Article Date: 2/1/2003

o.d. to o.d.
Should Patients Have to Ask?
Optional products abound in eye care. Do your patients know they exist?
BY NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O., Chief Optometric Editor

I remember a research study published in Contact Lens Spectrum back in 1991 by Australian optometrist Dr. Anthony Hanks. It discussed a proactive, rather than reactive, approach to contact lens fitting. In essence, the study compared the number of fittings performed by two groups of doctors. One group brought up the topic of contact lenses with all reasonable candidates and the other group waited for the patient to ask about contact lenses.

Guess which group did more fittings -- way more fittings. Yet how many of us today still bring up the idea of lenses to patients who don't ask? The reactive behavior is certainly not limited to contacts. I think the practice occurs with all "optional" eyecare products and services.

What are optional products?

Many products we prescribe and dispense in optometry are optional for patients. This is the case in many areas of medicine and dentistry also, especially in areas that are cosmetic in nature. By definition, the medical complaints that we work toward eliciting in every case history may not disclose an interest in optional products. Indeed, the patient may not even know an optional product exists!

With our emphasis on diagnosis and treatment of eye disease, are we forgetting some of the optional and cosmetic aspects? Is it our duty to inform and educate each patient?

Here are some examples of optional services and products:

Optometric sell-a-phobia

As optometrists, most of us shy away from any behavior that could be even remotely construed as selling a product. This is a condition I'm going to name optometric sell-a-phobia. Perhaps it comes from trying to show the public that we left our roots in opticianry and jewelry stores long ago and that we don't just sell glasses. Whatever the reason, I think we may be overly sensitive and we may actually overcompensate -- to the detriment of patient care.

Explain one thing

With so many options and lens modalities, how can you discuss all of them? Of course you can't -- and you don't want to. I just pick one thing (maybe two) for each patient. This is what I call the "explain one thing" approach. You can choose the topic based on the patient's interests, history, occupation, age, diagnosis or simply any interest you may have. The "If it ain't broke, don't fix it" philosophy directly contradicts the "explain one thing" philosophy. I believe that something doesn't have to actually be broken for you to offer something better.

Remember you aren't selling things, you're explaining new options -- so there's no rejection possible. It's fine if a patient isn't interested. Many won't be. Keep the explanation brief to avoid boring patients. It's good to ask early in the discussion if there is any interest. In general, bringing up new forms of treatment actually makes routine, dull visits more interesting and productive for patients.

Producing happier patients

Optometric sell-a-phobia is generally only in the minds of O.D.s. Patients want to hear about new options and they respect doctors who provide such information. It's one of the reasons they come to us.

The proactive approach results in happier patients, which leads to greater patient retention and referrals. And, if you perform more services for each patient and charge appropriately for them, practice revenue will increase as well.

You may contact Dr. Gailmard at

Optometric Management, Issue: February 2003