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Real Deal

How Would You Rate This Practice’s Handling of an Angry Early Bird?

A patient denied before-hours service takes matters into her own hands.

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SPARKLE CITY OPTOMETRY normally opened its doors at 8am. Receptionist Heather, a night owl, found she could only manage this by grabbing breakfast at the coffee shop next door and scarffing it down at the front desk. One morning, Heather looked up from her sandwich to see a woman peering in the window. Heather jumped a little, and the woman waved impatiently and pointed at the door. Heather suppressed an eye-roll and moseyed over, keeping her hand on the deadbolt as she leaned her face through the door crack. “Good morning, ma’am, we will be opening in 10 minutes!” said Heather cheerfully.

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 info@meredithoptical.com
  • “I know that, but I need to get my contact lens order and I really need to get to work as soon as possible!” she said.

    “Our staff are still arriving and getting the office ready. I will unlock the door at 8am and we can make that happen,” said Heather, stepping back.

    “Wait!” the woman exclaimed. “Can’t you just get them for me? I paid already; you just need to hand them to me!” 
    “It’ll just be 10 minutes,” continued Heather. “There is a coffee shop next door while you’re waiting?” she said, flashing her best smile at the scowling woman. She grabbed her food off the desk and marched back to an empty exam room, far from any windows.
    By 8am the lights and equipment were on and Heather’s coworker unlocked the front door. The woman made a beeline to reception and coolly gave her name to Heather, who had the boxes of lenses ready.
    “My eyes are actually bothering me, too,” said the woman. “I think it’s allergies. Can Dr. Wylam see me now?”
    Heather grabbed the schedule and studied it, while the woman scanned her name tag. “Yes, I think we can do that! I am going to need to pull your insurance, but I can do that while you’re in with him,” she said. “You have a $30 copay. I’ll take that and a technician will bring you back.”
    A few moments later, Dr. Wylam stepped into the exam room, already operating on autopilot. “Good to see you. My notes say you’re having some allergy issues. Let’s take a look at your eyes, chin up here, look at my ear, blink…”

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    The patient suddenly pulled her head out of the chin rest and shook her head. “Actually, I need to speak to you about your receptionist Heather,” she announced. “She was here at 7:50am and came to the front door but refused to give me my contact lenses. I’m making myself late for work but I couldn’t leave without talking to you. I’ve never been treated so rudely!”

    The doctor was shocked. “I’m so sorry that happened,” he said.

    “I’m sure you are, but I want to know what you’re going to do about it,” she said, clasping her hands.

    “Well I’m sure there will be a conversation, and…”

    “I think you should fire her,” the patient said bluntly.

    “I’m not going to do that,” said Dr. Wylam without hesitation. “We have an internal system for handling staff issues.”

    “Then you’re losing five patients: me, my husband, my son and my parents,” she said. “Now, I really need to go to work.”

    Dr. Wylam said goodbye to her and summoned Heather to hear her side of the story.

    There was no punishment or follow up, but a few weeks later Dr. Wylam received a voicemail from the patient, livid that the visit had been submitted to her insurance. She threatened to report fraud if he didn’t cancel the claim and reimburse her for the $30 copay.

     

    The Big Questions

    • Did Heather treat the patient badly, or is she blameless?
    • Should this exam have been submitted to insurance? Why or why not?
    • Is there anything Dr. Wylam can do or say to salvage the situation?
     

    Expanded Real Deal Responses

    Greg H. Minneapolis, MN

    Bill her insurance. Do not refund her a penny. Your open hours are your open hours…not 10 minutes prior. Let them walk; there are more fish in the sea. Chances are she’ll be back. Too bad for your staff. Sadly, the doctor’s hands become tied whenever a patient makes ridiculous demands, and reprimanding a staff member in front of a patient to assuage the patient’s overly ruffled feathers is a dangerous precedent to set. He was right to defend Heather at that point, but a follow-up apology letter with a gift card afterwards might have helped. PS: What office is still “getting ready” 10 minutes before opening?!!

    Lewis K. Milan, TN

    Heather should have gone and gotten the lady’s contact lenses. Insisting on firing her was unreasonable. We are there to serve our patients and anything reasonable that we can do to improve our services is indicated.

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    Danielle S. Fort Worth, TX

    The question you should ask yourself is, “If I were the patient, what would I want?” The staff member wasn’t in the wrong, but the manager/doctor was. Your staff doesn’t make the decision when to come in, so therefore you should mandate that enough staff members get there 10-15 minutes before 8am to unlock the door, get the office ready, and avoid problems like this. It’s a simple solution and far more convenient for the patient. In addition, the staff should be trained to go above and beyond for your patients. Don’t leave good behavior up to fate! The charges are a little tougher. If you schedule an appointment with a doctor, you should expect to be billed. The time you took on the schedule is time they lost on other patients with real issues and trouble. However, common courtesy shows the doctor could make the choice to waive the fee, due to the circumstances of the false visit. There isn’t one right answer!

    Tim O. Richmond, VA

    Not to be too hard on Heather, but she should come to work prepared for the day and ready to work once clocked in. Creating a customer experience will reinforce strong lasting relationships. Heather should have taken care of the customer immediately and not put her off. This would have eliminated the additional issues. Given the actual events, the customer charges should have been voided and no claim sent to the insurance company. It was bad enough that they lost the family’s business; you do not want to do more damage and risk an online review that could deter other customers from doing business at the office. The doctor’s response to the request for Heather to be fired was perfect. I would suggest the doctor go above and beyond once all the event details are known to keep the customer. Except for firing Heather!

