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Anon E. Muss
medicine forum Guru Wannabe
Joined: 22 May 2006
Posts: 136
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 Posted: Sun Jun 25, 2006 10:44 pm Post subject:
Re: sick of astigmatism (soft torics)
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On 25 Jun 2006 14:11:35 -0700, "Dr. Leukoma" <drg@leukoma.com> wrote:
| Quote: | p.clar...@gmail.com wrote:
but my view of many private doctors is not that they are doing a better
job. in fact it oftentimes seems to me that many patients who come to
me after having previously been to a private doctor have had their
wallets lightened to a significant extent unnecessarily (e.g. sold $400
progressives when simple OTC readers would have sufficed, etc.).
Ummm, wait a minute. I CHOOSE to wear Hoya ECP progressive lenses
with AR coating OVER my contact lenses. Why do I do that? Because I
once used OTC readers and this is a heck of a lot better. If my
patients can afford to pay for it, why shouldn't I offer it?
|
I'm preaching to the choir here, Dr. Leukoma, but...
You should offer it, depending on the person's complaints. There are
advantages to progressives with A/R coating over OTC readers (and
visa-versa). A patient should be informed of the pros and the cons of
the various lens options.
I always recommend the vary best and let the patient let me know what
want/need and what they can/can't afford.
When a person walks into a restaurant, a hamburger might suffice, but
if the patron asks what the waiter recommended and the waiter said
"Filet Mignon", is the waiter attempting to unnecessarily lighten the
patron's wallet?
When a person walks into a Mercedes dealer and asks what car the
salesman recommends and the person said a SL 600 when a C 230 would
get a person from point A to point B, is that salesman unnecessarily
trying to lighten that customer's wallet?
Realize there is a difference between recommending the best (being a
good doctor) and trying to pressure sell/cram something to a customer
(being a salesman).
Likewise, when a patient has a complaint and asks what I recommend, I
state what I recommend based on what I think would work best. If you
bring preconceived notions as to what that patient can/can't afford,
you are doing him a disservice.
And by offering the very best, it is good for the patient and the
practice. Good for the patient as they have the opportunity and are
exposed to the very best in eyecare. Good for the practice as in the
best options are typically have the largest profit margin. Good for
the practice as in happy patients with high-end spectacles refer in
their friends for the same.
People who want nicer clothes with superior service go to places like
Nordstrom's rather than WalMart. Likewise, those who want superior
eye care go to private practice ODs rather than, say, a WalMart OD.
Can't we be honest with ourselves here? It's pretty clear why people
go where they go for eyecare. You could make the same arguments for
the people who go to $499 LASIK factories versus $5000 LASIK surgeons.
Some people are driven primarily by cost, others are driven primarily
by quality. I enjoy all my patients and I take equally good care of
them, but to be honest, I would rather have my schedule filled with
those who prefer quality over cost. It makes no difference to a
retail OD because he makes the same no matter what he recommends.
Private practice ODs certainly need to watch themselves to make sure
their recommendations are not based primarily on profit. And retail
ODs need to watch themselves to make sure they don't get lazy and make
recommendations based on what is easiest for the OD. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sun Jun 25, 2006 10:53 pm Post subject:
Re: sick of astigmatism (soft torics)
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I'm not so sure this much preaching was necessary, and I think that
there are other more subtle arguments to be made, but what in the heck
is the point? Are you trying to prove how "wise" you are?
This has to do with somebody being able to find someone who is willing
to spend the time to do the job that is necessary. Time is money and I
don't care where you practice. If it isn't your money it is somebody
else's. If somebody goes through 8 years of professional training, I
would expect that they should be able to earn more than $35/hour. If
you are happy with that, fine. Otherwise, go do something else.
Personally, I would go do something else.
DrG
Anon E. Muss wrote:
| Quote: | On 25 Jun 2006 14:11:35 -0700, "Dr. Leukoma" <drg@leukoma.com> wrote:
p.clar...@gmail.com wrote:
but my view of many private doctors is not that they are doing a better
job. in fact it oftentimes seems to me that many patients who come to
me after having previously been to a private doctor have had their
wallets lightened to a significant extent unnecessarily (e.g. sold $400
progressives when simple OTC readers would have sufficed, etc.).
Ummm, wait a minute. I CHOOSE to wear Hoya ECP progressive lenses
with AR coating OVER my contact lenses. Why do I do that? Because I
once used OTC readers and this is a heck of a lot better. If my
patients can afford to pay for it, why shouldn't I offer it?
