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Wednesday / May 18.
HomemitwocentsPatient Communication Part II

Patient Communication Part II

Business consultant Michael Jacobs reflects on lessons learned from a high profile career in optics, giving readers his ‘two cents worth’ on the future for independent optometry. In this second article in the series he continues the discussion about the importance of patient communication.

In the first of this series of three articles I discussed the importance of good patient communication during initial contact with the patient and during the first appointment. This month I will review two important steps in the patient journey: Patient Handover to the dispenser and Payment.

Patient Handover

Let me start by saying that I am neither an optometrist nor a dispenser. I am, however, a patient and I will speak as a patient and an observer of the process of handover in the following paragraphs.

There are as many different handover methods as there are patients so to simplify this discussion I will talk about the typical optometrist handing the patient over to the dispenser immediately following the consultation. I am also going to assume that the dispenser is trained, qualified and experienced. The deregulation of dispensing was, in my humble opinion, a significant backward step for optometry, most especially for patients. The cost of an optical assistant is substantially less than that of a qualified dispenser but the quality of the advice to the patient is also less and the cost impact potentially substantial. The patient always pays, and so, as a patient I would hope to pay for qualifications and experience, not the cost per hour of an assistant.

Now that the patient has ordered their specs, it is important to advise them of the delivery expectations. Under promise and over deliver

The optometrist sets the scene for the dispenser in the consulting room and a good optometrist will (through good patient communication) explore all the patient’s needs and wants.

Assuming there are no other clinical issues, the optometrist determines the patient’s optical prescription. But does the optometrist’s analysis of the patient’s needs stop there?

I would argue that there is much more to be discussed and discovered. Does your patient spend most of the day at a computer or are they outdoors in their role as a surveyor or similar? Should they have, in addition to general purpose lenses, desktop lenses? Would safety glasses be appropriate to suit the patient’s role as a tradesperson, professional or hobbyist.

Does the patient play a sport? Would your patient benefit from scriptable safety glasses for cycling… would that save them from being knocked off their bike by an enraged motorcyclist… or protect them from injury caused by an insect hitting the eye at 50km/h. Perhaps scriptable, polarised sunglasses would suit their broader outdoor lifestyle or occupation (tax deductible for some).

Most optometrists will have heard the statistics – the average patient does not know that they can get scriptable sunglasses. Why? Because no one told them.

My wife is a massage therapist. Her hands are almost permanently oily (like eating fish and chips) so wearing conventional glasses is a real pain. Every time they are touched they get greasy. Did her optometrist ask about her occupation and offer her alternatives such as contact lenses?

So the optometrist has an obligation to do more than present a prescription. Further, they need to communicate the information gathered and recommendations to the dispenser. The best way to do this is on the patient’s file on the practice management system so that it becomes a permanent record that the rest of the staff can access.

In handing over to the dispenser, the optometrist needs to empower the dispenser to make decisions for the next stage of the process. In the patient’s mind, the optometrist is the trusted professional. The optometrist needs to demonstrate his trust in his dispenser. For example, “this is John, our highly qualified and experienced dispenser. He will take the recommendations I have determined during your consultation and provide you with a range of solutions. Choosing frames and lenses is complex and you can see from our displays that you have more than 800 frames to choose from… then there is the choice of lenses.”

So now John, the dispenser, is a qualified expert according to the optometrist and can focus on providing the patient with the solutions for their eye care needs based on your recommendation.

Personally, I believe the price of lenses (as opposed to frames) should be discussed at the very earliest stage of the dispensing process. The huge variability in lens types and costs ($80 to $800 RRP per pair) is often a shock to patients if only presented at checkout, whereas frames are most often clearly priced.

Typically, this is the point where fashion is introduced, but I would suggest that this is way too early. Practical considerations must rule. How big is the patient’s head? What sort of bridge do they prefer? Do they have issues with particular materials, such as acidic skin secretions that eat into metal frames? Is the weight of frame and lenses an issue? And I am sure my dispenser friends can think of many more.

I am not suggesting that fashion is not important. I am simply saying that fashion precedes function for the majority of patients and even when the patient insists that fashion is the most important factor, you have an opportunity to sell a second pair of specs that aren’t necessarily fashionable but do a better or more comfortable job of improving vision. A good analogy would be very fashionable high heel shoes for women. While many women will wear these clearly impractical and probably uncomfortable shoes at special times, they are not the shoes they wear all day.


Spectacles are made to a prescription.
They are tailor made for that specific patient. At checkout it is important that these facts are clearly conveyed to the patient. For example: “Mrs. Jones, you have agreed to purchase two pairs of spectacles. Each of these spectacles will take approximately seven days to make to your personal requirements. As a result, we require a minimum of a 50 per cent non-refundable deposit. If you are not completely satisfied with your spectacles we offer a guarantee so that you can be comfortable with your decision. How would you like to pay today (cash, cheque or credit card)?”

Any patient who is unwilling to leave a 50 per cent non-refundable deposit should not have specs ordered for them. End of discussion. Unfortunately, if a patient hesitates at this stage it is often because of sticker shock. This reinforces the need for early and clear discussion of price. But should they falter, give them an opportunity to return at a later date. Be proud of your recommendations and be prepared to write them down because it is possible that your patient has decided to do some comparison shopping. Open and clear communication will win over most patients (assuming of course that your prices are competitive).

Now that the patient has ordered their specs, it is important to advise them of the delivery expectations. Under promise and over deliver. Offer the patient a pre-appointment to pick up their specs and make sure that it is at a time when the same dispenser is available to fit and adjust the frames. In an ideal world the optometrist would also be available at this time to spend two or three minutes with the patient, just to give them confidence in their selection and ensure they are truly satisfied.

Next month I will offer my thoughts on spectacle delivery and the follow up communication stages of the patient communication process.

Michael Jacobs is a business consultant and columnist for mivision. He was the former Chief Executive Officer of Eyecare Plus for 10 years until early 2015.


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