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Non-tolerance to spectacles

U2.6.3 Non-tolerance to spectacles (2014)

What to do if a patient takes their prescription elsewhere and then doesn’t like the spectacles? That was the question asked last week, and many times before that.

I’m sure we all have warnings written on our prescription forms when we issue a private prescription, but I do wonder if any of our patients read them or understands them if they do. There’s nothing on the NHS form about such dangers. It’s hard to find a way of emphasising the importance of having the spectacles dispensed where the eye examination took place without sounding protectionist.

The query was the standard one: a patient takes a prescription from your practice to another optician who makes it up but then the patient non-tols. Who, then, pays for a new pair lenses? There is no black and white answer; it is always a question of compromise and good will.

Firstly, you must check that there hasn’t been a clerical error (it’s easily done). Every prescription issued by your practice must be legible and accurate, whether it’s taken elsewhere for dispensing or not. If a genuine mistake has been made, you must of course rectify it at your own cost.

The spectacles that are unacceptable, for whatever reason, should then be checked to see if they comply with British Standards. Again, if they are not within British Standards, a simple explanation to the other practice would resolve the issue. A re-check of the prescription itself, by your practice or the practice that made the lenses, can be done – although at whose cost is negotiable. A judgement has to be made as to the fitting and glazing quality of the specs; centration in particular can be a minefield.

There is likely to be a disagreement between practices as to why the original specs were giving problems; one will claim it’s the prescription the other it’s the fitting of the frame or the positioning/centration of the lenses. It all becomes very unpleasant, for everyone. Out of the many complaints received by OCCS over the years an amazingly large number were for when a dispense was done somewhere other than the practice where the prescription was issued. It is one of the most significant shortfalls of the legislation that freed up the supply of spectacles.

What to do? It rather depends on how badly you want to keep your patient (and their friends and family). If you go the extra mile, reimbursing the costs incurred or replacing the spectacles at no charge, even if you feel you were not to blame in the first place, will usually go a long way to reminding the patient why they came to you in the first place.

On the other hand, if you say “You made your bed now lie on it” to the patient (more politely than that of course) are you laying yourself open to a charge of unprofessional conduct? Not necessarily, because the prescription was issued by an optometrist (or doctor) employed by your practice. It would be necessary for the patient to show that an error had been made in the consulting room, but this is very difficult to prove (we all know a prescription can vary over the course of time). The fact that a patient may prefer one to another is not necessarily proof that an error has been made. If your practice takes every reasonable care to identify and rectify any error, you cannot be called unprofessional.

There is a very old military saying: “Get over heavy ground as lightly as you can”, which might be a useful dictum in these cases. We all hate it when patients take their prescriptions elsewhere but it happens to us all. You can get over the heavy ground by remembering to treat such queries with great courtesy, do everything reasonable to resolve the problem (up to and including supplying new lenses) and then you can walk away from it. Annoying as it is, it is part of modern practice life; deal with it and move on.

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