    Sheri H. Creighton, NE

    If Heather did not wish to be bothered before 8 o’clock, she should not have been sitting and eating her breakfast in full view of the windows. Was she clocked in? If she was, she is at work and should have assisted the woman. If not, she should be eating in a break room. Should the appointment be billed? Yes, the patient stated that she was having eye issues. She should simply have asked to speak to the doctor about a personnel matter. The only way for the doctor to defuse the issue was to apologize to the woman in person and explain the insurance issue versus the personnel issue. He should speak to his staff about using the break room. If you are clocked in you are considered to be at work and should assist patients even if it isn’t the stroke of 8 o’clock.

    Staci V. Sun City, AZ

    While it sounds like the patient was a bit over the top and demanding, I think it could have been handled a bit differently. It sounds like Heather was pleasant and tried her best to delay the woman, but it would not have been the worst if she helped the woman a few minutes early, unless store policy prohibits it or she herself was not qualified to dispense the lenses. While it was underhanded of the woman to make an appointment under false pretenses and she should have been up front about why she wanted to speak with the doctor, the visit should not have been billed to insurance. As for as the woman’s demand that Heather be fired, she was out of line, and the doctor did well in his response.

    Stewart G. San Francisco, CA

    1. No, the patient was not treated badly. There are many offices where rules are to start business at official opening time, not before. In some cases, premises insurance will not cover accidents during non-business hours. The employee was very polite. However, I would tell staff that they cannot eat in full view of the public. And if the patient had to get to work, why did she waste time creating that ruse right then and there?
    2. I wouldn’t have, because the non-medical nature of the visit became apparent at the time the patient spoke to the doctor.
    3. He shouldn’t bother. If the patient is offering their business predicated on removing an employee who did nothing wrong, that’s a patient you do not want in your practice. The doctor’s appreciation of their staff in these instances will go a long way to maintaining the office environment and increasing business.

    Sondra M. Wichita, KS

    Our policy states that we MUST have two people in the office before the doors are opened just to avoid this possibility. This gives an eyewitness to any unhappy occurrence and helps in controlling flow of the office. The only fault I see is that Heather made herself vulnerable by being visible. Office hours are office hours and clearly stated, if we make an exception for one, we must make exception for all. That’s bad practice as patients will think they can come and go at their convenience and not stated open hours. Insurance is justifiably filed. She stated her complaint and took the doctor’s time. The doctor stood up for his staff, that makes for a great work environment when staff know they won’t be penalized for upholding stated business guidelines. However, there should be policy in place regarding eating outside of designated areas.

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    Kenneth P. Oklahoma City, OK

    The practice took a chance on losing a patient or patients for a 10-minute issue. This sounds like an internal problem that needs to be handled quickly. Poor handling will cost the practice patients, reputation, and money. The office manager or the doctor needs to impress on the staff that they are in a customer service profession, and this was a big fail. Heather shouldn’t be fired. Nothing should have been filed. A nice gift card should be sent for the patient’s trouble. With all the competition out there, why would you risk losing this patient and her family for 10 minutes?

    Katie A. Nashville, TN

    Heather did not have to give the patient her contacts, but it would have been beneficial to the practice if she had. And that should always be the consideration taken by employees — to go the extra mile — especially with the competition from online companies and the unfortunate expectation of instant gratification becoming more prevalent. Our office realizes customer service is our best defense against online sales, so we try to put forth extra effort any way we can, even if it means staying over a little later to give a patient their glasses or working through the occasional lunch break.

    Daniel M. New York, NY

    She should have handed her the contacts. Nothing can fix this. No exam should be submitted. Copay should be taken in advance.

    Scott L. Greenville, SC

    Heather was not rude but she did handle the situation incorrectly. She took the time to open the door so it would not have hurt to get the patients’ contacts. She had them ready when the patient came in, so she could have just given them to her. Not a firing offense but punishable for sure. The exam should not have been submitted because the doctor did not actually look at her eyes. I would give her the $30 back and ask her not to return.

    Dennis I. Monroe, CT

    Unfortunately, Heather triggered a chain of events making a bad situation worse. Customer service is always the first priority. Customer service is what sets eyecare practices apart. Heather should have allowed the patient in and dispensed her contact lenses to her. The patient was already expecting a hassle, being late for work, and Heather just fueled the fire. There is no justification for the doctor billing the insurance company unless he actually gave the patient a diagnosis and a treatment. Since that wasn’t done, the office staff should immediately contact the patient and rectify the situation. There is a whole lot of room for staff education in this scenario and the doctor needs to adhere to appropriate exam protocols.

    Angel M. Cynthiana, KY

    Heather’s breakfast was not more important than patient relations. It would only have taken a moment to pull up the patient’s records and dispense the contact lenses. No type of examination or medical consultation was given, so she should not have been charged, or the visit filed. That was just throwing fat into the fire and I agree that it seems fraudulent.

    Monica T. Charlottesville, VA

    It is very frustrating when you come in early to try and get something done prior to opening, however since the contacts where paid for — I would have left her outside and gotten her contact lenses. It should not have been billed to insurance but very tempted to charge for the doctor’s time since she lied. I would refund the money and make notes in case she decided to return. I would also contact the insurance company and let them know to avoid getting in trouble with them. She doesn’t respect other people’s time and could have reached out to the doctor in a different manner. My doctors always shared emails or letters that needed to be addressed. If you want your staff to have the time prior to opening to be undisputed then I would put up a screen on the door so patients cannot see in or have a back desk they can work at — if she was just eating — she should stay in back to avoid this in the future.