I'm preaching to the choir here, Dr. Leukoma, but...
You should offer it, depending on the person's complaints. There are
advantages to progressives with A/R coating over OTC readers (and
visa-versa). A patient should be informed of the pros and the cons of
the various lens options.
I always recommend the vary best and let the patient let me know what
want/need and what they can/can't afford.
When a person walks into a restaurant, a hamburger might suffice, but
if the patron asks what the waiter recommended and the waiter said
"Filet Mignon", is the waiter attempting to unnecessarily lighten the
patron's wallet?
When a person walks into a Mercedes dealer and asks what car the
salesman recommends and the person said a SL 600 when a C 230 would
get a person from point A to point B, is that salesman unnecessarily
trying to lighten that customer's wallet?
Realize there is a difference between recommending the best (being a
good doctor) and trying to pressure sell/cram something to a customer
(being a salesman).
Likewise, when a patient has a complaint and asks what I recommend, I
state what I recommend based on what I think would work best. If you
bring preconceived notions as to what that patient can/can't afford,
you are doing him a disservice.
And by offering the very best, it is good for the patient and the
practice. Good for the patient as they have the opportunity and are
exposed to the very best in eyecare. Good for the practice as in the
best options are typically have the largest profit margin. Good for
the practice as in happy patients with high-end spectacles refer in
their friends for the same.
People who want nicer clothes with superior service go to places like
Nordstrom's rather than WalMart. Likewise, those who want superior
eye care go to private practice ODs rather than, say, a WalMart OD.
Can't we be honest with ourselves here? It's pretty clear why people
go where they go for eyecare. You could make the same arguments for
the people who go to $499 LASIK factories versus $5000 LASIK surgeons.
Some people are driven primarily by cost, others are driven primarily
by quality. I enjoy all my patients and I take equally good care of
them, but to be honest, I would rather have my schedule filled with
those who prefer quality over cost. It makes no difference to a
retail OD because he makes the same no matter what he recommends.
Private practice ODs certainly need to watch themselves to make sure
their recommendations are not based primarily on profit. And retail
ODs need to watch themselves to make sure they don't get lazy and make
recommendations based on what is easiest for the OD. |
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p.clarkii@gmail.com
medicine forum Guru Wannabe
Joined: 11 Sep 2005
Posts: 247
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| Posted: Mon Jun 26, 2006 2:51 am Post subject:
Re: sick of astigmatism (soft torics)
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sure. if the patient is informed that they have a negligible
prescription and that OTC readers will work fine for them, and they
choose to pay a high price for expensive progressives, thats fine. but
i've encountered quite a few patients who were simply told "they need
bifocals now" and were fitted with an overpriced set of no-lines. they
were surprised to hear from me that they could use OTC readers.
likewise i've encountered patients who are low myopes who see well at
near without any correction who are also wearing bifocals and were
never told they could just use single-vision glasses and take them off
to read.
I think as doctors we need to fully inform our patients of all their
options including the ones that don't involve us making as big a
profit. in my current retail situation, i don't make any profit on
sales of glasses or contacts by the optical staff in the office. my
only concern is that the patient got the best treatment they could when
the left my exam room. motivations can be very different in some
private offices since their income comes from exam fees AND mark-up on
materials.
i'm not saying thats what YOU do, or thats what Larry does, but I've
seen it happen a significant number of times. and I'm sure it can also
happen at retail locations by doctors who are more influenced by their
retail company than I am.
----------------------
Dr. Leukoma wrote:
| Quote: | p.clar...@gmail.com wrote:
but my view of many private doctors is not that they are doing a better
job. in fact it oftentimes seems to me that many patients who come to
me after having previously been to a private doctor have had their
wallets lightened to a significant extent unnecessarily (e.g. sold $400
progressives when simple OTC readers would have sufficed, etc.).
Ummm, wait a minute. I CHOOSE to wear Hoya ECP progressive lenses with
AR coating OVER my contact lenses. Why do I do that? Because I once
used OTC readers and this is a heck of a lot better. If my patients
can afford to pay for it, why shouldn't I offer it?
