Malpractice: Do You Need To Be Concerned?

Opticians today have to know about the science of vision, the design of both spectacle and contact lenses, and the various types of pathologies we may come across in our every day practice.  We routinely use Prentice’s Rule, the various tools of our trade, and we’ve all memorized ANSI standards as they apply to our field.  Yet technical expertise isn’t all we need to be competent in our field.  We also have to understand liability. 

Opticianry is a medical profession.  Fitting a patient with glasses or dispensing boxes of pre-packaged contact lenses may not seem much like a medical practice to you.  I mean, after all, you aren’t drawing blood or giving some poor patient a shot or some pills.  Yet, you ARE filling a prescription.  There are still plenty of ways that something could go wrong and cause your patient harm.  Malpractice will always be a concern for us as long as we work in this field. 

The National Boards contain a small percentage of questions geared toward office practice and liability.  The NCLE, in particular, may have questions concerning Triage as well as the Fairness to Contact Lens Consumers Act.  Questions about HIPPA could be on both exams. If you’ve already got your certification, you’ve probably seen those questions.  If you are still studying for your Boards you need to understand all applicable laws.

What is Your Weakest Link?

But just what is it that you, as an optician, should be concerned about?  The whole purpose of certification is to make sure that you know your stuff.  Once you do, and you are conscientious in following it, where is the problem?

Envision an ABO or NCLE question that might read something like this:

An optical practice is only as good as:

      1. the referring doctor
      2. the lab you use
      3. the product you sell
      4. the best employee
      5. the worst employee

All of the answers given are important to the success of an optical practice but the answer, of course, is the last one, the worst employee. Yes, that’s right.  It all comes down to the sorest thumb in the office, the dullest tool in the shed.  Everyone in the office can be brought down by the least one of all!

You might have a top notch doctor associated with your practice.  You might be the best optician with umpteen years of job experience.  Your lab may be the best on the planet, yet the strength of your combined practice rests on the shoulders of the worst employee you have. When it comes to liability, this employee can make or break you all. 

Of course, this employee is usually assumed to be the trainee, the apprentice, or the intern.  (And if that’s you, you might be huffing at me in indignation, and I don’t blame you!)  Yet just as often, the problem could be the employee who just doesn’t care.  The distracted employee.  The sloppy employee.

It could be the guy who hates his job, or the gal experiencing outside stress.  It might be a non-optician, such as a secretary, receptionist, or lab technician.  In a small optometric practice it could be the spouse or child of the doctor.  In a private optician’s office, it could be a family member or friend just coming in to help out. Really, it could be anybody not working to capacity or performing a job they’re not capable of.  It could be the co-worker you know is sub-par. 

But… what if there isn’t anybody like that in your practice?  What if your office is staffed with serious, seasoned, well trained professionals?  What if you are reading this article and scoffing because NO ONE at your office is sloppy, careless, or in possession of a really bad attitude?  What if you and all your co-workers are great people, certified (perhaps even licensed) for many years, and able to handle any and all optical situations?   What if nobody at your practice is likely to bring you down? 

Does that mean your office has no “weakest link”? 

Not on your life! 

Sadly to say, unless everyone in your optical staff is flawlessly perfect there is bound to be mistakes.  Days get hectic.  The phone rings non-stop.  Emergency patients need to come in, and more and more files pile up on your desk.  While the lab staff is working out straight, the mail comes in delivering more jobs to be processed.  Patients stop by (in a hurry) to have their lenses cut for their frames.  The doctor emerges from the exam room with a patient while there is standing room only in the frame room.  Everyone there wants to place an order, right now!  There are also more people standing around who just wish to ask questions. 

Sounds familiar, right?  I think we’ve all had days like that.  Sometimes it’s exciting.  Better a busy day than a dull one!  But what happens when the system breaks down?  Any little thing can do it.  Someone calls in sick.  Someone else comes in sick and is not working to speed.  The day may get a little too exciting and everyone is tired.  Someone may be on vacation (or quit) and everyone is working extra hard to cover the slack. 

In conditions like this an error occurring may be the norm instead of the exception.  Files get misplaced.  A tray gets dropped on the floor.  Employees jab themselves with screwdrivers.  People just aren’t at their best and may not communicate the way they would like to.  There may be friction… between staff and patients… between staff and staff.  In the midst of all this who knows what can happen?  Someone named Murphy once stated that if anything can go wrong it will.  In our business Murphy’s Law can get more action than that of Prentice…

The easiest mistake to make is a typo (and even doctors make them!)  In a pinch a host of other problems can happen.  Someone might say the wrong thing… or forget to say the right thing.  An appointment might not get scheduled, or a call might not get made.  Orders might get sent to the wrong lab.  Money might not even be collected! 

No one does any of these things on purpose (they are accidents, of course) which means that no one is aware that they’re doing them.  Which means they are far less likely to catch themselves making these errors…

Which mean that your office’s “weakest link” might just be… you.  