    Olga C. Yuma, AZ 

    Heather shouldn’t have let it get that far. If she had let her in and dispensed the contacts in the first place the other issues wouldn’t have arisen. Sometimes staff has to use their best judgement with patient satisfaction.

    Rick R. Girard, PA

    1. Heather is 100% to blame. If she would have eaten breakfast somewhere besides in full view of a potential situation like the one that happened, all of this could have been avoided. No, instead she adds fuel to the fire by not giving the customer the contacts, which would have taken minutes at the most and, again, avoided the situation all together.
    2. No, since the exam was never really performed. Granted she mentioned allergies and that in itself could constitute a reason to file, but losing five patients and then getting accused of insurance doesn’t seem worth the hassle.
    3. I doubt it. He waited too long. Seems like Heather takes the cue from her boss.

    Chani M. Highland Park, NJ

    Heather didn’t treat the patient badly per se, but she did make some serious mistakes. If the office is closed, don’t sit near the front window where patients can see you. This would have made the issue a non-event. Once she was spotted AND went over AND listened to her request she should have sucked it up and handed her the contacts, they were paid for anyway. Then she should have told herself never to sit up front again when the office is closed. The encounter with the doctor should not have been billed, I understand she took time with the doctor but how do you legally code this encounter? Not cool. Refund the copay as well. Tough call as to how to salvage the situation. I would hand write a letter of apology/explanation to the patient, telling her how much I value her patronage etc. etc. and that Heather was duly admonished. The patient was definitely not 100% right either, but that’s not the point here, the point is the interaction occurred.

    Robert M. Edina, MN

    Heather should have gotten the patient her lenses and thanked her for her business. This problem escalated when she decided taking two minutes to deliver the lenses could have made the patient happy. Heather could have made a much better decision. You could make the argument for billing insurance, however better judgement could have saved even more pain and distress. Dr. Wylam should retract the insurance bill and refund the patients co-pay since no service was performed or treatment plan developed. He should write the patient a sincere apology for the incident and outline what steps have been taken to prevent its reoccurence. He could include a gift card or an offer of free plano sunwear. He should then follow-up with a phone call inviting her back to the practice.

    Lisa T. Mountain View, CA

    She wasn’t rude, but wasn’t friendly about it. The exam didn’t seem to be an exam after all, so the patient should have been charged for doctor’s time, but not billed for any services. The doctor can assure the patient that her concerns are heard and that his staff was following opening procedures. Maybe he can evaluate this procedure in the future. Apologize for the inconvenience.

    David G. Beckley, WV

    Yes, I believe the insurance should be billed, the patient agreed to see the doctor. There is not much that can be done in my opinion. Pull the shades. I am sure the patient isn’t going to pay Heather for her 10 minutes off the clock. Also, for security reasons the door should be unlocked when the office is fully staffed.

    Barbara S. Ohio

    Heather should have let the patient in, this is usually an isolated incident and for the client to have seen the employee in the window and even addressed by her made matters worse. The time it took Heather to go to the door and let the woman know she could come back and the ensuing actions, she could have just got the woman her contact lenses which were already paid for. No, the exam should not have been submitted because clearly, the woman, right or wrong was using his time to make a complaint, however, had Heather let the woman in in the first place, this would not have happened. Dr. Wylam could calmly have let the woman know, he will train his staff to let patients know in the future, if they have extenuating needs to pick up product outside of store hours, that they need to call in advance the previous day.

    Amy P. Corona, CA

    Heather should not have been sitting at the front desk eating in view of the front doors. I understand that they were closed but she should have been somewhere that she was not able to be seen by patients. Personally, for myself I would have given the patient her contact lenses but then again, I also deliver contacts to patients that are unable to make it to my office before I close and they are on my way home. I do not feel the exam should have been submitted to the insurance because it sounds as if an exam was not performed. I would not fire Heather but I would definitely have a talk with her. I always try to treat my patients the way I would like to be treated. It does no harm to go out of your way once in a while. I don’t think there is much that can be done to salvage this situation.

    Judy C. Virginia Beach, VA

    Lesson 1: Don’t eat breakfast, or any other meal, in view of patients. 
    Lesson 2: Establish an office policy concerning allowing anyone in outside of operating hours and develop a “script” to use.
    Lesson 3: Refund the copay. Cancel the claim. This patient will never let it go if you don’t. Document everything.

    Ben R. Rockford, MI

    1. No Heather did not treat the patient badly but at the same time once you open the door for a patient you are kind of out of luck. If I had opened the door, I would have taken care of her. That said I would have made a “just a minute” gesture and disappeared out of sight if it was that important that I not open the door a few minutes early. 
    2. Depends. Did the doctor find something diagnosable if so then yes the patient used doctor’s time that he could have been using for a patient who had an actual concern.
    3. No this patient is someone who is just looking for a reason to make everyone as miserable as she is.

     

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    Real Deal

    When This Doc Moved to a Concealed Carry State, She Didn’t Expect Staff to Be Packing

    What would you say to an OD who balked at legal firearms in her office?

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    DR. COLTAN, A recent NECO grad, was taking a risk. She and her husband, both avid hikers and snowboarders, had relocated from Rhode Island to Colorado to open a new solo practice. Over the last several months, between per diem shifts at local practices, she had worked to build her new office.

