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Real Deal

When a Student Extern Disrupts an Office’s Established Procedures, How Can an Owner/OD Regain Control?

An optometry student extern is causing problems for a practice. How can the owner rein her in?

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DR. ABERDEEN’S practice was set in the outskirts of Dover, Delaware. The majority of patients had vision care plans and wore contact lenses, and several months ago she’d written to her alma mater offering to become a preceptor. The externship director listed Dr. Aberdeen’s office as a contact lens rotation, and soon a list was sent with student names and dates.

ABOUT REAL DEAL
  • Real Deal scenarios are inspired by true stories, but are changed to sharpen the dilemmas involved. The names of the characters and stores have been changed and should not be confused with real people or places.
  • ABOUT THE AUTHOR
  • NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at [email protected]
  • The first extern, Emily, was happy to be accepted as this meant she could commute from her grandparents’ home 30 minutes south of the office. Dr. Aberdeen spent a great deal of time preparing for her extern, including establishing a work station, a series of enrichment assignments, and a customized office policy manual. Dr. Aberdeen also held a 10-minute huddle with her staff to explain the unique role of an extern within the office. While Dr. Aberdeen didn’t directly manage or supervise the staff, she would be overseeing all externs personally.

    Emily’s first day was spent shadowing Dr. Aberdeen in patient care. As this was Emily’s first externship, she was excited and projected confidence and charisma. Dr. Aberdeen was flummoxed. She had expected Emily to remain silent while shadowing her, speaking only if asked a question. Instead, her extern was engaging family members in idle chit-chat during the exams, or offering unsolicited treatment plans.

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    The last patient of the day was a very nice man Dr. Aberdeen had seen for at least 10 years. During the slit lamp exam, she invited Emily to quickly look into the ‘scope over her shoulder, where the beginnings of a nuclear sclerotic cataract were in focus.

    “Cataract,” Emily confidently announced to the room, as though she were on a quiz show. The patient sat back quickly.

    “I have a cataract?!” he exclaimed, looking frightened. Dr. Aberdeen did her best to back-peddle and educate the patient about his pre-cataract, a conversation she hadn’t planned to have for another six months.

    Despite regular coaching, her extern continued to put her educational exuberance ahead of Dr. Aberdeen’s relationships with her patients. Monovision patients were advised that they were wearing ‘old technology’ and should consider multifocal lenses; those with prescribed prism were given lectures on the virtues of vision therapy; and dry eye patients were encouraged to ask for punctal plugs, a procedure Dr. Aberdeen didn’t feel confident performing.

    A breaking point came when Dr. Aberdeen learned Emily had been criticizing some of her policies to the technicians. “These vision care plans are supposed to include dilation and the full contact lens fitting,” she said with authority. “It’s not right to charge for follow up visits, you can get in trouble for that.” One of the techs brought the information to the office manager, who circled around to Dr. Aberdeen. She felt offended, and in an attempt to mitigate some of her stress she found herself assigning Emily to more workups and fewer complete exams. This prompted more complaining, including comments about ‘free labor.’

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    Just before Emily’s midterm grades were due, Dr. Aberdeen sent an email to the director of the externship program. “I can appreciate how engaged Emily is in patient care and the profession,” she wrote, “but this is my business. I don’t think she’s fully appreciated that. Her clinical skills are sound, but I had expected to spend more time teaching and less time cajoling.”

     

    The Big Questions

    • What would you change to improve the remainder of Emily’s rotation with Dr. Aberdeen?
    • If you were the program director, how would you respond to Dr. Aberdeen’s email?
    • Where is the line between educator and business owner, and how can a preceptor find it?
     

    Expanded Real Deal Responses

    Gary S. Muskegon, MI

    If I had a patient with a 10-year history of pre-cataracts, I would have told him nine years ago, confirming each year that they are still way off in the future and not to worry. Lots of monovision patients? This is a wakeup call! Don’t be a dinosaur. If you know what the managed care rules are, then educate the intern who only has ivory tower learning. If you are violating the plan rules, either drop the plan or change before the plan calls you on the carpet. The intern must be addressed by the doctor as to what is expected and to not jump in or override the doctor’s decisions. If the Don Quixote-like jousting with the way the practice is run doesn’t stop, the intern will damage her future prospects of being employed anywhere.

