Real Deal: The Case of the Remake Reckoning

An optician loses profits over lens redos, and a discordant doc threatens a boycott

This article originally appeared in the July-August 2015 edition of INVISION.

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Kam, the owner-optician of Central City Optical in Birmingham, AL, was about to lock the doors of his small shop for a lunch break when he recognized a patient crossing the street, waving. Kam held the door open as Libby Tyson raced inside.

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“Hey there!” said Kam, noting Libby was holding the glasses he dispensed to her two weeks ago. “Are you still unhappy with your glasses? Did you end up talking to your doctor?”

Kam’s boutique didn’t employ a doctor, so many of his customers, like Libby, brought prescriptions from local ophthalmologists without dispensaries of their own.

Libby sat down at the dispensing table and fished around in her purse. “I actually saw him this morning. He checked my eyes again and told me to give you a new prescription,” she looked up as she pulled out a piece of paper. “He said he tweaked the numbers a little, and the lenses should still be under warranty. Is that true? I don’t want to pay twice.”

Kam smiled and said, “Sure, I do want to check your glasses first.” He measured her PD and dotted the lenses, then took the eyewear and new script to his workbench. Upon performing lensometry, he found a 100 degree axis change in the right eye and the addition of prism, 0.75D BO. Kam frowned. The onus of a remake shouldn’t fall to the patient, of course, but Kam didn’t like that it fell to him. He checked the signature on the prescription; it was an ophthalmologist shared by many of Kam’s customers.

“Miss Tyson, I can have your glasses ready for you on Friday, and there won’t be a charge,” Kam said.

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“Oh, super. Thank you!” said Libby, standing to leave. Then she froze and turned around. “Actually, would you mind explaining why I can have two different prescriptions in the same month? Are my eyes going to change again?”

“There’s a chance the ophthalmologist left off the one, here,” he said as he circled the axis with his finger. “I think it was supposed to be a 115, not 15. Also, sometimes patients need prism but it’s possible the doctor didn’t check that part of your vision during the first exam.”

Libby’s eyebrows shot up. “My doctor messed up? Unbelievable.” She fumed, then said, “Well, I don’t want you to pay for that. Give me the bill. He’s going to pay for this, and I am going to go over there and get my records. Can you recommend a better doctor?”

Kam immediately regretted his honesty, but he handed over a bill for the lenses.

Three hours later, Kam’s phone rang; Libby was calling to cancel the lens order. When Kam asked her why, she said the doctor told her Kam made the glasses wrong. She had lost trust in both and just wanted to start over with someone else.

Almost as soon as Kam hung up the phone, the ophthalmologist himself called.

“I’d like to know why an optician thinks he knows more about refracting than an M.D.,” the doctor said. “Don’t my patients pay your salary? What are you thinking?”

Kam was flabbergasted, embarrassed and tongue-tied. “I’m sorry, the conversation got away from me.”

The doctor interrupted. “I don’t agree with your business practices,” he told Kam. “I won’t be recommending my patients to your optical anymore.” With that, he hung up.

Numb, Kam reflected on his situation. Would this doctor encourage his colleagues to boycott Kam’s office, too? He was used to certain ophthalmologists blaming him for redos, even when the refraction was wrong. Without their referrals, his customer flow would suffer. But between the expensive remakes and being blamed and disrespected, Kam felt quite bleak.

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THE BIG QUESTIONS

1. Did Kam cross the line between professional respect and honesty to the consumer?

2. How might Kam establish a sense of fairness in his remake policy?

3. If you were Kam, how would you attempt to repair the relationship with the MD?

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REAL DEAL RESPONSES

OLIVIA M.
Cedar Hill, TX

I don’t want to say that Kam crossed a line because our profession is based on trust: trust from our patients that we are taking the best care of their vision and not here to take their money. Trust from our opticians, that they are passing on the best vision correction and materials. Trust from our doctors, that they are providing patients with the best medical information. Kam’s mistake was his wording. He caught the mistake and was willing to fix it, but he didn’t want to take ownership of it.

