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Stop cheating your patients


Many optometrists are cheating their patients. This cheating comes from a good place-they are trying to help. This very common paradox comes into play when a well-intentioned doctor stops short of making strong recommendations in order to not sound “salesy.”

Many optometrists are cheating their patients. This cheating comes from a good place-they are trying to help. This very common paradox comes into play when a well-intentioned doctor stops short of making strong recommendations in order to not sound “salesy.”

Here is a common example: A 48-year-old computer worker is complaining of eye strain and headaches after a few hours at the computer. She uses the computer all day at work, and at the end of the day she can't see well enough to drive home. She has been prescribed glasses before but “isn’t going to pay those ridiculous prices” when she can get by with the drugstore glasses that she has always used. (She likes to leave pairs lying all over the house.) This patient also thinks the $10 copay should be waived this year because we didn’t tell her about it before she arrived.  

More practice management: Why it's OK to be bossy

We all know that she needs high-quality progressive lenses with AR treatment, but only half of us are confident enough to tell her. And half of the ones who will tell her will list it as one of her options. When we dillydally around this topic, we are cheating our patients. 

Which is better: one or two?

Here are two scenarios of what could be said to this patient at the conclusion of her exam. Read them both, and decide which one is best. Neither one may be perfect, but please choose one.

1. “One thing you could do is wear progressive lenses, and you could add an anti-reflective treatment to them that might help with some of the strain at the computer. But the progressives have only a little part for the computer and are hard to get used to sometimes, especially at the computer, and that AR is hard to keep clean. Plus, they are expensive, and your insurance won't pay for them.  Because your distance vision is pretty good without glasses, you could just keep on using those drugstore glasses. And for that eye strain, follow the 20-20-20 rule: every 20 minutes look at something 20 feet away for 20 seconds.”


2. “In our office, everyone who uses the computer for more than three hours a day gets a prescription for glasses to help with the strain and damage it can cause. In your current job, you far exceed that limit. Our eyes simply aren’t designed for that type of work, and those drugstore glasses are not enough for you at work. We have known for many years how much strain can come from hours of near demand, but new studies are showing damage from the type of blue light that comes from our computers and smart phones. For you, I am prescribing a progressive lenses specifically designed for computer users, and they will have a coating that will help with eye strain and protect you from blue light. It is important that you use these at work. They will help with your headaches and other symptoms."  

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Next: Which is better?


We all know that number two is better, but for some reason, many of us find ourselves using script number one.  

Many optometric consultants teach this same lesson, but they give the wrong reason. The consultants say to make strong recommendations in the chair because it helps you sell more glasses-which it does. But that is the logic that makes us feel too “salesey.”  

I contend that you should change the reasons that you make strong recommendations to patients and stay out of their financial business. We are eyecare professionals, not financial advisors. If we do it for the good of the patient, then we can have the satisfaction of taking care of people. The financial benefit will still be there, but it isn't our priority.  

More from Dr. Rothschild: Why you need a practice mission

Stop the “good, better, best” routine

There is another method created by business people to help us get more (financially) out of our practices. The “good, better, best” routine is built on the first scenario above, which shows your patients choices on how to best correct their vision. “Good” may be a plastic-lined bifocal, “better” may be a regular progressive, and “best” is a digitally-surfaced progressive lenses with high-index material. This is built on the assumption that everyone wants the best, and they will pay for whatever they can afford. The truth is that the recommendation from the doctor is now voided by these choices because the staff is communicating that they are all acceptable choices.

If you tell your patients what they need to see their best, then they all have the opportunity to get the best. When the recommendation is made with the motivation to take care of the patient, everybody wins.  

Next: Financial objections


Financial objections

Certainly there will be situations in which patients are unable or unwilling to pay for your recommendations. Wait until that problem arises to address it-don’t anticipate or create the problem yourself.

When someone hears a dollar amount that she must pay, silence is not an objection. Silence is thoughtful consideration that sometimes leads to an objection. It is also consideration of what account has this much money, which credit card she should use, or other payment strategies. During conversations about money, when silence occurs, wait seven seconds (count in your head) then ask, “Are there any questions I can answer?”

More from Dr. Rothschild: 5 tips for planning a successful practice event

Be ready for objections with Plan B

Objections will arise, so we must be ready with our plan. The recommendation doesn’t change, so we have to help the patient decide how to handle it. Plan Bs can include alternative payment methods, discounts, or less-than-ideal products. But if the patient decides to choose a lesser product, it is against our recommendation, and we must make that clear in a respectful way.  

Your patients come to you for help on taking care of their vision, and you know how to do that. They deserve your best.

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