    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 info@meredithoptical.com

    Soon the time came to begin hiring employees, a task Dr. Coltan had been dreading. She had never even interviewed someone before, but within a few weeks she was able to secure employment contracts with Barbara, a receptionist/insurance biller, and Doug, an optometric assistant who had some optical knowledge.

    Barbara and Doug helped Dr. Coltan a great deal with promoting the office leading up to the grand opening, as they had connections with many local businesses and community leaders.
    On Dr. Coltan’s first day in business she was ecstatic about the seven exams her team had scheduled. The day flew by for everyone, and after locking the doors she invited Barbara and Doug to the break room for pizza and cake.

    “Thank you so much for all your hard work today, and for pounding the pavement this last week!” she said, her eyes misting up.

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    “You’re very welcome!” said Doug. Barbara, seeing Dr. Coltan’s emotional expression, reached out and gave her a big hug.

    “Thanks Barbara,” she said, sniffling. As she dropped her arms she whacked her hand against something hard on Barbara’s hip. “Oh! Ouch,” she exclaimed. “Oops, are you okay?” asked Barbara.

    “What was that?” Dr. Coltan wondered aloud.

    Barbara swept her long cardigan back to show Dr. Coltan her sidearm. “I have a concealed carry license,” she said casually.

    “Whoa!” Dr. Coltan’s heart skipped a few beats. She had never seen a handgun up close before, and instinctively backed out into the hallway. Doug and Barbara chuckled at her reaction, but Dr. Coltan felt her stomach turn in knots.

    “It’s okay!” Barbara called out, “I’ve worn it for fifteen years. It’s an essential safety measure for the office.”

    Dr. Coltan, still looking in from the hall, shook her head slowly. “It doesn’t make me feel safe,” she said quietly.

    Doug and Barbara gave her a look of surprise. “There will be a lot of patients carrying,” Doug said. “This is Colorado. That’s just the way it is here.”

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    The next day, Dr. Coltan found herself avoiding Barbara. She used the phone pager system rather than talking face-to-face and kept clear of the break room during the receptionist’s lunch break.

    That evening, she brought up the issue with her husband.

    “I don’t know if I can live like this,” Dr. Coltan sighed. “I feel hyper-focused on the hip or pocket of every person that walks in, wondering if they have a gun!”

    “Can you put a sign in the window telling people they need to leave their guns in the car?” he asked.

    “I mentioned this to Doug today, but he felt sure I’d lose patients,” she said. “I can’t believe I am on edge in my own office… I feel so blindsided by this.”

    The Big Questions

    • Should this new business exclude a portion of the local population? How would you phrase signage at the front door?
    • Barbara is an asset to the practice, has done nothing illegal, and is not willing to stop carrying. How should Dr. Coltan proceed?
    • If you work in a state that allows it, how do you feel when interacting with patients who are carrying?
    Darrell L.
    Goodlettsville, TN

    Interesting and thought-provoking Real Deal. The gun debate. A politically charged topic meets office management. I am a Tennessean, from the Nashville area, an optician/owner of a mom and pop optical shop and a believer in self-preservation. Through 40-plus years of dispensing, I have worked with numerous trainers and law enforcement, teaching them how to cope with presbyopia and the front sight. Yet, it is not just those who are paid to protect us, the general public has been coming to me for years who carry, some concealed and some open. At the age of 12, I was given the 12-gauge shotgun you would probably expect a Southern boy to get. I was also taught the proper use of the gun. If you don’t know how to use a tool, whether a lensometer, a hammer or a gun, then don’t pick it up. The doctor did a great job hiring. Barbara and Doug are working for the doctors’ best interest. “Avid hikers and snowboarders” and moving to Colorado implies they did visit before they moved. In Colorado it is legal to carry both concealed and open. Somewhere along the way they should have encountered locals who openly carried. Therefore she should not have been “blindsided” unless she had put on blinders. The first thing the doctor and her husband should do is take a handgun safety course to alleviate the fears they have. I’m not advocating that they buy a gun; they will be better educated after the course to make that decision themselves. They took a risk and moved to Colorado; I’d be more afraid of the bears. Partly, I feel sad that we live in a time that more of the populace feels the need to carry protection. Partly, knowing the person carries and has passed the course to own and carry making them one of the good guys, I feel relaxed. The gun is not the issue—that person needing my service is. But in the end, the doctor has every right to seek like-minded employees, have a pleasant office atmosphere and to decide who meets her criteria for patient base.

    Joyce P.
    Raleigh, NC

    Usually those who have licenses to carry are doing it for protection, not to run out and start shooting the world up. We need to be more concerned about those who are carrying illegally, not legally.

    Daniel M.
    New York, NY

    If you move to a state with open carry laws you have to accept that people will do just that.

    Douglas C.
    Beachwood, Ohio

    Fear is derived, in this case, from ignorance. Dr. Colton needs to go to a range and take a class on gun safety and learn how to shoot. Doing so will allow her to gain an understanding of firearms and will make her more comfortable around them. When people conceal carry, you don’t know they have a gun … but are you safer around them or around someone who you know has one? There’s no difference. The doctor should have a gun policy for the office that states that people who are legally allowed to possess a firearm should be allowed to have it. Whether she likes it or not, it’s legal.

