This month I would like to revisit the question of handling a non-tolerance issue from an outside dispense.
The purpose of the Optical Confederation advice on non-tolerances was to try to stop patients from feeling like a ping pong ball being bounced between prescribing practice and supplying practice, and thus enhance the public’s view of our professions as caring and considerate.
We all understand how difficult it is to sort out any problem when the refraction and dispensing occur at different practices and, once an unregistered seller enters the frame, the problems are magnified many times.
So, how best to help our patients and keep our own sanity? Nearly every case is different and needs careful, unbiased thinking. If it is your practice’s prescription that has been taken for dispensing elsewhere it is quite difficult not to take it personally; you have provided the very best care and it does feel like a slap in the face when such a patient walks away.
If a non-tolerance does occur, it is not unreasonable to re-check the prescription but I would stop at that. Do not spend your time or effort checking the spectacles – they are not your problem. If the prescription is correct, the patient must return to the supplier for them to sort out the error or refund their money. You may well have an opinion as to why the patient is having problems (a poorly fitting frame perhaps) but that is not your concern. Your manner must be pleasant and polite with no accusations as who did what and why.
If a re-check shows a different prescription, that too has to be shared with the patient. It might be that there is a clinical problem (diabetes for example) or there was a misunderstanding (focal length perhaps). It might well be a simple clerical error (such things happen) or perhaps the difference is so small as to be insignificant, which is more difficult to explain to a patient.
When the cause of the non-tolerance can be ascertained, the best way of dealing with it has to be agreed on. If the ‘different’ prescription can be explained satisfactorily (diabetes is a classic case) you may say very reasonably that these things happen. If you had supplied the spectacles you would of course have changed the lenses at no charge, but since the prescription was made up elsewhere that must be corrected by that company. If the fault lies with your practice, a clerical error say, it is your responsibility to put it right, but how? This is the tricky part. You must issue a corrected prescription to the patient and offer to speak to the supplier as to how this can be rectified. You can speak to them, explain the error and say: “If you will supply the new prescription to the patient and send me the bill I’ll be happy to settle up”.
#dispensing #non tolerance