Drg |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Mon Jun 26, 2006 3:50 am Post subject:
Re: sick of astigmatism (soft torics)
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p.clarkii@gmail.com wrote:
| Quote: | i'm not saying thats what YOU do, or thats what Larry does, but I've
seen it happen a significant number of times. and I'm sure it can also
happen at retail locations by doctors who are more influenced by their
retail company than I am.
|
By virtue of the fact that you would even consider it is resprehensible
to me.
Getting back to overhead. If you aren't paying overhead, the optical
shop is paying it for you, and if you aren't generating enough patient
revenue for the optical shop, then you are as worthless as tits on a
boar to them.
The more you say, the worse it gets.
DrG |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Mon Jun 26, 2006 3:58 am Post subject:
Re: sick of astigmatism (soft torics)
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p.clarkii@gmail.com wrote:
| Quote: | I think as doctors we need to fully inform our patients of all their
options including the ones that don't involve us making as big a
profit. in my current retail situation, i don't make any profit on
sales of glasses or contacts by the optical staff in the office. my
only concern is that the patient got the best treatment they could when
the left my exam room. motivations can be very different in some
private offices since their income comes from exam fees AND mark-up on
materials.
|
This is about as patronizing as anybody has ever been to me on this or
any NG.
The plain fact is that we keep a display of OTC, non-prescription
reading glasses on the counter at the checkout. They are way cool.
Since when are you unmotivated by making a profit? Don't be a
hypocrite.
DrG |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Mon Jun 26, 2006 4:04 am Post subject:
Re: sick of astigmatism (soft torics)
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Dr. Leukoma wrote:
| Quote: | p.clarkii@gmail.com wrote:
I think as doctors we need to fully inform our patients of all their
options including the ones that don't involve us making as big a
profit. in my current retail situation, i don't make any profit on
sales of glasses or contacts by the optical staff in the office. my
only concern is that the patient got the best treatment they could when
the left my exam room. motivations can be very different in some
private offices since their income comes from exam fees AND mark-up on
materials.
This is about as patronizing as anybody has ever been to me on this or
any NG.
The plain fact is that we keep a display of OTC, non-prescription
reading glasses on the counter at the checkout. They are way cool.
Since when are you unmotivated by making a profit? Don't be a
hypocrite.
What am I saying? According to you, every dollar you make is profit |
thanks to the optical shop who pays the bills. Let's not get all tied
up in our conflict of interest, now. You talk like your employment is
a public service.
DrG |
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Dick Adams
medicine forum Guru
Joined: 12 Oct 2005
Posts: 300
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| Posted: Mon Jun 26, 2006 4:36 am Post subject:
Re: sick of astigmatism (soft torics)
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"Dr. Leukoma" <drg@leukoma.com> wrote in message news:1151293814.512959.187340@m73g2000cwd.googlegroups.com...
| Quote: | If you aren't paying overhead, the optical shop is paying it for you,
and if you aren't generating enough patient revenue for the optical
shop, then you are as worthless as tits on a boar to them.
|
Possibly good performance could generate good will. Grifting to
enrich one's employer might be a disservice to one's employer as
well as one's customers.
(I don't think people who purchase eyeware are patients. If you
want patients, I think you need a medical degree.)
But perhaps I am too naive.
--
Dicky |
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RM
medicine forum Guru
Joined: 25 Mar 2005
Posts: 326
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| Posted: Mon Jun 26, 2006 11:08 am Post subject:
Re: sick of astigmatism (soft torics)
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And you keep stepping in it again!
So you are arguing that he should rip off his patients to generate more
revenue for the optical shop? Then you are just validating his arguments
against you and other private doctors who might prefer to sell people things
they don't need just to maximize their revenue.
I suggest you wise up and quit posting now.
===========
"Dr. Leukoma" <drg@leukoma.com> wrote in message
news:1151293814.512959.187340@m73g2000cwd.googlegroups.com...
| Quote: | p.clarkii@gmail.com wrote:
i'm not saying thats what YOU do, or thats what Larry does, but I've
seen it happen a significant number of times. and I'm sure it can also
happen at retail locations by doctors who are more influenced by their
retail company than I am.
By virtue of the fact that you would even consider it is resprehensible
to me.
Getting back to overhead. If you aren't paying overhead, the optical
shop is paying it for you, and if you aren't generating enough patient
revenue for the optical shop, then you are as worthless as tits on a
boar to them.
The more you say, the worse it gets.
DrG
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Mon Jun 26, 2006 11:48 am Post subject:
Re: sick of astigmatism (soft torics)
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RM wrote:
| Quote: | And you keep stepping in it again!
