Article Date: 1/1/2009

A Forceful Discussion About Compliance
the business of contact lenses

A Forceful Discussion About Compliance

BY GARY GERBER, OD

You can't force patients to play by the rules and be compliant any more than you can force a smoker to quit. We can educate patients by showing them pictures of nasty looking infections and warning them that if they continue down their current path of noncompliance that danger and eyeglasses await them.

But, just as you can only lead a horse to water, we can't force compliance on patients. Admittedly, it does get rather old and tired telling patients the same stories about the dangers of noncompliance over and over again.

What else can we do? Short of giving up and saying, "Just as many smart people will continue to drive without seat belts, our patients will continue to practice risky behavior," is there anything else we can do?

Let's get back to our horse and water example. We led the horse to water, not beer or wine. We gave the horse every possible chance to drink and replenish himself with much needed clean water. We didn't offer him a can of soda and say, "Here. If you're really thirsty drink this. It's not water, but it should quench your thirst." Instead we did what was appropriate and "clinically" correct. We didn't ask the horse whether he wanted soda or water — we led him to water.

We should do the same thing for our contact lens patients, but we often fall short. Most of us think we do, but I'd argue otherwise.

If we're trying to foster better corneal health, vision and compliance, then why are two-week disposable lenses still the most widely prescribed modality? Why aren't more patients dispensed an annual supply of lenses and care solutions? Why do so few lens wearers have eyeglasses with their correct prescription? Why do so many wear inferior plano sunglasses over their lenses? Why do most get examined at an interval beyond the recommended minimum of once per year?

Be a Leader

We could blame all of the above on the current state of the economy. After all, if someone is about to lose his house or was just laid off, quality sunglasses aren't a priority. While that's certainly true, all of the above items have occurred for nearly as long as we've fit contact lenses — including during stellar economic times!

So why do we have all of the above lens-related issues? For the same reason most of us have trouble with our staff — lack of firm leadership, direction and focus.

We're generally great clinicians and lousy leaders. We're afraid to look patients in the eye and say what's best for them. We need to start leading patients to the same "contact lens water" that we lead a horse to by more forcibly pulling on the reins.

It's not enough to say, "You might want to consider throwing your lenses away more frequently" or "You ought to think about getting examined more often than once every two years." No, we need to tell patients unequivocally, unapologetically and exactly what we want them to do. "I am going to fit you with daily disposable lenses because they are better for you." "I have already put you into our recall system for next year's exam." "You should be wearing high quality sunglasses that give you the best UV protection possible."

Take Control

Am I crazy? Actually tell a patient what to do? What about free choice, or educating patients and letting them choose?

Sorry, it's time for a new paradigm. It's time to toughen up and grab the reins of your patients and practice and control your destiny. It's time to act like the expert that you are and tell patients what's best for them. CLS


Dr. Gerber is the president of the Power Practice – a company offering consulting, seminars and software solutions for optometrists. You can reach him at (800) 867-9303 or DrGerber@ PowerPractice.com.



Contact Lens Spectrum, Issue: January 2009