glaucoma check. Even though he was going blind, he insisted that his herbal remedy was best."

Rather than disagree with the patients' disagreements, Ms. Suter finds that when the doctor and staff show an interest in the patient's efforts, "the patient feels more respected and is comfortable staying in the practice."

"We present our recommendations with verbal and printed explanations," says Sheldon Kreda, O.D., of Fort Lauderdale, Fla. "If these recommendations are not accepted, we discuss the additional benefits the recommendation would provide. We never belittle the patient or make them feel uncomfortable about not taking our advice. We smile and do the best for them. Often, our advice sinks in later."

Dr. Gurwood explains, "If a physician's position and knowledge is so weak that it cannot withstand the practice of constructive debate, they should be out of business. Discussion and team-building permit ownership of a prescribed plan."

Dr. Gurwood uses the disagreement as an opportunity to "allay fears, build trust, inspire faith and educate — all solid foundations of practice building and healing." He also offers: "Besides, what harm could come from being open-minded enough to listen and consider other approaches to the problem? In the end, by pointing out the advantages and disadvantages, the differences in strategies of two different solutions, both patient and doctor can be enlisted to the same ‘healing train.’"

Alan Glazier, O.D., of Rockville, Md., adds a note of caution regarding the patient who is more passive in his disagreement. "I find resistance on rare occasions," he says. "Most resistance is silent; patients nod their heads in agreement and likely do what they want, but we never know about it. I find this most when I recommend progressive glasses and patients have either heard negative things about them and instead opt for separate reading and distance pairs or a lined bifocal, even after my strong recommendation to at least try multi-focal progressives."

Dr. Anderson notes that the negative statement(s) about progressive lenses may have come from someone who may not have received quality care. Her solution? "It works well to fit the patient with the best frame and lens design and offer them a 30-day guarantee."

Dr. Anderson often backs up her recommendations with samples. When a patient challenges her recommendation for a daily disposable contact lens, "I simply dispense daily disposable trials and explain the cost involved," she says.

The result: "The disagreement stops when the patient experiences the ultimate in comfort and convenience," she says.

Dr. Glazier finds that most patients prefer the doctor to make the decisions, unless it concerns an elective procedure, such as LASIK. For example, if the patient arrives for a contact lens appointment, "it is the doctor's duty to make a strong recommendation as to the type of lens and wear schedule," he says.

"The patient may prefer a certain wear schedule and if so, it may be wise to decide this together," says Dr. Glazier. "But outside of that instance, the doctor is the expert, and the patient is seeking expertise."

When price is the issue

Regardless of the economy, some patients will always argue price, and many will assume that private-practice optometry charges higher fees than retailers.

"I tell staff that patients have two assumptions," says Dr. Kreda. "One, the quality of services and materials from our office are superior, and two, services and materials from our office cost more. The staff's job is to convince patients that assumption number two is either false or insignificant."

Dr. Kreda's solution is to charge a fair fee for the exam. "It's easier to defend the higher fees for your superior services than it is to defend higher prices for identical products," he says.

Other practices bundle service offerings with fees for materials. "… We offer follow-up visits as part of the package when soft contact lenses are ordered," explains Dr. Gurwood. "I explain, ‘you might be able to purchase these contact lenses on the Internet for less, but when you require me to check them, at the cost of an office visit, what are you really saving?"

Dr. Glazier takes the approach of explaining his optical as the "pyramid" of quality. "…Patients can find glasses cheaper elsewhere, but not with the level of quality we provide, combined with customer service," he says. "For progressive wearers, we try to explain the quality in terms of optics and the benefits of going with higher-end products in terms of field-of-view and minimal adaptation with our products."

Dr. Glazier even logs on to contact lens Web sites to show that his prices are competitive. "That's usually all it takes," he says.

Dr. Gurwood and Dr. Anderson agree that the time to discuss fees is during the examination. "Explaining the products and expected cost is essential so that patients can make an informed decision," says Dr. Anderson. "Many consumers are influenced by presentation as well as price. Some will still want to shop elsewhere, and they may be back if you created a lasting impression of quality and expertise."

Dr. Gurwood uses a chart or handout to cement the point that "the value the patient receives from a skilled professional, where recourse is immediate, is worth the fee."

Dr. Miller says she assumes that every patient is price conscious. "I have no difficulty up-selling or promoting luxury eyewear as well as having an economy line for those who prefer that option," she explains. "The key is to promote value for the money spent."

Dr. Miller cites two other keys: "Lay the groundwork for the future needs or desires of the patient" and "know your patient."

Is it a good thing?

Can optometrists find happiness with patients who choose to act as consumers? Most of the subjects we interviewed answered yes. The consumer approach affords "an opportunity to impress the patient as well as clarify any misconceptions," says Dr. Anderson. In addition, Dr. Gurwood notes that empowered patients "more faithfully follow the course of therapy to the letter and to the end."

Says Dr. Kreda: "Years ago, a clothing store advertised, ‘an educated consumer is our best customer.’ This would be golden advice for any practitioner." OM

Optometric Management, Issue: November 2008