So you are arguing that he should rip off his patients to generate more
revenue for the optical shop? Then you are just validating his arguments
against you and other private doctors who might prefer to sell people things
they don't need just to maximize their revenue.
I suggest you wise up and quit posting now.
|
C'mon, RM. Show me where I either said that or implied it. For
goodness sake get the chip off your shoulder.
If somebody gives you office space, equipment, and utilities free of
charge and there is an optical shop outside of your door, or next door,
need I draw the inference for you?
Not only that, but if your employer just so happens to be selling low
end eyewear, they've got to make it up on volume, which means that you
cannot afford to make your exam too long, or too expensive for that
matter.
Y'know, RM, it's one thing to imply(which I didn't) that a commercial
optometrist gives a quick exam for low price, but it is quite another
to accuse your colleagues of unethical behavior, which is about the
only arrow you have in your quiver.
DrG |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Mon Jun 26, 2006 12:16 pm Post subject:
Re: sick of astigmatism (soft torics)
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Dick Adams wrote:
| Quote: | "Dr. Leukoma" <drg@leukoma.com> wrote in message news:1151293814.512959.187340@m73g2000cwd.googlegroups.com...
If you aren't paying overhead, the optical shop is paying it for you,
and if you aren't generating enough patient revenue for the optical
shop, then you are as worthless as tits on a boar to them.
Possibly good performance could generate good will. Grifting to
enrich one's employer might be a disservice to one's employer as
well as one's customers.
|
Good performance gets return business. Most of the patients I
encounter cannot remember the name of their last optometrist. Good
performance also minimized liability. Good performance is always
desirable, now, isn't it?
| Quote: |
(I don't think people who purchase eyeware are patients. If you
want patients, I think you need a medical degree.)
But perhaps I am too naive.
|
You're not naive. Just deliberately unpleasant. If I treat someone
for glaucoma and they go out and purchase a pair of eyeglasses from my
"shop," is that person a 'partient' or a 'customer' or both? If that
same person walks into Walmart with my prescription and purchases a
pair of glasses, then they are obviously viewed as a 'customer' by
Walmart.
By the same token, the optometrist located in a Walmart still has to
meet the requirements for state licensure, which means that they can
indeed treat glaucoma. I just don't know how many of them do. I think
that some chains don't really want their OD's to "waste" their time
doing medical treatment. I could be wrong on that, but I don't think
so.
DrG |
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RM
medicine forum Guru
Joined: 25 Mar 2005
Posts: 326
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| Posted: Mon Jun 26, 2006 1:29 pm Post subject:
Re: sick of astigmatism (soft torics)
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Okay!
You said this:
--------------
Getting back to overhead. If you aren't paying overhead, the optical
shop is paying it for you, and if you aren't generating enough patient
revenue for the optical shop, then you are as worthless as tits on a
boar to them.
In reply to him saying this in the message you responded to:
-----------------------------------------------------------
in my current retail situation, i don't make any profit on
sales of glasses or contacts by the optical staff in the office. my
only concern is that the patient got the best treatment they could when
the left my exam room. motivations can be very different in some
private offices since their income comes from exam fees AND mark-up on
materials.
Maybe I've taken something out of context and if so I'm sorry. But
regardless I'm tired of wallowing in this smelly gutter with you so have
your fun insulting people without me. You're showing your ass but
apparently you don't realize it.
"Dr. Leukoma" <drg@leukoma.com> wrote in message
news:1151322520.630329.202420@b68g2000cwa.googlegroups.com...
> C'mon, RM. Show me where I either said that or implied it. |
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p.clarkii@gmail.com
medicine forum Guru Wannabe
Joined: 11 Sep 2005
Posts: 247
|
| Posted: Mon Jun 26, 2006 1:37 pm Post subject:
Re: sick of astigmatism (soft torics)
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Dick Adams wrote:
| Quote: | Possibly good performance could generate good will. Grifting to
enrich one's employer might be a disservice to one's employer as
well as one's customers.
|
thats the point.
when you take your car to be worked on somewhere and they tell you
there's just a slight problem and its quick and inexpensive to fix,
then you respect that person and you feel good about going back and
recommending them to others. people appreciate getting treated well,
having things explained to them, and not getting ripped off. it builds
business by gaining trust.
| Quote: |
(I don't think people who purchase eyeware are patients. If you
want patients, I think you need a medical degree.)