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    Robert M. Edina MN

    The first mistake Dr. A made with Emily was assuming she would act in a certain manner without setting expectations. To improve the balance of her time there, Dr. A should tell Emily exactly what she expects and what behavior is unacceptable i.e. gossiping with the staff, etc. This insight will help Emily in her career. As the program director, I would have a conversation with Emily about the importance of listening to Dr. A and discussing patient issues in private and not in front of staff. I would also let her know the externship is a privilege and should not be taken for granted. There is not a line between business owner and teacher. There is much to learn from both. She should take full advantage of a great opportunity.

    David G. Beckley, WV

    She should have told the extern to shut up and not engage in any direct communications with the patients about diagnosis and treatment or any criticism of the doctor’s office policies. The extern was there to learn, not manage. When the extern enters the real world things don’t always happen like in the school clinic. Very rude.

    Chani M. Highland Park, NJ

    I wouldn’t have waited so long to sit down with Emily and tell her exactly what was expected of her. I would have nipped this in the bud on day one in a more aggressive manner. If I was the program director, I would call Emily in and tell her that her grade was in trouble unless she shapes up. As a preceptor and business owner, expectations, as well as written guidelines, should be discussed and dispersed. In order to salvage the rest of the rotation, I would sit down with Emily and have a really candid discussion about how to turn it around and make sure the staff knows that it is being dealt with so that simmering resentment does not ensue.

     

    What’s the Brain Squad?

  • If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.
  • Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.

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    Real Deal

    An Experienced Optical Employee Bristles at Working Under A New-to-the-Industry Supervisor … Put on Your GM Hat and Help Sort This One Out

    As far as she’s concerned, this is one spurious supervisor.

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    LINDY HAD BEEN the sole employee of an elderly optometrist for two years; when he retired she applied to the only other practice in her rural Nebraska area: a corporate chain located inside a mall. Eric had joined the company four months before Lindy—he was recruited away from managing a Men’s Warehouse on the opposite side of the mall, and now he was Lindy’s supervisor.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at [email protected]

    The pair often butted heads, much to Eric’s annoyance. He was making his way through manuals, webinars, modules and off-site training, but Lindy seemed to relish challenging his every move. Today was no different.

    Lindy found her supervisor in the lab. “Eric, can I get your help with something?” She gestured towards the sales floor. “Recognize her from last week? You did this order.”

    “Oh, yeah,” he said, sucking his teeth. “Took forever for her to pick out a frame.”

    “I’d like to remake these lenses,” Lindy said. “The seg height is too high by 3 millimeters.”

    “Impossible. I used the iPad app. Just adjust the nose pads so it sits lower,” instructed Eric.

    Lindy pointed at the frame. “If it goes lower the bridge will rest on her nose.”

    “Try it. Three millimeters isn’t bad enough to justify a remake.” Eric sensed Lindy would continue challenging him so he grabbed the frame out of her hands. “I’ll show you; it’s good training.”

    The pair joined a very annoyed customer, seated at a dispensing desk.

    “I’m going to lower this frame a bit and that should fix the problem,” Eric announced brusquely.

    The woman let Eric fiddle with the frame, and when it was back on her face she gyrated her head wildly. “This doesn’t look any different,” she said.

    “You’ll need to take a few weeks to adapt but this is going to work great,” he said, shoving his hand in hers in a shake good-bye. Lindy averted her gaze as the woman wandered back into the mall.

    “Remakes hurt our stats!” Eric said, for perhaps the hundredth time.

    A few hours later Lindy was measuring a patient for progressives when Eric plopped down next to her.

    “Here Lindy, I think you were looking for this,” he said, resting the iPad on the desk.

    “Thanks Eric, but I’ve got my super-duper marking pen here,” she replied flatly.

    “We want to maintain the same high quality though, and patients love new technology!” he said, smiling at the patient. “This thing really is neat. Here, I’ll do it, can you grab the Blue Light Pen from the lab for me?”

