Article Date: 12/1/2000

So you're doing well financially and are busier than ever. But do you have time to pay attention to the details of your practice that your patients focus on? Patients may notice problems with your staff before you do.

One detail your patients will key in on is the behavior and personality of your staff. If they're misbehaving, it will affect your patients' opinion of you and your practice. Not only that, but other problems are sure to exist, although they may not be obvious. That's why the role of an office manager is so important.

If you don't already have an office manager and you're willing to admit that your own management skills may need some work, look into hiring someone to manage your office for you. After all, it's good to be nice, but if you're nice to a fault, you're the only one who's going to pay. Get someone else to take charge for you. That's what the O.D. in this case ended up doing, and it solved his staff behavior problems.

Foundation of training

Dr. Reynolds has two financially successful practices, but they weren't realizing their full potential as businesses. His problems revolved around his staff at both locations.

He missed a major step in managing his office � he never properly trained staff himself, and he didn't have an office manager at either location to do it for him and to maintain order. Consequently, their ignorance of proper procedures and behavior led to other problems.

Problem areas

Dr. Reynolds' failure to properly train and educate his staff led to the following problems/predicaments:

         The staff at both locations had poor language skills � they didn't use scripts and their language wasn't professional enough on the phone when speaking with patients.
For example, a patient asked to schedule an appointment at a certain time, and the staffer replied that they only took morning appointments that day of the week. This is a big no-no. Never tell patients when you're not there because they think you should always be there.

         A commission system was in place and his staff was getting very competitive with regard to which location was generating more money.

         Cliques formed, and if a staffer wasn't a part of the group, they'd make life miserable for her.

         Both staffs were also lax in educating patients. In one instance, a patient asked to take his spectacle prescription elsewhere, and the staff members simply wrote it out and handed it to the patient without saying anything. In this scenario, patient education would've been vital in preventing the patient from leaving the practice.

         The staff in both practices also had a habit of huddling together in the front of the office in clear view of patients. They'd talk about non-work-related topics and make patients feel as though they were disturbing the huddle, rather than feeling welcome.

         Both staffs were resistant to change. Any time Dr. Reynolds brought in new information or introduced new techniques, they'd balk at the ideas.

The root of the problem

In trying to locate the source of Dr. Reynolds' staff problems, I noticed that he, too, used poor language, which his staff adopted. Language is important in optometry, especially for independent practitioners who need to use professional office language to set themselves apart from corporate offices that use more of a store "shop" language.

See "Don't Say/Say" for examples of how to make sure the language you and your staff use in the office is professional.

Also, as I mentioned earlier, Dr. Reynolds didn't educate his staff or his patients. The most logical solution in this case was to hire office managers for both locations.

Implementing management

Before recruiting, I looked at the staff from each of Dr. Reynolds' office locations, but didn't find any manager types. Dr. Reynolds and I interviewed candidates and finally hired a manager for each practice.

I outlined a job description for each manager, which detailed the expected flow of communication between the doctor, the manager and the staff. It explained what the manager would report to the doctor.

The main job of the manager was to make sure the staff didn't deviate from the office policy, which I also helped develop. I incorporated a system of checks and balances so that Dr. Reynolds could run his office instead of having it run him.

Group meeting

Both staffs came together for a group meeting. Dr. Reynolds and I explained to them that we wanted to discuss some changes that we wanted to make to shape up and restructure both practices. We also told them that we needed their help.

During our meeting, I highlighted examples of proper verbiage, terminology and telephone skills. I also went over the key points shown in "Don't Say/ Say."

I also told the staff that Dr. Reynolds and I considered each and every one of them to be a valuable asset to the practice, but that they should talk to us if they had a problem with the new direction we were taking.

I then explained the importance of everyone having common goals for the welfare of the practice and consequently, for themselves as a part of the practice.

Scripting school

I taught Dr. Reynolds how to script, and I created scripts for the duties he performed (e.g., direct ophthalmoscopy and biomicroscopy). Standard, effective scripts make patients more motivated, educated and enthusiastic about their visits because they're given more information.

In the office manual, I made up scripts for the staff about not mentioning when the practice doesn't see patients (e.g., mornings on certain days). I also taught them scripts for automated refractometry, automated lensometry, dilation, etc. I stressed to both Dr. Reynolds and his staff that every script should address three elements.

I also made it clear that they were expected to recite the scripts with enthusiasm, to look the patient in the eye and be interested. I explained the correlation between good intraoffice education and recall efficiency. I stressed the need to educate patients that all of the tests performed are preventative medical evaluations and that once patients understand that, they know they're being recalled for health testing and not just for a new eyeglass prescription.

The payoff

Properly educating your staff and patients is a must. Even if you're doing well financially, as in this O.D.'s case, you could increase your success even more if you just fine-tune some important details, such as office language and staff behavior.

If you have trouble controlling your staff and their language skills need a little work, hire a manager to retrain and supervise them. You're sure to notice a difference � a staff that ain't misbehavin.'

Dr. Kattouf is in private practice in Warren, Ohio, and he's president and founder of two management and consulting companies. For information, call (800) 745-EYES or e-mail

Note: The stories in this column are based on actual consulting case files. All practice data are real; the names are fictitious.

Scripting Pearls

Answer these patient questions:

1)         What are you doing to me?

2)         Why are you doing this to me?

3)         Why must this procedure be performed every year?

Don't Say:


no-line bifocals

progressive addition, then explain


medication (drops are OTC; this is a prescribed drug)



"he" (referring to doc)

"the doctor" or "Dr. Smith"

I can see you Monday at 8:00

Dr. Smith can see you Monday at 8:00

stock (lenses and frames)


trial lens

diagnostic lens ("trial" denotes free or of no consequence)

machine (automated perimeter

instrument (any device that gathers data)


fee (price is a store term)

check (Dr. Smith will see you for a contact lens check)



Optometric Management, Issue: December 2000