The Business of Contact Lenses

Communication Breakdowns, or “Say What?”

The Business of Contact Lenses

Communication Breakdowns, or “Say What?”


Throughout my career, I have read with great interest the musings of many of our colleagues as they have written about patient communication, or more importantly, the lack thereof. Maybe I'm just getting old, but it seems to me that communicating with my patients is getting harder every day.

Just today, I had a patient come in wearing her new multifocal contact lenses. She was doing great—yeah, doubly great. Not only did she have her fancy new multifocal lenses on, but she had a pair of opaque lenses on over them. She bought the opaque lenses at the—and I am not kidding here—“The Shell station down on I-45. Why, they have a nice display of all of the colors— better than yours,” she explained. “Really?”

After taking the time I didn't have to re-educate this patient, I was reminded of something Dr. Irv Borish hammered into my head as a fourth year. “Clarke, everything that happens in your practice is your fault. Do you follow?” It only took me a decade to capitulate to this wisdom. Everything that happens is the result of something you did or didn't do, or said or didn't say.

Communicating with your patients is a coin with two sides. Just as important as what you tell them is what you don't tell them, and much of what you don't tell them stems from your lack of knowledge.

Educate Yourself First

I recently placed a new patient to my practice on a peroxide care system. She returned for her two-week follow up as angry as any patient I've ever had. It seems she got arrested at an airport for having hydrogen peroxide and nail polish remover (read, acetone) in her travel bag. My composed, professional response to her was, “Say what?” Well, I didn't know that those two things, when mixed together, form a high-powered explosive. Did you?

Never mind that the TSA has a policy that exempts contact lens solutions that we should all have printed in our offices called the “Travelers with Disabilities and Medical Conditions” policy ( This patient was mad because I, the fancy Diplomate expert, was unknowledgeable on this subject. Consider how much better it would have been had I already known this information and had forewarned her. You are right again, Dr. Borish.

As former U.S. Defense Secretary Donald Rumsfeld said, it is the unknown unknowns that get us. The fewer of those we have, the smarter we look.

Make Information Accessible

The other part of the equation is that most patients have minds like steel sieves. Much of what we tell them passes through without so much as a hint of recognition. So, not only do we have to know stuff that might be important to our patients, but we have to communicate it in ways that they remember it, and cannot deny that you told it to them in the first place.

Brochures and handouts are the best way. Making information available on your Web site is also important. I am adding content to my Web site for patients to reference. The real art here is giving the right amount—something more than nothing and less than a copy of Bennett and Weissman.

We now educate all patients about the peroxide issue, and it makes us look smart. I don't think I should have to advise a patient not to wear colored lenses over the ones I prescribe, but maybe I'm wrong. She tells me that, “all of my friends do it. It'll be okay.” “Say what?” CLS

Dr. Newman is in private practice in Dallas, Texas, specializing in vision rehabilitation through contact lenses and corneal disease management, optometric medicine and refractive surgery. He is a Diplomate in the Section on Cornea, Contact Lenses, and Refractive Technologies of the AAO. You can reach him at