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The impact of addressing patient concerns.
By Bethany Fishbein, OD
July 17, 2024
It’s common to hear a practice owner ask how to improve their eyeglass capture rate, or how to get better acceptance of a new specialty product or service.
They think the answer lies in training their optical staff to be better salespeople, or getting their front desk team more comfortable discussing higher-dollar amounts – but these efforts often don’t have the impact the owner desires.
The Power of Identifying the Chief Complaint
I have the great fortune to observe many optometrists in a wide variety of practices – and more often than not, I see the biggest opportunity right in the exam room, in the first few minutes of conversation with a patient: identifying the chief complaint.
Whether it’s a technician or the OD starting patient visits, they should be trained in the best way to ask patients the main reason for their visit … AND… how to truly listen to their answer and let that guide the rest of the encounter.
It feels ridiculous to identify this first-year optometry school lesson as one of the biggest areas experienced doctors can improve, but in my experience, a thoughtful case history (and recommended treatment to solve the patient’s problems) almost universally sets high-performing optometrists apart from their lower-performing colleagues.
The chief complaint should reflect the main reason the patient is in the office at that moment, and be the focal point for the exam and any prescription or treatment recommendations that follow.
The Need to Train Support Staff to Meaningfully Identify Chief Complaint
I’ve observed many techs who’ve been trained with a list of items required for a comprehensive case history, and dutifully record all of the required information – last exam, current mode of vision correction, ocular history, family history, medications, allergies, etc.
As they mentally “check the boxes” making sure they got everything they were supposed to, the complaint (if it’s noted at all) becomes another item on the list.
I observed an encounter where the tech did a history just like this, and did a hand-off to the doctor saying, “This is Arjun, he’s 29 and is here for an eye exam. His last exam was two years ago. He tried contacts a while back and didn’t like them so he just wears glasses. He’s had some dry eye, and takes Topamax for migraines.”
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The OD took this information and walked into the exam room, excited to use some new technology in her practice to help the patient with his migraines. She was friendly and professional, did the exam and provided a detailed and compelling recommendation for specialty eyeglass lenses to help the patient.
The OD handed the patient off to an optical staff member, who reviewed pricing for the lenses. The patient said, “I think the glasses I have are OK,” and asked for his prescription. The doctor and optician both identified “cost” as the reason the patient didn’t get the glasses – but in reality, this was not the case at all.
The Real Reason Many Patients Walk with Their Prescription
When the patient paid his co-pay and got his prescription at the front desk, he told the staff member there that he’d like to order some contact lenses. The staff member explained the need for a contact lens fitting, and offered to schedule another visit for that, but the patient said he didn’t know if he would have time, as he was getting married in a month and had wanted the contacts for his wedding and honeymoon in Costa Rica.
So, it turned out that cost was not nearly as much of a factor as the fact that the patient came in planning to get contacts for his wedding! Glasses and migraine relief were not his priorities, and the doctor’s recommendation didn’t solve the issue the patient came in for.
In this case, it was a closed-ended question that led the technician and ultimately the doctor to miss the opportunity to meet the patient’s needs. The tech started their history with, “So you’re here for an eye exam?” The patient answered affirmatively, and that was assumed to be the primary reason for the visit and recorded as such.
The doctor followed the assumption that the patient was “just” there for a “routine eye exam” and latched onto the piece of the history that she deemed most important – the migraines. Unfortunately, it was not the most important to the patient, and treatment was not a priority to him.
Asking the Question the Right Way
Had the initial question been asked differently – “What can we help you with today?” – or if the doctor had asked, “Is there something going on that led you to schedule this exam?” the patient might have given an answer which would have led to an entirely different outcome in both patient satisfaction and dollars for the practice (contact lens fitting, supply of lenses, plano sunglasses AND even potentially an appointment to come back and get glasses to address the migraines once the wedding chaos was over!)
Doctors – I challenge you to make sure you know why your patient is in your chair and what they hope to get from the visit before you even pull the phoropter in front of them. Typically only a very small percentage of patients are truly there because “it’s been a year and they’re due” and have zero active complaints.
There will be times where you find something surprising or want to make a recommendation to address something the patient wasn’t aware of.
Addressing the main concern first lets the patient know they were heard, and gives them confidence that they’re being taken care of. “I know your main concern is to get contacts for your wedding, so we’re definitely going to fit you with lenses today. I am also seeing some things that show me your migraines may be related to your eyes, and would like to go over that with you as well.”
Before you end the exam, ask yourself whether you acknowledged and prioritized treatment for whatever the patient was most concerned about when they came in. When you do this, you will see the rewards in patient satisfaction and financial success.
Bethany Fishbein, OD, is a co-owner of two practices in New Jersey, a practice management consultant and certified executive coach. She can be reached at: bethany@leadersofvision.com