    Lindy smiled politely at her patient and gave Eric her seat. As she walked, Eric’s voice carried across the optical sales floor: “We strongly recommend a blue-blocking lens to prevent macular degeneration, which is a permanently blinding disease.”

    Lindy’s eyes rolled; she knew blue light was a scare tactic, and when she got back to the desk she’d be sure to give the patient the full story.

    The Big Questions

    • If you were this store’s general manager, how would you go about reconciling Eric’s by-the-books approach with Lindy’s experience?
    • The importance of blue blocking lenses is hotly contested. Should office staff be expected to take the position of the company, or is it an individual’s duty to advise patients as she sees fit?
    • How could a corporate supervisor best balance customer service against store statistics?
    Tom S.
    Holland, MI

    Eric is not a kind coworker. Store statistics mean nothing if your patients are not happy. Blue light filters should be a patient-by-patient recommendation and not an assumed choice. You have to get to know your patients and their needs and come to a recommendation.

    Chris D.
    Lake County, FL

    I was at that corporate place and am now in private practice. A third party, competent tenured peer or manager needs to mediate. Acknowledge the strengths both have. Defer optical experience to the optician and the corporate position to the GM. Stress the importance of ethics and proper wording-based research — not marketing. For example, “these lenses may….” or “because blue-light may….” And the optician needs to adapt to some new technologies and embrace changes as well. They should train together. Newbie and experienced both learning at the same time. Utilize both of their talents to tackle a new device so they can see from both perspectives. I have been the one to bridge these two positions.

    Stewart G.
    San Francisco, CA

    To be honest, Lindy needs to look for a new job. Unless she can live with compromising her principles, she’s going to constantly have tensions with her supervisor. Her supervisor is acting like the owner of a commercial franchise I worked for many years ago. He would try to sell a customer (and I use that word purposely) anything, as long as he made more money, and the staff were rewarded for doing likewise. The customer, of course, didn’t know any better. When you sell 1.74 index to a -0.50 prescription, you understand what you are dealing with.

    Nancy C.
    Cortland, NY

    Being in a licensed state, with a degree in ophthalmic dispensing, I see this occurring more and more. I approach with offers of explanation first. When informed my knowledge isn’t needed and stated in front of a patient, I go on break or lunch. Making a point to be very busy with operational maintenance. When the realization of better understanding is needed (it comes), and has been requested, I offer an explanation, again, never changing what was said or offered in the first place. The patients see and understand. Trust me, no job should compromise your professional ethics. Some corporate jobs require the “offer” of products and enhancements as part of your position. Just offer them to the patient, with education on the products, and your job requirement’s fulfilled.

    Judy M.
    Pittsfield, MA

    There should never be a discussion about methods of measurement etc., between employees in front of customers. It makes the customer lose trust in the optical department. The general manager should get involved before the situation becomes out of control. Customers will sense the tension between employees. New technologies do ‘wow’ patients, but where I work we always use two methods of measuring: machine and hand measurements. Once an established patient has measurements that work for them, we may do just one form.

    Rick R.
    Girard, PA

    1. First off, let’s be clear on something. If I were the general manager of this fictional optical (which by the way sounds strangely similar to a chain I once worked for), I would have NEVER hired some half-wit from Men’s Warehouse to be a supervisor. I think we all know how that works out. But if I were in this scenario I would have talked to both of them because a disgruntled customer being subjected to these two would be a formal first step in the counseling process. That behavior was uncalled for by both parties.
    2. Again, having worked for this fictional company it is not your decision to make — whether you agree or disagree. But Eric’s over-the-top response about blue light was totally in the wrong.
    3. Train your people so you can keep mistakes to a minimum. “Controllable remakes.” Guess how many times I have heard that one?

    John L.
    Nashville, IN

    Typical corporate conundrum: a manager with only four months of experience in the optical business trying to exert his optical knowledge over an associate whose only experience has been as an employee of an elderly optometrist for a period of two years. Meanwhile, the customer is caught in between their differences in “experience.” Unfortunately, this is the future of our business, unless optometrists, opticians and our customers demand that formal training and a proof of competency is required for all opticians. If optometry expects that the full benefit of their Rx will be realized by their patient, qualified opticians are a must.