|
they are patients and they are also customers. eye health is what is
tested in an examination as well as refractive error. thats a medical
examination but i don't belief there is any "semantic rule" that states
only medical customers can be called patients. |
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Anon E. Muss
medicine forum Guru Wannabe
Joined: 22 May 2006
Posts: 136
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| Posted: Mon Jun 26, 2006 2:00 pm Post subject:
Re: sick of astigmatism (soft torics)
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On 25 Jun 2006 19:51:36 -0700, p.clarkii@gmail.com wrote:
[snip]
| Quote: | likewise i've encountered patients who are low myopes who see well at
near without any correction who are also wearing bifocals and were
never told they could just use single-vision glasses and take them off
to read.
|
Every single presbyopic myope who was able to do that has been able to
figure that out on their own. Without exception. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
|
| Posted: Mon Jun 26, 2006 2:01 pm Post subject:
Re: sick of astigmatism (soft torics)
|
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RM wrote:
| Quote: | Okay!
You said this:
--------------
Getting back to overhead. If you aren't paying overhead, the optical
shop is paying it for you, and if you aren't generating enough patient
revenue for the optical shop, then you are as worthless as tits on a
boar to them.
In reply to him saying this in the message you responded to:
-----------------------------------------------------------
in my current retail situation, i don't make any profit on
sales of glasses or contacts by the optical staff in the office. my
only concern is that the patient got the best treatment they could when
the left my exam room. motivations can be very different in some
private offices since their income comes from exam fees AND mark-up on
materials.
Maybe I've taken something out of context and if so I'm sorry. But
regardless I'm tired of wallowing in this smelly gutter with you so have
your fun insulting people without me. You're showing your ass but
apparently you don't realize it.
|
Let's review the situation, shall we? My first remark was that $70 did
not seem like a professional fee. Frankly, I didn't have any
particular image of any particular OD...it's just that I could not
figure out how a person with a difficult-to-fit prescription was going
to be able to be properly serviced by someone whose fee seemed
incommensurate with the time required. What followed was a stream of
inferences and innuendo about the lack of professional ethics of
private practice OD's. Personally, I have nothing against the 10 or 12
commercial OD's who practice within a 5 to 6 mile radius of me. I can
only control what goes on inside of my office, and what I do with my
head and my hands. The ethics or lack thereof of the OD down the
street, and who they work for is the least of my concerns.
My comments above describe the business model, and not the ethics of
the O.D. You are employed by your company to generate prescriptions
for the optical shop. You are not there as a public service. There is
nothing illegal or unethical in that business model. It is simply a
reality. And, yes, you do have to walk a tightrope. But, as an O.D.,
you did take the same oath that I did, which is always to put the
patient first.
So, let's leave it at that and agree to disagree about fees and not
question our ethics.
DrG |
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Dick Adams
medicine forum Guru
Joined: 12 Oct 2005
Posts: 300
|
| Posted: Mon Jun 26, 2006 3:17 pm Post subject:
Re: sick of astigmatism (soft torics)
|
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|
"Dr. Leukoma" <drg@leukoma.com> wrote in message news:1151324173.190218.161260@y41g2000cwy.googlegroups.com...
| Quote: | ... I think that some chains don't really want their OD's to "waste"
their time doing medical treatment.
|
I think I should be able to straightforwardly get eyeglasses which
allow me to read highway signs at night, to recognize faces on the
other side of the street, and, if I am a student, to read what is written
on the blackboard. (Don't care about the conditions of employment --
mosly my eyecare people have been employed my medical groups.)
| Quote: | ... Most of the patients I encounter cannot remember the name
of their last optometrist.
|
I remember the names of 2, of possibly 7, phoropter operators
who, in the last several decades, upgraded my prescription in such a
manner that I did not need to return for repeat measurements or new
"glass". Both were on-the-job-trained ladies who worked for Dr.s
(both OMDs). I could ask for them next time, but it was not
my choice. Those two times I could finally read the 20/15 line.
(There was one OD who did a good job, but he did not last. I have his
name written down, but could not find out where he went next. Probably
was taking to long with the refractions.)
| Quote: | You're not naive. Just deliberately unpleasant.
|
Just tellin' it like I see it.
(With 20/15, sometimes)
I think it is fine when ODs or technicians check pressure, but I'd
presume that treating glaucoma would be one of the things that the OMDs
should do.
--
Dicky |
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