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The Wavering Waiver

If waivers and disclaimers don't work, then what is the alternative?

Gary Gerber, O.D.

How many patients do you have who can't adapt to their progressive lenses? I'm not referring to those who simply require a prescription change or seg height adjustment to be satisfied. Rather, how often do you have patients who just can't wear progressive lenses? What about toric soft lenses? Likewise, how often does a patient ignore your advice to not reuse an old frame and then subsequently damages that frame beyond repair?

If you look at your practice data, you'll most likely find that these numbers are small, usually infinitesimally small. In the rare case when they are not insignificant, digging deeper usually reveals that most of these situations could have been prevented. For example, a progressive non-adapter might have had some missed vertical prism in their refraction. But, by the time you discovered it, the patient lost interest in trying another pair of lenses. Or, the toric patient had some “funky” internal astigmatism that wasn't properly accounted for when you first fit the lenses.

What waivers really say

As rare as these occurrences are, I'm still surprised at how many practices have patients sign waivers and disclaimers before they'll place product orders for them. These policies essentially tell patients, “We won't take responsibility for your decision.” The doctor's logic: “There needs to be some degree of personal accountability. Otherwise, why would the patient even try to adapt to their new PALs?”

However, this argument misses a piece of logic that the patient uses: “Dr. Jones recommended these new PAL lenses. Therefore, I guess he thinks I'll see really well with them. He said it might take a few days to get used to the new lenses, but when I do, I'll see great. Still, if that's the case why is he asking me to sign this waiver in case the lenses do not work? Seems odd. Maybe I'll just stick with the lenses I have now?”

Using such logic, can you blame a patient for not accepting your recommendation? Globally they are hearing, “These lenses are great. But not so great that they are a slam dunk guarantee for you.” Yet, if as stated above, “the house wins” nearly every time, why not adopt a friendlier patient policy, and ditch the waivers? Why not exude confidence since you can be confident in your recommendations, given the very high likelihood of success and your excellent track record?

For patients who want to use their own frame, it goes without saying that careful inspection and subsequent education should precede using it. But if you do carefully inspect it, and agree to use it, why turn the tables again (as with the PAL patient logic example) and have the patient sign away your responsibility for the frame?

A simple approach

The simple solution: Be forthright and honest. If you don't think the frame will survive being used again, don't use it. If you agree to use it, assume any inherent risk. What's most puzzling in practices that use disclaimer forms is what happens when the frames actually do break. More often than not, the practice remakes a new pair of glasses in a new frame and either doesn't charge the patient anything additional or makes the glasses at a significant discount. If that's the final outcome, why not do that initially and avoid this situation entirely?

I'd bet an inverse relationship exists between the number of disclaimer forms patients have to sign and the number of those getting the products from your practice. OM