Dealing with Patient Problems -
Method or Madness?
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When William Shakespeare wrote the lines that became famous, he had Polonius speak the aside as, “Though this be madness, yet there is method in’t.” That line evolved to become, “There’s a method to his madness.”
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Can it be said of your practice that you have a method to figuring out a patient’s eyewear problem or do you rely on what can be perceived as madness? Though many patient complaints begin with the most common of all statements (“I can’t see!”), do you have an established way to discover what their real difficulty is and then a way to correct it?
In today’s business environment, we can ill afford to pass off customer difficulties or even complaints as just crabbiness. Today, customers will not continue to patronize a business that just looks at them and says, “ Sorry about that!”
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From observation at a variety of businesses, I suspect that there is very little in the way of established troubleshooting procedures being taught today. For example, suppose a patient comes in to your practice with their rather new glasses in hand and says, “I can’t see with these and I paid over $700 for them!” What’s your first response? (Don’t even think about saying, “Sorry about that!”)
If you manage to say something halfway intelligent that keeps them from throwing their eyewear at you or, worse, loudly demanding a refund for “this piece of #$%@!” in front of your other patients, what do you do next? Some opticians go directly to the hot beads, warm up the frame, and start to manipulate it. Others, put the patient in line to see the doctor. The variety of things done approach madness, particularly when the solution is simple.
Do you have specific procedures in place that all of your employees know and actually use? If not, you’re at the mercy of the one who handles the problem, including their own state of mind at that moment. To save your business and develop – even grow – a loyal customer base, I suggest a specific guide that will help analyze the problem and then find a way to solve it.
With that as a goal, what would be the things you would consider in discovering the problem? In no certain order (at this time), we should look at the frame as it’s worn on the patient, the balance of the frame as it sets on their face, the patient’s measurements, the prescription history of this patient, any history of problems, the optical characteristics of their lenses, and what the patient is saying about their eyewear.
That’s a rather long list but it doesn’t have to take an extended time to go through those things. After all, making the patient wait for 30 minutes while we consider each thing will probably result in a dissatisfied patient no matter what we do. That being said, what should be checked first? Start with the simplest things.
Listen to what your patient is saying to you and gently ask some questions to help you understand what they see as the problem. It’s probably going to be more than “I can’t see!” Most likely it’s, “I can’t see everything clearly” or even, “I can’t see when I read.” It may be something like, “When I look through the bifocal area, everything seems to be higher on one side.” Whatever they say, follow up with questions that don’t get answered with a simple “yes” or “no.”
Listen carefully and watch their body language, because they’re certainly watching yours. As best you can, stay relaxed and calm, not getting defensive and challenging. You want to instill confidence and assurance that the problem they have can and will be solved.
I had a patient who came in complaining that everything was blurry. “This prescription isn’t working for me anymore. It was fine for a few weeks but now, I think I need to see the Doctor again.” I held their glasses up to the light – starting with the simplest solution first – and then went to the lab. There, I used a lens cleaner and the ultrasound cleaner. When I returned the glasses to them, they put them on and exclaimed, “Wow! That’s much better! What did you do?” I replied, “I cleaned them.”
Check their history. If you establish a regular habit – or even a requirement – that every interaction with a patient must have some documentation, you will save yourself time in diagnosing the current problem. They may have a history of coming back within a couple of days of receiving a new prescription with the complaint that they can’t see as well with the new glasses as they could with their old prescription. That’s likely an adaptation situation. Perhaps they wait several years between eye exams and new lenses.
Look at their current prescription and notice if there is a significant difference between OD and OS. Often this will cause a sense of things being “not right” to the wearer, particularly if this is something they’ve never had before.
Check their previous prescriptions, assuming that they have been with you before. If not, you may have to call their previous Doctor. If they have a prescription that has changed significantly, they most likely have an adaptation that has not been completed. Did you explain this to them when the prescription was ordered and again when it was delivered? They must be reassured that, given some reasonable time, their brain will adapt and learn to use their new prescription. I sometimes use the illustration of brain memory, telling them their brain remembers what they’ve been using and, with the new prescription, the brain is a bit confused until it adapts and learns that this new prescription is really the best one.
Check their measurements. Make sure the PD you have is accurate. Are the optical centers in the correct place? (You may need to review the symptoms and effects of unwanted prism induced by misplaced optical centers.) Check the fitting height, as appropriate for the lens. Check the pantascopic tilt. If this is off, the image coming through the lens toward the eyes will not go through the eye’s center of rotation as it should. Is the vertex distance correct?
For the prescription to act like it did in front of the phoroptor, this distance needs to be very close to the same. Moving the lenses away from the eye - increasing the vertex distance - will effectively change their prescription, making a plus prescription stronger and a minus prescription weaker. The opposite will happen if the lenses are moved closer to the eyes. All frame adjustments need to be considered as a possible source of the difficulty.
Even if their vision is better, since it’s different, the patient may think they can’t see as well as they should. This again is an adaptation situation that needs time to resolve.
When dealing with patient complaints about their vision, all these things plus things like tint, anti-reflective, lens thickness and many others need to be considered. Establish a given protocol for solving patient difficulties. Start out by establishing a certain priority. Test this by using a known problem. Determine if the problem is solved in a logical manner and with a minimum amount of wait time. If necessary, rearrange the protocol until you have one that takes you from problem to solution in a reasonable time frame by starting with the simplest and most straightforward solution, moving on to the more complex.
So, for example, if you suspect that the problem presented it due to the frame adjustment, start there with optical centers, PD, vertex distance, tilt and frame balance on the face. If that is in order, you may next want to consider their optical parameters. This is where the difference between OD and OS and the overall change from previous prescription needs to be examined.
Having arrived at this point in the troubleshooting protocol, you may be close to a doctor consult but be sure you’ve checked everything first before you use up valuable time on a reexamination in the doctor’s chair.
Having a tested method will likely prevent a sense of madness. Having said that, occasionally, you’ll meet up with the patient who complains they can’t see and you’ll go through everything you should and be at the point of both frustration and a consult. Then, they’ll spring it on you by saying, “Oh, I know what it is.”
You’ll reply, “Oh?” but be thinking, “Sure you know. That’s why you’re here asking me.” (Don’t say this out loud.) Then they’ll reply, “I’m wearing my husband’s glasses. Sorry about that!” and walk out. Don’t say it. Don’t say it. Just relax and move on to the next patient, using your method – not your madness.
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