    Brian C.
    Prescott Valley, AZ

    My office is in the Wild West of rural Arizona. Lots of people open and conceal carry weapons. I am not anti-gun. I grew up with weapons, so I was trained to properly care for and shoot pistols, rifles and shotguns. Took hunter’s safety classes as a teenager. I hunted elk, deer, duck, geese, doves for years. I own a shotgun currently. It is locked, unloaded, action open with a gun lock in the action, and the ammo is safely stored in a separate location. I put up a sign on my door that reads “No Firearms Allowed by Section 4-229” that AZ approved several years ago. I see them at the local VA I work in, at the local hospitals, and all the private practice MDs in my area. I am not an outlier on this issue. I did this because in the news at the time, somebody carried a concealed firearm into a business and dropped it causing a discharge (nobody got hurt). At the same time, I had a patient come in wearing TWO .45 ACP semiautomatic Colt pistols in holsters, open carry (Wyatt Earp style). He was wearing camouflage pants and black shirt with menacing writing on it. He revealed in his medical history that he had mental illness. This made my staff very nervous. In the lobby, I nicely asked him to leave his pistols in his car for the exam, showing him the 8×11 color sign on the door. I stated that in the 20 years my office was open that we never had a robbery or shooting or a need for a pistol. He huffed that I was “infringing on his second amendment rights.” I told him he could either leave the guns in the car for the exam or see another gun-friendly OD or MD down the street. He canceled, walked out the door and I haven’t seen him since. I frankly don’t care if I lose the business of people who feel (logically or illogically) that they need to carry a gun everywhere because they perceive a threat (real or unreal). My point is:

    1. My office is my private property. I will do what makes me comfortable and safe. I will do what keeps my staff and patients comfortable and safe. I will control my office and what happens in it.
    2. My office will be sued if a gun-toting person shoots or discharges a weapon that hurts anybody else. I need to limit my liability.
    3. If you don’t feel your life is in immediate danger, then you don’t need a gun. If you feel your life is in immediate danger, and that you really need a gun, then you probably don’t need an eye examination right now.
    4. Car accidents killed 11.9 people per 100,000 people in 2017. Guns killed 12.2 people per 100,000 people in 2017. I don’t let people drive cars in my office. I don’t let people have guns in my office either. Accidents killed 00.0 people per 100,000 in my office from 2002 to the present, and I intend to keep it that way.
    5. This is not a political issue. It’s a common sense issue.

    Sherri H.
    Kansas City, MO

    In states where conceal and carry are commonplace, to ask someone to leave their firearm in the car could indeed cause them to go someplace else. Dr. Colton feels very uncomfortable because she has not been around firearms. Maybe she should take a conceal carry class to get familiar with what conceal carry is all about. She might even feel empowered by the knowledge and know-how of handling a firearm. I personally feel more comfortable when I know someone is around with a conceal carry on them. She should also talk with other doctors in her area for their advice on this topic.

    Angel M.
    Cynthiana, KY

    Pro- or anti-gun, that is an overly phobic reaction by Dr. Coltan to a trusted staff member. Maybe Coltan should seek counseling or move, because she can’t plant herself in a state that has a conceal carry culture, and demand that the patients and staff change for her. PS: Y’know, she has a gun right in her name…

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    Tory M.
    Dumas, TX

    I would tell Dr. Coltan her fear is unreasonable and is because of unfamiliarity with firearms. Bad people conceal weapons all the time and you weren’t scared about that possibility? If not, you’re very naive. It was only after you were aware of it that it caused irrational fear. People are surprised if I mention I’m carrying concealed, because they can’t tell. Not the fact that I carry, but that they couldn’t tell. My advice is to ask the staff member to take you to the range and learn how to handle one safely and see what it’s like. It’s fun. And it’s freeing if you have a fear of firearms. Just like learning to drive a car, using a power tool, checking angles before dilating to prevent angle closure glaucoma, etc. If you are familiar, nothing to fear. You are going to have people ask you about prescriptions for using firearms; whether long rifles, shotguns or handguns. You might as well have a little knowledge about how they work to be a better expert too.

    Brandy W.
    Atlanta, GA

    1.) You should absolutely NOT exclude concealed-carry patients from your practice.
    2.) Dr. Coltan should expand her horizons, take a weapons safety course and learn. She clearly has zero experience whatsoever with weapons, and it seems she is making a judgment based on fear instead of education. I believe that she should respect her employees’ right to defend themselves, which is something she cannot do.
    3.) I love to see patients carrying, or anyone for that matter — it makes me feel safer. I also conceal carry and rarely go anywhere without the means to defend myself. Many criminals carry weapons — we know this. I want to be able to level the playing field.

    Julie U.
    Jupiter, FL

    I think the doctor should accept her employee with her weapon … she did before she found out. It is really great for the staff. Heaven forbid if someone came in with a weapon. At least they are protected. I carry in my business too and when customers find out we tend to talk about it in a positive way. The world is a different place, sadly, then it was years ago. I say CARRY on.

    Dr. Craig F.
    Rushville, IN

    I have no problem with someone legally carrying a concealed weapon. This doctor should roll with the punches and learn to live with it. When she goes to the grocery store, or shopping at retail locations, she will be walking by other people that are carrying concealed weapons. Maybe she should take a gun safety class so she can understand the benefits and risks of carrying vs. not carrying a weapon.

    Dennis M.
    Cedar Park, TX

    I’ve been a concealed carrier for over a decade and I suggest getting more educated on self-defense. Those of us with LTC are good people that have had EXTENSIVE background checks. Yes, it’s a way of life for a big portion of our country and is growing larger every day. I would suggest taking self-defense/beginner shooting classes and get to know the community. I’ve taken many first-time shooters to the range and seen their faces brighten dramatically. You don’t have to own a firearm, just be familiar with them. They’re not bad at all if you respect them and be responsible.