    Cynthia S.
    Mequon, WI

    I would have a long private conversation with Eric regarding his behavior in front of the customer. I would explain the experience and qualifications I have as an experienced optician. I would let him tell me about the new technology and I would attempt to appease him by trying the iPad technology he is insisting upon, but I would also use my own tried-and-true method of fitting and assisting my customer. If he ever embarrassed me in front of a customer after a private conversation, I would take matters to a higher power. If there was no resolution, I would look for a different job.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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    Real Deal

    Two Patients Collided in This OD’s Parking Lot — Is He Liable for Anything? Here’s Your Chance to Weigh In…

    You could call it a case of ‘hit and nun.’

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    DR. PHILBIN’S PRIVATE practice served several towns in southern Arizona. The day was winding down when a staff member pulled him aside. “Derek just showed up. We had him booked at 3:40. Do you still want to see him or should we reschedule?” she asked. “He does have an outstanding balance of $340, by the way.”

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at [email protected]

    Derek was a longtime patient and the childhood best friend of Dr. Philbin’s son. He sighed dramatically, smiled and nodded. “I’ll see him.”

    Moments later they met in an exam room. “Thanks for seeing me Dr. Philbin,” said Derek. “How’s Bugs?”

    Dr. Philbin took a second to recall the ancient nickname his son used to have. “Oh, fine. He graduated college last year and lives in Houston,” he replied. “What are we doing today?”

    Derek pulled a form out of his back pocket. “I was hoping you could help me get a tint for my car windows, since I have such sensitive eyes,” he explained. “A letter from a doctor is all I need.”

    “Oh, Derek buddy, it’s so rare for someone to have a true medical need for that, and I can tell you right now you don’t qualify. You’d need to be a danger to others on the road,” he said. “I’d recommend a great pair of wraparound sunglasses; do you have those?”

    “I hate wearing sunglasses, they bother my nose,” he said, throwing his head back in exasperation. “There’s no test you can do? I’m sure I won’t pass.”

    “Sorry bud,” said Dr. Philbin, “but it was great seeing you. Tell your parents I said hello,” shaking the young man’s hand.

    Ten minutes later Dr. Philbin was at his desk reviewing e-mails when a receptionist paged him to the front. Patients and staff members were gathered near windows facing the parking lot. He could hear the receptionist behind him: “It’s a fender bender.”

    Just then Derek entered the building followed by Sister Bethany. Dr. Philbin was eyecare provider to many of the nuns at the local convent.

    Her appointment that day had been for a dilated fundus exam. Eager to avoid a spectacle, he herded them both into his office.

    “Is everyone okay?” he asked worriedly.

    “Oh, I’m okay,” the elderly nun said magnanimously. She was still wearing her roll-up dilation glasses.

    “Well, what happened?”

    Derek spoke up: “I was backing out of my spot, but the sun was in my eyes and I couldn’t see her behind me.”

    “These things happen,” she said, patting his shoulder. “It is very bright out there.”

    “I guess you’ll need to exchange insurance information?” Dr. Philbin suggested.

    Both parties paused and looked at each other, and Sister Bethany spoke slowly, delicately. “The last time one of us had an accident it was preferred to work things out privately, directly with the church.”

    “That’s good for me too,” said Derek quickly. “That’s what I did last time, I’m fine with that.”

    Dr. Philbin struggled to stay quiet as they exchanged contact info. As they were leaving Derek mused aloud: “This seems like a pretty good reason for tinted windows!”

    The Big Questions

    • Dr. Philbin is concerned about Derek’s willingness or ability to pay the church. Is it his place to volunteer these concerns?
    • Considering Sister Bethany’s eyes are dilated and the accident happened on company property, what (if any) actions should the practice take?
    • If you were Derek’s doctor, how would his last comment affect your behavior?
    Minh T.
    Decatur, GA

    1. There’s nothing wrong with handling accidents privately vs. having insurance involved.
    2. The parking lot is not the office so practice has nothing to worry about.
    3. Tinting windows is no big deal if not less than 35 percent transmittance … tinting the front windshield is what matters; each state has their own rules regarding such. Refer to that for proper protocols.

