Four questions for contact lens patients

Anxiously anticipating building my patient base, I did a very interesting exercise before I started practicing optometry in 1978. I sat down and made a list of all the things I disliked about going to my current doctors’ office visits, including my internist, dentist, and orthopedic surgeons. I didn't critique my optometrist because my father is my optometrist, and this was not a therapy session.

The common theme throughout the list was that most of my doctors didn't spend much time with me during my examination. They never actually talked to me in specific terms about their findings, nor spent much time with me during my visits.

They always had an ancillary person come in and finish the visit before I could ask my questions. After making that list, I began to develop my philosophy of practice. I vowed to educate and communicate with my patients.

This philosophy  doesn't take a lot of chair time. I've been able to incorporate it into my normal patient flow. During the examination, I ask questions that will stimulate conversations. That is where I learn the most about my patients. My questions usually require my patients to pause and think before they answer.

Over the years, I have honed my ability to ask questions and gain important information. I found that these short but worthwhile conversations with my patients are the essence of building my practice and the key to successful problem solving.

This, in turn, establishes a nice rapport and relationship with my patients. I have come to rely on 5 questions-4 of the questions I always ask, and 1 question my staff and I never ask, even though it looms in the air. These questions help me gain pertinent information about my patients and have a little fun during the examination.

1.“Do you love your contact lenses?"

I ask this question when I begin to take the patient's history. Taking a contact lens history can be rote and extremely short-especially if it’s with a long-time patient. It usually goes something like this: the contact lens patient is in your chair. You exchange pleasantries. You ask the patient how he is doing with his contact lenses. He responds, “Fine,” without any forethought or hesitation. You move on with your examination, and all is right in the world. Not so fast-most patients are unaware that eye irritation during the day or lens dryness at the end of the day doesn’t have to occur. These problems are not part and parcel of wearing contact lenses in all cases.

There is a whole class of patients called “silent sufferers.” These patients think they’re fine even though they can't wear their contact lenses as long as they want, and/or they use copious amounts of lubricating drops throughout the day. These patients don’t know what they don’t know. But when identified, we have a good chance of resolving their issues. By asking the patient “Do you love your contact lenses?” it requires the patient to take a moment and think. Regardless of the answer, I take the opportunity to discuss what I can do, as his doctor, to make him love his contact lenses more. 

2.“Have you ever thought about contact lenses?”

I bring up this question sometime during the examination of my non-contact lens wearers. I like to call this group “the patients who don’t know yet that they want contact lenses.” How do you increase your new contact lens fits? Advertise? Newsletter? Pray? How about asking this question to the patients who just come in for glasses? In all fairness, most optometrists attempt to bring contact lenses into a conversation with this group of patients.

They do so by either asking their patients, “Are you interested in contact lenses?” when they are sitting in the exam chair or when they call the office to make their appointment. In either case, if the patient says, “No,” the conversation ends. I suggest that you change the wording a bit and ask every single non-contact lens wearer who sits in your chair if she has ever thought about contact lenses. The patient will pause before answering. That pause means she is thinking, and you will get more than a yes or no answer. Whatever her answer, I have a contact lens to tell the patient about.

The conversation usually goes something like this:

Patient: “Well, I thought about contact lenses, but they are too much of a hassle.”

Me: “Let me tell you about daily wear lenses that you never have to clean.”

Patient: “I was told I could never wear contacts because of my astigmatism.”

Me: “Let me tell you about a new lens that is made for patients with astigmatism.”

Patient: “I used to wear them, but they were too uncomfortable.”

Me: “Let me tell you...

Among the 5 optometrists in my practice, we fit at least 1 new patient a day from asking this question.

3.“If I could do nothing more, would you still take these lenses?’

This is my favorite question. I will ask a patient this question at her first contact lens check after I have asked her how the contact lenses are doing. Picture this: the patient is here after you fitted her with new multifocal soft contact lenses 2 weeks ago. You ask her how she is doing, and the patient says, “Well they’re not perfect, and I would like it to be clearer when I read.” If you’re like me, a warm flush comes over you, and you start thinking about why you even fit this patient with contact lenses and why you even became an optometrist. You should have gone into your father’s jewelry business. Just chill for a moment.

As you’re sitting there smiling at the patient, you tell her that you are going to see what you can do to make it better, but by the way, “If I could do nothing more with these lenses and this was the best it could be, would you still take these lenses?” You will be amazed at how many patients’ say, “Oh, absolutely!” We ask them to complain, but we tend not to quantify the complaint. Could they live with a little blur? They knew from the beginning that it wasn't going to be perfect. We as optometrists are so obsessive about trying to make it perfect that we sometimes forget that it doesn’t have to be perfect for the patient to be happy. You will still try to improve her reading and get rid of the blur, but if you already know she wants the lenses, it's a more relaxed visit.

4.“If you had an eye infection and couldn’t wear your contact lenses for a week, how would you function visually?”

No great mystery here. I usualy ask this question at the end of the examination. I need a short, but sweet conversation about the patient’s current glasses situation. Asking this question takes the patient’s mind off the cost of glasses and gets them thinking about real-world situations. Most contact lens patients think their glasses are fine. There’s that word “fine” again. Thinking that they can drive to work and function all day is another story.

5.“How many boxes do you want?”

This is the question I never ask. If you or any of your staff asks this question, fire them immediately. In this case, when the patient pauses to answer, he is thinking that he can buy one box per eye and use them all year. Remove those words from your lexicon. Selling an annual supply is a philosophy. It’s a way of thinking that benefits the patient, as well as the office. I assume that the patient will purchase a year supply when he leaves my office.

Once I determine that the patient is doing well with his contact lenses and is ready to purchase, I tell them that his annual supply will be shipped directly to him at no charge or that I have his supply in the office. Whether you discuss the fees or you turn the patient over to a staff member, the discussion is the same. My staff and I tell patients about the savings associated with purchasing an annual supply (we offer a small discount), as well as any rebates and solution cost savings for daily disposable lenses.

We then remind the patient about the services we offer for annual supply purchases. We will replace any loss or damaged lenses (within reason). If his prescription should change during the year, we will exchange his opened or unopened boxes at no charge. We will provide him with a limited amount of lenses if he runs short before his next annual examination. If an annual supply is not in the offing, then we set up reminders to contact patients when they are about to run out of lenses. A simple calendar does the trick.

These questions and my techniques are certainly not quantum physics (“rocket science” is way over used), but they are an effective way to establish a rapport, educate, and communicate with your patients and provide the best possible eye care.ODT