    John L.
    Nashville, IN

    Ultimately, the decision of whether a staff member carries a firearm while at work lies solely with the practice owner. There may be serious legal or insurance issues that the doctor may want to discuss with her lawyer. Hoplophobia is a real problem with some people and the decision to relocate to a less conservative area may be necessary. Shooters, particularly presbyopic ones, have special visual needs, something that may help build a new practice.

    Dennis I.
    Monroe, CT

    Dr. Coltan needs to grow up and be more tolerant. In fact, I think she needs to spend a little time at the gun range getting trained in the use of firearms. Who knows; maybe she’ll like it? Fear of guns is irrational. More people die at the hands of a drunk driver than the wrong end of a gun. She is not afraid of cars or beer, is she? Yes, this hit a nerve with me; as I have lost very young patients to gun violence (Sandy Hook). Guns don’t kill people. People kill people. Learn to handle the (whatever object causing fear) and fear goes away.

    D Bailey
    Huntsville, AL

    We all have certain rights that we can choose to exert or not. I have a license to drive a car, but my boss won’t let me park in the spaces saved for our patients. I can buy alcohol, but the doc won’t let me drink at work. We have policies covering these issues. If I don’t agree with the polices, I can always find another job. The owners should set their policies to reflect the type of business/environment that makes them comfortable. As an employee or as a patient, all that is important is that the doctor is providing exemplary service. If so, they will have many people wanting to work and see them, regardless of whether they allow dogs, alcohol, legal marijuana, and yes, even guns on their property.

    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

    How Should an Office Handle this Disgruntled Patient with Unpaid Bills and Ongoing Medical Needs?

    The doc wants to keep treating him and hopes to erase that negative online review despite his overdue balance.

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    DEENA, BILLING MANAGER at Rose Family Vision in southern Rhode Island, was reviewing an accounts receivable statement when her extension rang.

    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 info@meredithoptical.com

    “Hi Deena. You asked me to tell you when Edwin was about to check out. Can you come to the front desk?” said a receptionist.

    “I’ll be there in a minute,” she replied, grabbing her clipboard.

    Edwin, an older gentleman, was pacing the showroom when Deena arrived. He saw her and nodded in recognition. “Nice to see you again, Edwin,” said Deena, extending her hand. “Let’s sit someplace quiet.”

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    Deena escorted Edwin into an empty exam room and closed the door. “So, I know you had your eye exam today with Dr. Rose,” she said, “and we still have the glasses you ordered in 2017.”

    Edwin rolled his eyes, both annoyed and embarrassed.

    “You paid half, but you do still owe $240 on these glasses, and we have a $15 monthly late fee which has essentially doubled your bill,” she said slowly. This elicited a short expletive from the patient, but Deena continued. “At your insistence, Dr. Rose agreed to schedule your appointment today and will bill your insurance, but we do need to address this past due balance.”

    Edwin leaned forward in his chair. “I was hospitalized for a month and couldn’t get my glasses when they were ready, then I was recovering, and then I started getting the late fee bills and harassing phone calls, and decided I didn’t want them anymore,” he huffed.

    “Yes, I did read that in your online review,” Deena said delicately, pulling from her clipboard a printout of the two-star evaluation. “However, glasses are custom made for you, and as I had said last year, we can’t cancel an order after it is completed.”

    “Those glasses are useless now,” he replied. “I got cataract surgery down in Florida last winter and the prescription is completely different now. Why should I pay for something that I can’t even use?!”

    Just then Dr. Rose knocked gently on the door and came in.

    “Hi Edwin. Hi Deena,” she said gently, sensing the tension. “I wanted to join the conversation after today’s exam.” She took a seat next to Edwin and faced Deena. “Edwin needs a LipiFlow treatment, and we discussed using CareCredit to make that happen.”

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    Deena looked at her boss, dumbfounded. Awkward silence followed.

    “Edwin, why don’t you come out with me, one of our staff is going to explain CareCredit and help you fill out the application paperwork,” said Dr. Rose.

    Deena stayed put. Dr. Rose returned a moment later.

    “I know what you’re going to say,” began Dr. Rose, “but he needs medical care. Attach the optical bill to the new charges and put it all thru CareCredit, if that makes things easier for him.”

    “What a mess,” moaned Deena.

    “We need him to change that bad online rating,” said Dr. Rose. “It’s killing our average.”

    “I’d rather fire him as a patient,” she replied.

    “Come on, Deena,” Dr. Rose scoffed. “I need you to get Edwin back on our side.”

    The Big Questions

    • What can Deena do about the outstanding optical bill and “useless” glasses?
    • Should an outstanding optical bill ever block ongoing medical care?
    • If you were Dr. Rose, would you have done anything differently?
    Craig F.
    Rushville, IN

    I think Dr. Rose should have made this suggestion to Deena away from the patient. It would have put Deena in a less awkward position. Also, Dr. Rose should have backed up Deena and told Edwin he needs to pay for the glasses. If Edwin is belligerent, ask him to pay 50 percent of the glasses cost. That should cover the costs of making them.

