Dealing with non-tolerance

Exploring the why

The underlying reason a patient might be having problems can be fairly wide ranging. In the first instance it is important that practice staff listen carefully and understand exactly what the patient is unhappy about. Good communication is essential here.

A patient may be feeling apprehensive or even annoyed about having to return to the practice. Offering them some reassurance that the practice will do all they can to help can defuse some tension.

Exploring the patient’s concerns through a series of questions can ensure the patient feels listened to. Practice staff should consider a range of questions, including: Can the patient describe what they are experiencing? Is it the comfort of the frame or the vision? Are they using their glasses correctly (for instance, is a pair for distance being used for reading)? Are there any notes in the clinical record that could help you determine what might be happening?

It can be helpful to write down exactly what the patient is describing in their words, so that if staff need to consult a colleague, all the information is available. Paraphrasing a patient in this way can also help make them feel as though you have understood their concerns.

When a patient has concerns, it is usually best to go back to the starting point. Below are the main areas that I would consider when troubleshooting:

• Have the right type of spectacles been made up? Are they multifocal or single vision lenses, and is this what the patient wanted?
• Have the spectacles been made up to the right prescription? Focimetering the spectacles and checking this against the clinical record can help you make sure it’s not just a simple administration error
• Is the frame fitting correctly? Checking the fit is important, particularly for multifocals
• Have the spectacle lenses been made up correctly? Are the lens measurements accurate? Comparing these measurements to the patient’s old spectacles can be helpful to consider what the patient has been used to previously. It is also important to consider whether there has been a change in lens manufacturer/design as this can also be a source of non-tolerance
• Is there a large change in prescription? If there has been a significant change, it can take the patient a bit longer to adapt to the new prescription. Is there a note to this effect on the clinical records?
• Can the patient achieve the expected acuity? If the patient is trying to read N5 when the clinical record states the best corrected acuity is N8, the patient’s expectations will need to be addressed
• If you have considered all these but can’t identify the source of the problem, take advice from a dispensing optician or optometrist.

Farah’s three top tips on non-tolerance

1. Listen carefully to the issues the patient is experiencing, and repeat this back to show you’ve understood their concerns
2. Try to tackle non-tolerance issues from a positive standpoint; reassure the patient that you’re going to do whatever you can to put things right
3. Patients who’ve experienced non-tolerance issues which have been managed well by practice staff often become the most loyal customers, and great ambassadors for the practice.

About the author

Farah Topia is an optometrist and clinical adviser on the AOP’s regulatory team.