The Business of Contact Lenses

The 12 Commandments, Part 1

By Clarke D. Newman, OD, FAAO

I have had optometric externs in my practice for many years, and I found very early on that I repeatedly told them the same things. So, a colleague, Joe DeLoach, OD, FAAO, and I created what we called “The 12 Commandments.” Each commandment has several corollaries. These apply generally to optometry, but have special significance for contact lens practitioners. We’ll review our first six commandments here and the second six in my next column.

The Top Three

The first commandment is, “First, Do No Harm.” Sounds Hippocratic enough. The corollaries that we added to this commandment are, “Don’t fix nuthin’ that ain’t broke” (I wrote an example of that in my October 2010 column), “Don’t fail to fix things that are broken,” “Beware reducing minus power,” and “Beware changing the binocular balance.”

The second commandment is, I think, the most important. It is, “Obey the Chief Complaint.” Expert status in anything requires very good pattern recognition, and every pattern in health care begins with the chief complaint. Our corollary here is, “When in doubt about what to do, what is broken, or what to fix, refer to the patient’s Chief Complaint.” Listen and all of the answers are right there. To an experienced practitioner, the differential diagnosis is almost always present after an unfiltered cognition of the chief complaint and the history of present illness. Obviously, a good history is critical.

This truism is a good segue to the third commandment, “Your Staff Will Make or Break You.” The corollaries are, “Hire good people first and foremost (patient care skills can be trained, people skills cannot be trained),” “Pay them well,” “Train them well,” and “Use them to the fullest extent of their training.”

Having a staff with good people skills who get along with each other is invaluable. I am convinced that the stress level of every physician in America is directly linked to whether they have a compatible staff with good people skills. Rock stars are great, but Michael Jordan didn’t win until they put a team around him. Give me team players.

Time, Money, and Lens Fits

The fourth commandment is, “Time is Money.” Our corollaries are, “Time is your money,” and “Time is your patient’s money.” I am terrible at time efficiencies. I know it, but I try. I avoid wasting time by prescribing the right thing to the right patients and by becoming an expert at the lenses that I use to reduce chair time. Look, the complicated cases will always take more time, but there are ways to reduce chair time and costs. Never cut corners, though, to save time. Using your staff to reduce time is also vital.

The fifth commandment is, “Swing for Average.” Our corollaries are, “Make relative gains,” and “Don’t strike out.” When presented with the need to make a large change in a prescription, don’t give it to the patient all at once. Move the patient in the direction of the change, but don’t give him so much at once that he cannot adapt. You could provide the whole correction and look like a hero, but you also might strike out. Getting into the mentality of looking at a patient’s previous prescription and the new manifest, then crafting the best prescription will save your bacon many times over.

The sixth commandment is, “A Reading Addition Is not a Microscope.” Amen, brother! The corollaries are, “Measure your working distances,” and “Use the weakest addition you can get away with.” When Hurricane Katrina brought thousands of displaced patients who had lost glasses to my door, out of necessity I used age and working distance to determine adds, and my remakes went way down! So, now I do the same thing in my office—same result. CLS

Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine and refractive surgery. He is a Diplomate in the AAO and a consultant to B+L, Alcon, AMO, and Oculus. Contact him at cdnewman@earthlink.net.