graphic by Karla durangprang
Has a technician crossed the line when he warns a reckless patient of over-wear dangers?
This article originally appeared in the October 2015 edition of INVISION.
Brookside Vision Services, located in a sleepy hamlet in eastern Ohio, was a well-known resource for contact lens fittings. Dr. Omura’s last patient of the day was Patty Bouchard, a new patient in her early 20s. Richard, the technician, pretested Patty and interviewed her about her contact lens wear.
“How many hours a day would you say you wear your lenses?” Richard asked, ready to enter her responses into the computer.
“Oh, all day,” Patty said. “I live in my lenses.”
“So, is that 16 hours a day? Maybe 7 a.m. to 11 p.m.?”
Patty cutely shrugged, and said somewhat proudly, “Overnight.”
Richard checked the empty, tattered box of contacts Patty brought from home. “How often do you sleep in your lenses?”
ABOUT REAL DEAL
Real Deal is a fictional scenario designed to read like real-life business events. The businesses and people mentioned in this story should not be confused with actual eyecare businesses and people.
ABOUT THE AUTHOR
Natalie Taylor is an experienced optometry practice manager for Advanced Care Vision Network and a consultant with Taylor Vision. Learn more at tayloreye.com.
Squinting in thought, she replied, “I keep them in for a few months, until I start to feel them.”
“And when was the last time you had an eye exam?”
“It was … 2012? 2013?”
Richard stopped typing and turned to Patty. “Contact lens prescriptions expire in a year, and these lenses are approved for only two weeks. How did you …?” Richard paused, perplexed.
“My vision has been the same for a long time, so I just reorder online. Once my cousin gave me a box of a different brand, but the numbers were pretty much the same. I just need to see the doctor because I can tell my eyes have really changed,” Patty said. She was clearly pleased to have gamed the system.
But Richard felt like he had identified a criminal. He rushed to complete the pre-exam and report to Dr. Omura.
“She’s not responsible enough for contact lenses,” Richard told the doctor. “She’s just going to keep abusing them and she’ll end up with serious problems.”
Dr. Omura gently dismissed Richard, simply saying, “We’ll see.”
Several minutes later, Dr. Omura emerged and asked Richard to pull trial lenses and put them in Patty’s eyes. Richard was incredulous, but he retrieved the lenses and returned to Patty’s exam room. Her contacts were out and she was texting, her smartphone 6 inches from her nose. As he washed his hands, Richard couldn’t help himself.
“It’s dangerous to wear contacts for so long,” he said. “I saw a patient last week who slept in the same pair of lenses for months and they caused an ulcer. He’s basically blind and has to get a corneal transplant from a cadaver.”
Patty looked up incredulously. “No one ever told me that!” Then she turned back to her phone to search the Internet for images of “eye ulcers.”
Richard felt sure he had set Patty straight. He may even have saved her eyes. After finishing his duties, he left and told Dr. Omura the patient was ready.
Two days later, Dr. Omura called Richard into the practice manager’s office. Patty had posted a negative review online describing how her doctor neglected to inform her of the dangers of wearing contact lenses and she had to hear it from the “assistant.” Richard explained what he had said to Patty in private.
“Why would you scare the patient like that?” Dr. Omura said. “You should have told me what you had said!”
Richard was stunned. “You knew she was non-compliant. She needed to hear it before something bad happened!”
Dr. Omura’s face turned red and Richard knew he had crossed the line — big time.
THE BIG QUESTIONS
1. Should Dr. Omura fire Richard? If not, what should happen?
2. As Patty’s doctor, how would you have handled her non-compliance?
3. How might the practice approach Patty to address and perhaps edit what she wrote?
REAL DEAL RESPONSES
DR. GIGI C.
WASHINGTON, NJ
I tell the contact lens patients, even established ones, the good and the bad of life in contact lenses. They need to know about the possible complications including possible loss of vision. To withhold that information is not ethical in my opinion. The doctor should have educated his non-compliant patient. It was his job, not the assistant’s job.
DR. JOHN D.
BLACKSBURG, VA
Good intentions aside, Richard should not go around or above the doctor. He should get a warning this time. I would apologize for any confusion and not throw anyone under the bus. Let the patient know that our health care team is that, a team. As Patty’s doctor, I would have explained that contacts are a privilege — and a serious medical device. I always educate my patients on the risk, proper wear and potential for harm. I would have refit her in one-day disposable, check in one to two weeks, and then Rx for no longer than six months. See her back for a follow-up before any extension. This aggressive regimen will help stress the importance and potential risk.
ROBERT M.
EDINA, MN
Richard should most definitely be talked to sternly at the very least or be put on probation at the most. Staff should not interfere with medical patient care or give their opinions of medical matters. It is all right for him to go over the proper wearing schedule and how the lenses should be cared for. The complications and consequences of over-wear are for the doctor to explain. As for the doctor’s handling of the situation, he was drawing from his experience and expertise when deciding how to approach the over-wear situation.
MARTHA D.
ST. LOUIS, MO
Richard should be commended for notifying his patient about the dangers of wearing her contacts for so long. I wish more doctors would refuse to fit patients who are non-compliant. In this case, the doctor should have told the patient the dangers after Richard told him about her problems.
LESLIE B.
RALEIGH, NC
The doctor should have educated her on the benefits/risks of proper contact lens care after the tech informed him of the patient’s lens history. The tech should not be fired for caring about the safety of the patient.
DR. STEWART
G.
SAN FRANCISCO, CA
The assistant should not be fired. The doctor should go online and note that all his staff are completely qualified in what they are doing and are extensions of the doctor’s practice. What the staff member told the patient was totally appropriate. He recognized a very seriously incorrect behavior and made an effort to correct it.