    David G.
    Newport Beach, CA

    Dr. Philbin shouldn’t volunteer any concerns regarding ability to pay the church. It’s likely Derek’s unpaid balance is due to his relationship to the owner. A simple explanation of the effects of dilation isn’t enough. The practice should implement a written dilation “waiver” to explain the side-effects. Ironically though, it doesn’t sound like Sister Bethany was at fault and the practice was proactive in giving her dilation sunglasses. Dr. Philbin should have performed a light sensitivity/glare test to affirm his reasoning, then brought Derek to his optician to find some comfortable sunglasses. Derek’s lack of education and testing led to his unfortunate remark.

    Melania N.
    MINEOLA, NY

    1. It’s not the OD’s place to voice his concerns.
    2. The practice should take no action; they’re not responsible for what happened. I wouldn’t have even brought them back in for discussion in the first place.
    3. I would have replied with “Sunglasses would have prevented this from happening as I had recommended.”

    Lisa Lynne M.
    MOORE, OK

    This is why it is critical to have all patients sign a dilation consent form stating “we recommend you bring a driver.” If the patient chooses to drive dilated, they assume the risk.

    Dave G.
    Lansing, MI

    I would not mention anyone’s ability to pay to another, but I would have asked for a payment against his balance “…while you’re here.” When he asked about testing, I would have explained the costs and left it to him to decide if he wanted to pay for it. To protect the practice, some form of documentation should be taken. If not a police report, have each party write their version of the incident.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

    Continue Reading

    Real Deal

    This Myope’s Broke: How Would Your Office Handle Her?

    Her illicit contact lenses trigger more problems than she bargained for.

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    SATURDAYS WERE ALWAYS overbooked for Dr. Coakley, who owned a small private practice in a college town. His first patient of the day was ready in an exam chair when he walked in at 8:10 a.m.

    ABOUT REAL DEAL

    Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

    ABOUT THE AUTHOR

    NATALIE TAYLOR is owner of Artisan Eyewear in Meredith, NH. She offers regional private practice consulting and ABO/COPE approved presentations. Email her at [email protected]

    “Hi Stephanie, nice to meet you, I’m Dr. Coakley,” he said, perching on the stool. She was 20 years old and appeared to be in pain, cupping her left eye gingerly.

    “Hi,” she said meekly. “I think I have pink eye or something.”

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    Dr. Coakley gently pulled her hand away and saw a very swollen lid. “OK, let’s get started,” he said, pulling the slit lamp over her lap. During the exam he learned Stephanie’s last exam was 14 months ago in her home state. She had cracked a lens in her glasses six months ago, thought she was “about a minus 3” and ordered trendy contact lenses off a Facebook ad. Dr. Coakley noted corneal vascularization and pretty gnarly GPC.

    “I am going to prescribe an eye drop. You can’t wear contact lenses until things clear up, and I would like you to come back in two weeks so we can do a complete exam,” Dr. Coakley explained. “I can do a proper contact lens fitting at that time.”

    “Do you know what the price is for the drops?” Stephanie asked. “I’m a poor college kid,” she added, with an embarrassed chuckle.

    “I don’t, but your insurance should cover a good portion,” he reassured. “I can’t imagine it being more than $20.”

    Stephanie checked out at the front desk and called her mom for a credit card number for the $60 specialist co-pay.

    Later that week Dr. Coakley’s staff obtained a faxed copy of Stephanie’s chart from her regular doctor. There was no indication of a contact lens fitting, nor mention of an online verification request, but the receptionist did mention a $340 outstanding balance.

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    At her next appointment the technician pretested Stephanie and made note that she was still wearing a contact lens in her right eye.

    The first thing Dr. Coakley did was evert her lids. “When was the last time you used the eye drops?” he asked.

    “I didn’t end up going to the pharmacy,” she admitted sheepishly. “My roommate had some Visine — that’s definitely made my eyes feel better.”

    “Unfortunately your eyes are still sick, so we need to reschedule again. I need you to go without contacts in both eyes for a while and use the drops. These contact lenses are not fitting you well and they frankly may not even be the right prescription, so I would recommend throwing them out as soon as you get home so we can start over.”

