contact lens economics

Know When to Say "No"

contact lens economics
Know When to Say "No"


As much as we like to please every one of our patients, exude confidence and let patients know that we're expert contact lens practitioners, we occasionally come across an "unfittable" patient.

Admittedly, with all of the new contact lens modalities and new technology available, such "unfittable" patients are rare, but they do exist. Do you know how best to handle these unusual, but frustrating case presentations?

Refund? Did You Say Refund?

One of my favorite movies is "Breaking Away" (perhaps because I'm an alumni of Indiana University -- where it was filmed). There's a memorable scene in the movie where the father, a used car salesman, grabs his chest (as though he's suffering a heart attack) in response to being asked for a refund.

Is this how you would respond if that "unfittable" patient were to ask for his money back? After all, who can fault him for asking? If you bought something that didn't perform as promised, wouldn't you ask for a refund?

Of course, the logic flaw here is in the phrase, "perform as promised." Make sure to have easy-to-understand documentation available for patients outlining reasonable expectations from contact lens wear as well as what happens if the contact lenses don't work. Personally, for as rare as these events are, I don't have problems recommending that my clients give refunds to their patients -- even though the last time I wrote about that in detail I received some pretty heated replies. For the purposes of this article, let's just say that if you have good preemptive policies, then refunds should be rare -- rare enough that if a patient asks, then I'd go ahead and write the check and move on to the next patient.

My original premise stated that we like to please patients, exude confidence and convey that we're experts. Knowing when to say, "No, you can't wear contact lenses" can accomplish all of the above goals.

Are You Ready to be #15?

Another way to fend off a refund is to not fit the patient in the first place. Let's take the case of the 31-year-old engineer who presents stating, "I've tried for 11 years and have gone to 14 different eye doctors. No one has ever been able to get me to see correctly with contact lenses. I heard you were really good and decided to give you a chance."

For whatever reason, personality, prescription, dry eyes, unavailable parameters, etc., the odds of you fitting this patient are slim to none. I would therefore recommend telling him at the first visit, "The odds of me being able to fit you with lenses are slim to none. I know this now because I'm an expert contact lens fitter and have been doing this for 22 years. If 14 of my colleagues were unable to fit you, then I doubt I can either. However, if you'd like me to give it my best shot, I will. Here's how we'll proceed . . . ."

Your "Face" is Safe

Have you lost face (the fear of this is the biggest reason why most of us blindly take on these impossible cases) with this patient by saying the above? I don't believe so. Instead, you've let him know that you're confident in your clinical skills, you are indeed an expert and he should recognize you as such.

Approaching the patient in this manner may allow you to actually retain him as patient, albeit not as a contact lens wearer, but as a happy patient who respects your honesty, integrity and clinical acumen. You have a better chance of this patient becoming an enthusiastic referral source by letting him know up front his odds at success are nil than by joining his roster of "unskilled" doctors.

The Power of "No"

Sometimes saying, "No, you can't wear contact lenses" can serve as an effective way to build your contact lens practice. Give it a try and see how well it works. The result just may surprise you.

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