STEVE W.
WAYNE, PA

Too much information to the patient. Most labs honor one exchange for doctor change. I would make the appropriate adjustment and charge for prism. Take expensive ice cream to the MD staff and ask if you can have one moment with the MD. Just “sorry” will probably do it.

JEFF G.
SPRING VALLEY, CA

Kam made the mistake of playing doctor. If the patient wants to know if her eyes are going to keep changing you have to let the patient know you are not a doctor and refer that question back to her doctor who made the Rx.

MICHELE S.
Birmingham, AL

I keep a copy of every outside prescription. When this happens, I show a copy of the original Rx and the new Rx. I neutralize the glasses on the auto lensometer and print it out. Show them the printout. Tell them that the doctor knows more about their eyes than I do.

LARRY W.
COLUMBUS, OH

I would have called and spoken to the doctor, respectfully but honestly. I’d say that I would do the remake, but I would ask, “Is this the one we need to go with? I will do the remake but it is costing me out of pocket. I value your business and will do it.”

DR. DAVID M.
Burlington, IA

The proper response would be “Yes, the doctor made a mistake. Changes and errors don’t happen too often, but must be taken care of when they do. I will remake the glasses for you at no charge. I want you to be happy.”

CASSANDRA B.
INDIANAPOLIS, IN

Certainly, we want to be honest with patients, but it is not professional to do so in a manner that will cause them to lose confidence in their doctor. I would have said to Libby, “Because eye exams are both subjective and objective in nature, sometimes what works in the exam room doesn’t translate too well to the real world. I am sure that this will be just fine for you. Fortunately, I have an agreement in place that will take care of the cost of having to redo this prescription one time in the first 60 days. I will call you when they are ready.” Kam should factor in his remake rate into his lens pricing. If I were Kam, I would schedule an appointment to speak with the doctor. Perhaps arrange to show up with some treats and apologize. If possible, have a discussion with the OMD where I thank him for the referrals and have an honest discussion about how remakes affect my business and how I don’t want patients to lose faith in either of our businesses.

DANIEL H.
Houston, TX

Beware when accepting outside scripts. Compare old and new Rxs and make sure everything adds up. If you see a glaring error or drastic change, call the patient’s doctor’s office to inquire, and keep records of your call. Tread lightly when giving out info about a doctor who sends you business.

BARRY S.
Seaford, NY

I think Kam handled it perfectly. At no time did he throw anyone under the bus, but both the doc and the patient did. I have gone through exactly this scenario for years … decades. I did suffer the reduced referral flow. And I was depressed and dejected. But it is situations like these that show you the path away from dependency. It has changed my thinking. I have no doc, and take no VCPs. I began to think differently, thinking what people want, rather than what they need, and how I should reposition myself. It’s liberating. And scary. And it’s turned out to be wildly successful.

DOREEN D.
MARBLE FALLS, TX

I would tell the MD to hire an optometrist who knows how to refract and stay with the medical side of the practice and surgeries. The only Rxs I cringe over are the ones from MDs.

ROBERT M.
Edina, MN

Both the doctor and Kam made some poor choices here. Kam should call the doctor and apologize for what he said. He should also put together a clear understandable remake policy and deliver it to each of his referral sources. He should also make up a glasses check form that verifies the prescription and compares it to the old one. An assessment as to why the optician thinks the patient might be struggling should be included. Remakes happen. Fix them and move on. Show your professionalism.

KIRA C.
Weatherford, TX

My business also does not have a doctor on staff, and this is a situation we run into fairly often. This gets sticky when it’s consistently wrong from the same doc or tech. That’s when I think it’s time to talk to the doc directly. If that goes poorly, then I think it’s time to share a little more info with the patient. I hope a doctor who referred to me would do the same were the situation reversed. If there’s no respect in a professional relationship, there really can’t be a relationship.

MARTHA D.
WHEATFIELD, IN

First of all, I never play the blame game. I hate making mistakes on someone’s glasses and I am really hard on myself when I do, but even after 34 years, I still make them. I think patients respect you and your work much more if you just own up to it. If it is a lab error or a doctor error, I prefer to speak to the doctor directly to see if there is a change or what the doctor wants us to do. But you can run into the doctor who feels he never makes mistakes no matter what. That requires a delicate touch.