    “I don’t get it,” she said, defensive. “I gave the contact lens company my other doctor’s info and they said they’d confirm everything. I got the contacts… so someone must have checked my records and approved it.”

    “There was no indication the office was notified of your order,” he replied. “To be honest, that doesn’t surprise me. The internet is the Wild West.”

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    She groaned. “My regular exam is covered by insurance but since we aren’t doing it today do I have to pay another $60?”  Dr. Coakley nodded. “Great. I shouldn’t have come back,” she muttered.

    Dr. Coakley escorted Stephanie to check out, but at the front desk she had one more question.

    “Now that you have my records from my old doctor, can you give me the glasses prescription she wrote?” she said, holding her broken glasses.

    The Big Questions

    • Is there anything you would have done differently if you were Stephanie’s doctor in this case?
    • Have you ever dismissed a patient for not complying with a treatment plan? How about using contact lenses without a prescription?
    • Would you give a patient a faxed copy of an outside prescription? Why or why not?
    Nancy C.
    Cortland, NY

    No, I would not provide a copy of another doctor’s Rx. I would instruct the patient that information needs to be provided by them. I would explain to the patient there was no CL Rx to verify or fill. The CL she is wearing was not prescribed and is equivalent to street drugs—a crapshoot. I would review proper procedures for exams, CL fitting and follow-ups, and have it in writing to have signed as understood. Then I would explain that I cannot provide services, nor will ever, as noncompliance and disregard has been the obvious choice of conduct. I would not be willing to accept responsibility for such a patient. I would provide a list of providers in the area, smile and wish her luck.

    Angel M.
    Cynthiana, KY

    Stephanie’s previous office did nothing wrong; they faxed everything Dr. Coakley would need to start the fit. They definitely were in the right, alerting his office that she was a bad debt. Most noncompliant patients tend to dismiss themselves when they don’t like what the doctor tells them! Just make sure you document, document, document everything — and I mean everything. And giving a patient someone else’s faxed Rx, especially when they are a bad debt and have no history of contact lenses, etc., is beyond the pale of professional courtesy and could land Coakley’s office in hot water — considering she had never had a contact fit — if she re-orders sub-par contacts again and has permanent damage as a result. I’d tell noncompliant grifter Stephanie that she needs to call her doctor for a copy, and document, document, document. PS: Did I mention to document everything?

    Nina C.
    North Chesterfield, VA

    I would not write a prescription from another doctor’s faxed record. I would charge her for a refraction so she has an updated glasses Rx, so she can discontinue contact lens wear and also for the specialist copayment.

    Jenna S.
    Fargo, ND

    If she was a bunny hill skier who went down a black diamond slope and broke her leg, she wouldn’t think twice about paying for follow-ups and following the doctor’s instructions. The doctor needs to have a real serious talk and let her know what the long-term implications can be to her vision and her life. I would not release her Rx to her from another doctor — it wouldn’t be mine to release. She needs to talk to them about that. I would consider filling it in my office but she would need to pay for it before the order, since she has a history. I would have our opticians try to repair her frame, even if it is with superglue and tape, especially if it means she throws those contacts away before she ever leaves the office.

    Martha D.
    Wheatfield, IN

    Unfortunately, we have run into this situation too often. When we do, the doctor will always try and advise the patient on the best course of action. If the patient is non-compliant then he’ll refer them to an ophthalmologist for further review. He will prescribe glasses to get them by until the eye is completely healed. The glasses would probably have to be changed a couple of times. The doctor would release a patient from his care if they were noncompliant. We did have a patient once who would sleep in his contacts all the time, get eye infections and end up in the emergency room. He quit coming to see us because we “nagged him” about his over-wear of contacts.

    What’s the Brain Squad?

    If you’re the owner or top manager of a U.S. eyecare business serving the public, you’re invited to join the INVISION Brain Squad. By taking one five-minute quiz a month, you can get a free t-shirt, be featured prominently in this magazine, and make your voice heard on key issues affecting eyecare professionals. Good deal, right? Sign up here.

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