    Nikki P.
    Gunbarrel, CO

    Look at the actual frame and lens cost to the practice; how much did the practice lose? Charging him that amount may be a good compromise and no one is at a total loss. An outstanding optical bill should never block ongoing medical care. If Dr. Rose had already discussed his options with him and both agreed CareCredit was the best solution, Dr. Rose should have told Deena immediately and assisted Deena in the conversation the whole time to ensure a smoother conversation.

    Barry S.
    Seaford, NY

    Opticians should become more aware of just what their added value is to an “eyeglass product.” If you subtract this added value, you come close to what online would charge for the same materials. So, if the buyer/patient isn’t receiving this added value, why are they being billed for it? It seems to me that the years of control we’ve had over the eyewear transaction have imbued most offices with a sense of entitlement to the buyer’s dollars. If nothing else, the situation described speaks volumes for separating the eyewear purchase from eye-based medical care. In any event, hope they enjoyed punishing the client for not picking up the eyewear and paying in full for it. I think we can all agree that the 50 percent deposit more than covers the lab costs for the lenses, while the frame can…well, you know. Think about it.

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    Gigette H.
    Washington, NJ

    My office has patients pay in full prior to processing any order of eyewear. We have a cancellation policy and a restocking fee policy. We state on the back of our superbill all the policies regarding payments, refunds and warranties. We also research deductibles, copays and coinsurances extensively prior to the patient’s visit. My staff and the patient know the patient’s financial responsibility at the time of service. Because of the work done pre-appointment, we have almost no billing afterwards. After years in practice, I try to be prepared for most eventualities.

    Craig L.
    Coconut Creek, FL

    After six months of not picking them up I would donate the lenses and write the rest off. You did not lose money. The deposit covered the cost of the lenses and the patient has nothing. I would then note on his chart in the future that he must pay in full upfront from now on. I would never bring it up to the patient. They lost $250 and have nothing. The patient is always first, and the profit comes from good optical karma!

    Greg K.
    Dodge City, KS

    The situation should have been handled within 90 days of the original order unless the extenuating circumstances had been explained to the office. Multiple attempts to communicate with the patient should have been made. If no response, then the frame could have been returned to inventory to reduce the patient’s balance and the “custom” lens cost remains the patient’s responsibility. We bend over backwards to accommodate a patient’s needs and situations, but with no explanation from the patient, at the 120-150 day mark the account should have been turned over to collections. At that point, all future orders are paid in full on the day of the order.

    Lynnette G.
    San Mateo, CA

    I too would’ve taken the patient to a quiet place and reviewed the charges. 1. Offer to remove the monthly service fees, allowing the patient to pay the original balance with CareCredit. 2. With his Rx change, depending upon the new Rx, offer to redo the lenses to a single vision lens in an Rx for whichever works best for the patient (no additional cost/SV lenses are relatively inexpensive). 3. Sign the patient up for CareCredit and wrap the remaining balance up into CareCredit. 4. Meet with the doctor prior to the visit and discuss what she was doing/set up a protocol with regards to handling patients. There is no right answer and communication is key.

    Stewart G.
    San Francisco, CA

    First of all, the practitioner should never have come in and changed the conversation without consulting his office manager first. It completely undercut the OMs credibility. Alternative forms of payment should be presented in a unified manner. Given how long the glasses had not been paid for, there should have been rules within the practice to handle this: It should have been sent to collection and/or a dismissal letter sent so that the review should be superfluous. This way, the bad review could have been discussed online because the patient is no longer a patient of the practice. If none of this is an option, treat the unpaid bill as bad debt and ask for all payments in full in advance of any services being rendered to the patient.

    Judy C.
    Virginia Beach, VA

    How badly do you want to retain the patient? 1. Update the Rx in the glasses he ordered two years ago. 2. Put everything including his medical treatment into CareCredit minus the late fees. 3. No one should ever withhold medical treatment. Ever. 4. Happy patients tell everyone they know how happy they are. 5. Unhappy patients tell anyone who will listen how unhappy they are. The practice has all the control in this case.

    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

    How Did This Trunk Show Turn Out So Wrong?

    They had such high hopes: What can the practice do better next time?

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    FUNG EYE CARE WAS an established optometry clinic on the outskirts of St. Louis, MO. Dr. Fung and her two partners employed 20 staff, a few of whom had just returned from an out of state conference. Lead opticians John and Mike were buzzing about all the new frames at the event, and asked to meet with the doctors to discuss an idea.

    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 info@meredithoptical.com

    “We would really like to throw a trunk show at the office,” said John.

    “John and I will do all the prep work, but we want to do it the Friday afternoon before Labor Day weekend, from 3-6 p.m.,” said Mike.

    “We’ve never done something like that before,” said Dr. Fung. “Where would we start?”

    “Normally two doctors see patients Friday afternoons. I’d like to reschedule the last two hours and block that time out, so if someone comes to the event without an active prescription they can be seen immediately,” John replied.

    Dr. Fung looked at her fellow practice owners, who nodded their agreement. “Okay guys, I like your confidence! Obviously, there’s some pressure to be profitable to make up for the lost appointment times, but an event could be a lot of fun for the community,” she said.

    John and Mike spent the intervening five weeks in party planning mode. Two of their frame reps with multiple lines agreed to attend. The pair decided on a tropical theme and accumulated a variety of grass skirts, streamers, leis and cardboard signs.

    Mike posted several times on the practices’ Facebook and Instagram accounts, and John reached out to the local paper to ask a reporter to visit during the event. The front desk mentioned the event to everyone who called in, and a framed sign was placed at the check-in counter. In the week leading to the big day, the opticians noticed several patients opting to hold off on purchasing to take advantage of trunk show discounts.

