CONTACT LENS MANAGEMENT
"No One Ever Told Me That!"
Protect yourself from lawsuits through communication and documentation.
BY PAMELA J. MILLER, O.D., J.D., F.A.A.O.

A patient's first response when she's faced with problems or injuries associated with contact lens wear is often the infamous, "No one ever told me that!" Despite your protestations to the contrary, if you didn't document properly when fitting, refitting or examining your contact lens patient at her scheduled visits, you could be in deep trouble.

Patients sometimes live in their own worlds. Most new fits are so excited to be "leaving their glasses behind" they simply don't hear everything. Even experienced wearers have "hearing" problems, particularly when you're changing lens type and care, when they're overwearing their lenses or they're new patients.

Triple protection

Effective communication is vital. It involves actions as well as words. The following initiatives on your part help protect everyone from misunderstandings that result in poor patient control, patient loss and even litigation when the patient is injured or wants a refund.

• First comes the actual patient scheduling for progress visits, annual exams, troubleshooting, etc.
• Next, make certain there are no problems or that patients have followed through with your recommendations when a problem has occurred. Call patients the day after dispensing. If they're having any difficulty, this is an opportunity to remedy it. Calling them also reinforces the importance of communication and your personal philosophy of caring.
• Then, constantly re-evaluate patients' visual and safety needs. Not only may their prescriptions change, but the need may arise for other things, such as sports, sun and safety protection and glasses for special needs such as computer vision.

Once that's done

Patient communication must also include both of these elements:

Informed consent. You must tell patients about their viable options, the risks and advantages of contact lenses and your recommendations. When they ignore your advice, try to get them on track, re-explain the risks and benefits or formally terminate them. You're not obligated to see a patient just because she wants to see you. Noncompliant patients risk serious injury; you can tell them that they can no longer be your patients. Most people comply when they see how serious you are.

Documentation and record keeping. Documentation is critical to protecting everyone. You must document the patient's informed consent or lack of compliance. Note everything from patient instructions, wearing schedules, order records, warnings about visual need changes, special notations, telephone emergency forms and follow-up to commonly asked questions.

Using standardized forms will create consistency and minimize memory problems. Proper documentation will help you control your practice and decrease your exposure to lawsuits. Ultimately, you're responsible for reviewing staff procedures, records, follow-up and all information your staff disseminates.

In managing the contact lens patient, informed consent is a living and breathing entity, to be constantly refined and upgraded as the industry changes. Documenting it is a heavy, but necessary, burden if you expect to minimize your liability.

A vital skill

So remember, good communication is a vitally important skill. Even if patients threaten to sue out of frustration when they feel you aren't listening, you can remedy the situation if you communicate with them. Examine your patients carefully, inform them, document what you've done and everyone wins. OM

Dr. Miller serves as an expert witness and management consultant. She's also a well-known lecturer. She has written three books, is a contributing author to four others and is widely published. She's served on numerous editorial boards and most recently was the editor of the AOA Contact Lens Section newsletter.