ETHICAL CHALLENGES ABOUND IN EVERY PRACTICE. HOW DO YOU NAVIGATE THEM?

MY SON has a summer job at a bagel store. You wouldn’t think he’d encounter an ethical dilemma there. But, sure enough. . .

A repeat customer requested his usual order — a whole wheat everything bagel with cream cheese. (For those not from the northeast — the only place in the country where real bagels can be had — “everything” refers to the bagel topping).

After preparing the bagel, my son noticed it wasn’t whole wheat but instead pumpernickel. In fact, all the “whole wheat” everything bagels were pumpernickel.

He asked his boss, “Are you aware that the whole wheat everythings really aren’t?”

“Yes. It’s OK,” his boss replied. “Serve them as is. No one will notice.”

GO WITH IT, OR LIVE WITH GUILT?

Hence, the dilemma:

1. Tell the customer and risk reprimand.
2. Don’t tell the customer, follow the boss’s directive, and live a life with the guilt and shame.

If you’re thinking, “That can’t happen in my practice,” you’re partially correct. While you (probably) don’t serve bagels, you do serve the public. On the retail side of practice, both you and the bagel store serve customers.

UNHAPPY WITH REMAKE

It’s happened to everyone. After a few remakes, the patient’s glasses are absolutely perfect. Yet, the patient is unhappy with the vision. (A related, tangential aside: check the base curves, and ask the patient whether he, or a significant other, doesn’t like the frame!)

Several industry “standard” solutions have been employed that essentially give the patient back the exact same pair of glasses he or she isn’t happy with. We wipe them off, keep them on a shelf and give patients a vacation from the glasses for a few days before calling them up and telling them, “They’re ready.”

The scientist in us might profess that patients who do well in these “new” glasses are doing so because of a placebo effect, or perhaps something related to the Hawthorne effect. The fact remains that nothing was changed and the patient was told otherwise. But, if the patient sees better, is that ethical? If he or she doesn’t complain about pumpernickel, and maybe even says it’s better, is that ethical?

AS GOOD AS IT GETS

What about the patient who is told, “I’m sorry, this is your 19th visit and no matter what modifications I make to your right contact lens, I can’t get the vision any better than 20/25+. I understand it’s not as good as your left, but that’s as good as it’s going to get.”

Have you really tried every contact lens? RGPs/sclerals? If you don’t fit them yourself, have you discussed referring the patient to someone who does? Are you giving up because you’re just tired of seeing the patient, losing money on every visit (we’ve all been there — no shame) or because he or she really can’t be helped?

Ethical challenges abound in every practice. Use the above examples as thought starters to delve into those germane to your own practice.

Above all, if you live outside the northeast, please don’t refer to them as bagels. What you have is a piece of bread with a hole in it. OM

DR. GERBER is the president of the Power Practice, a company specializing in making optometrists more profitable. Learn more at www.powerpractice.com , or call Dr. Gerber at (888) 356-4447.