    Friday morning the staff arrived in Hawaiian shirts, full of energy. The day flew by and soon it was 3 p.m. The office looked fantastic: the frame reps had plenty of space to spread out their trays, the food and drinks were beautifully displayed, and a dozen helium-filled balloons at the sidewalk swayed in the breeze. The team waited eagerly near the front door.

    At 3:15 p.m., a man with his two small children came in and went straight to the food table. Mike greeted them.

    “Oh, I’m your frame rep’s husband,” the man said, pointing towards the showroom. “We’re on our way to camp for the holiday weekend as soon as she’s done. Six o’clock, right?”

    “Right,” Mike replied feebly.

    A couple who had exams earlier in the week showed up to browse and enter the raffle, but by 5 p.m. it was just the staff and the reps.

    Eventually Dr. Fung cornered Mike and John. “Guys, what’s going on? Where are the people?” she asked.

    Just then a woman walked through the front door. “Hi, I’m a reporter with the Post Dispatch,” she said, greeting the group.

    John and Mike looked at each other weakly.

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    The Big Questions

    • What could John, Mike and the rest of the staff have done differently to attract more attendees?
    • Is there a way to salvage this event? How would you handle the reporter?
    • Should Dr. Fung, as the practice owner, have done something different? As owner, would you agree to another trunk show in the future?
    Sam M.
    Princeton, NJ

    Five weeks wasn’t enough time to prepare. You have to do mailings, email, social media etc. Did you do newspaper ads? Did the participating vendors help in marketing? I also wonder if there were too many brands shown. A trunk show should be something special. We do a Lafont Trunk show every year because it IS a special line. We sell 30-35 frames in a three-hour period. Also, don’t give up! Trunk shows build on themselves. Every year you will get more people coming in. Make it a yearly event.

    Anissa L.
    Berkeley, CA

    It’s so hard to put together an event such as a trunk show. So, kudos to the lead opticians for the excitement. There are a few things I would have changed. 1. It’s never a good idea to put an optical event directly before any holiday. At that time families are spending time and money together. Solution: It would have been smarter to put the event two weeks after Labor Day. That way there would have been a better turnout and any vacation money would have been put back in people’s bank accounts. 2. Advertise! Post! Retweet! Anything to get the word out. It seems like that wasn’t done to entice people to come into the office. Maybe they didn’t know it was happening. 3. Too much excitement. When an office isn’t known for a trunk show, wait until the third go to get maximum turnout. Next time’s the charm!

    Scott K.
    Dover, OH

    First: Never have a trunk show on a holiday weekend — too many people traveling. Second: Send postcard mailers to specific household income or net worth homes in the surrounding area. On one side of the postcard make it simple and eye catching. On the other side, give some details about the trunk show but keep it clean and easy to read. Third: If possible, email your top customers. Fourth: Have the sale the same weekend every year to build up awareness over time. Fifth: Run a large ad in the local paper — go big or go home.

    Judy C.
    Virginia Beach, VA

    1. Wrong day, wrong theme. Never schedule an event on a holiday weekend. Never. Tropical theme is great, but perhaps during cold weather when everyone is dreaming about their summer vacation. Have a Kid’s Day in early August or a Mom’s Day in the spring.
    2. Nothing to salvage. Divvy up the food among the staff and reps and call it a day. Use the time with the reporter to talk about eye health and lens/frame options.
    3. Start planning the next trunk show immediately. Choose a date and a theme and set a timeline for publicity. Build excitement beyond the practice. Invite the neighborhood!

    Lois S.
    Winter Park, FL

    I think they had the right idea, but needed to NOT have it on a holiday weekend, and hold it during the week, in the daytime or afternoon. Perhaps they could stay an hour later to accommodate people after work. I would have it on a busy doctor day, so your patients coming out of the exam room will purchase. If you have no more exam spaces available, write up the order, hold it in the computer, make an exam appointment, and offer them the special pricing then. Perhaps they could have contacted their best-purchasing patients by phone or postcard to inform them of the event.

    Jenna G.
    Fargo, ND

    First thing: BAD DATE/TIME. The Friday before a long holiday weekend is not a good time to try and get people to come shop. They want to get out of town. Why clear the schedule? Instead, use that time to target patients who want to buy glasses, have them come in for their exams, and have a bigger selection to choose from. Let them know there is going to be a party and you want them there! Use the reporter to talk about the practice, not just the event. Maybe they should sit down with the practice owner and talk about what is unique about the practice. Don’t send away free advertising! Unfortunately, you can never totally predict turnout. We have had trunk shows where I have done the exact same amount of marketing, and some are hits, and some are misses. Document and evaluate. Be brutally honest about what went well, and what didn’t. Learn from it, and do it differently the next time.

    Jon L.
    Madison, IN

    As the founder of McDonald’s would say, “Early to bed, early to rise, advertise, advertise, advertise.” Ray Kroc knew that if you want business, you have to let everyone know what you are all about. Don’t think that happened here.

    Alicia M.
    Anchorage, AK

    Their first and biggest mistake was the timing of the show — Friday afternoon on Labor Day weekend. The only thing folks want to do is get off work early and finish loading up the camping and boating stuff, and leave for the weekend. Not go visit their eye doc’s office. I think if they had picked another day, possibly a Tuesday or Wednesday afternoon not preceding a holiday weekend, they would have done better.

    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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