Cough, cough.  Sputter, sputter.  Yes, it could be you!  (Or it could be me were I working for you!)  Or it could be your most trusted worker or best buddy there at the office.  We’re all human and Murphy rules. 

Your Best Defense: Documentation  

So what can you do to protect yourself and your practice?  The answer is documentation… as much as you possibly can.

A few years ago a patient brought me a contact lens prescription that was missing information.  The contacts were toric, but no astigmatism power or axis was written!  I sighed, told the patient it would be a couple of minutes, and called the doctor’s office.  But the receptionist there couldn’t help me.  The doctor the patient had seen had left the practice and taken his/her records with them.  Oh no!  The patient was apoplectic.  He had just paid for this exam only a month ago.  What was he supposed to do, pay for another exam all over again?  He wanted his contacts now!  I called the office back.  Surely there was SOMETHING that could be done! 

And there was…  The staff at the other office put their heads together, searched every record they had, and found the contact lens TRIAL order invoice which had the patient’s name on it.  Bingo!  They gave it to one of the remaining doctors, he/she OK’d it, and a new Rx was written and faxed.  Man, we had one REALLY happy patient who credited US with saving the day! 

But the real hero was that saved invoice.  You should save EVERYTHING that might someday be useful!

The good thing is that most offices are using digital systems now.  Few offices rely on tattered, dog-eared little file cards for patient records anymore.  Everything can now be stored in a computer system, in detail.  You no longer have to struggle to decipher what some other employee scribbled at some undefinable time in the past.  With most optical office programs, you can tell at a glance when the patient came in, who sold them their glasses, who made them ready, and who dispensed them.  You may even have a digital lab invoice!  If anyone made a typo, or some other booboo it may show up here. 

Most programs also include areas for leaving notes.  You can indicate here that you told the patient the lenses would be thick, that you recommended anti-glare, and that you told them the doctor’s charge for an exam without insurance.  If everyone follows the program (and that can be problematic too) it should leave a careful, well defined paperless paper-trail that can be backed up on line.  You don’t have to worry about fire, flood, or a cup of coffee spilling on some patient’s records. It’s you first line of defense against malpractice.

You should also make photocopies of each patient’s Rx, and SAVE THEM.  I really can’t emphasize enough how important that is.  Since the easiest mistake to make is a typo, the chance of someone typing a prescription wrong can happen at any time.  Having that Rx to refer back to can save you a lot of trouble.  Let me give you an example of a true story I heard recently. 

A patient caame into an optical shop, presented a prescription, and asked for a pair of reading glasses. The optician filled the prescription and at dispense the patient could read every line on the reading card: Happy patient.  Well, not so apparently.  He found the glasses didn’t work as well for his computer and brought them back. His Rx in the store’s computer system, thankfully, was written in proper bifocal form:

+0.75 sp
+1.00 sp
Add 1.75

Although the optician could have interpreted the Rx for intermediate power, it was decided to call the doctor to get the intermediate script.  The next morning they called the busy opthamologist’s office and spoke to a pleasant sounding receptionist who looked up the patient’s record in their computer.  Over the phone she informed the optician that the Rx in their records was:

+0.75 sp
+0.75 sp
Add 2.00
 

It was a slightly different Rx so she was asked to confirm it and she did so. (the optician wrote it down on a post-it note) The office was then asked if they could fax the proper prescription.   Later in the day, a fax from the doctor’s office came in.  It read:

-0.75 sp
-0.75 sp
Add 2.00

But what was this?  Minus instead of plus?  The optician found their post-it note which still read +0.75 OU.  Something was definitely wrong here!  They called the doctor’s office again and asked for clarification, explaining that a mistake might have been made.  Another Rx was faxed:

-0.75 sp
-0.75 sp
Add 1.00  for intermediate only

By this time tempers were flaring.  The optician insisted that the receptionist had said +0.75 not -0.75 and that these new prescriptions had to be wrong.

Thankfully, the office had made a copy of the original doctor’s Rx and it was retrieved from the file cabinet.  And it was… correct.  No typos had been made when entering it into the ordering computer. (The optician who had sold the job must have breathed a sigh of relief!) 

But now there were THREE legal prescriptions, all dated the same day, all electronically signed by the doctor, and all were different.  So what was the office to do?  At that point management took over (after all, isn’t that what management is for?) and the original Rx was interpreted for intermediate with a +1.00 add. (which he could legally do.)  One would hope that the manager had called the doctor’s office again to try to rectify the problem, but since it really does sound as if that doctor was having a problem with Murphy’s law, and may have had a “weakest link” problem (it sounds like the Rx was typed wrong into their own computer!) who knows how far that got.  At least they had a copy of the legal Rx carefully stored in their file cabinet. 

The patient picked up his new computer glasses and was very happy with them.