Prescribe Everything the Patient Needs

“Do you prescribe everything the patient needs?” is the first question Independent Strong asks in the section on managing your practice’s finances. Let’s drill into this question and see how to improve our level of care and the fiscal health of our practices.

The difference between prescribing dress glasses and prescribing both dress glasses and sunglasses simultaneously is about $600,000 per year per full-time equivalent doctor. Doctors agree that most, if not all, patients should be wearing protective lenses against the sun’s harmful rays, yet, the overwhelming majority of patients are not.

Many doctors do not prescribe everything the patient needs. In many practices, doctors will prescribe only what they think the patient can afford. This is a fundamental mistake.

Here’s how to not make that mistake. The key idea is to make sure that you have identified everything the patient needs. Many times patient needs are not recognized. This is often because the patient does not think the eye care practice can do anything about the problem.  

So, let’s look at how we determine patient needs within a practice. One important way to recognize patient problems is through the history-taking process. We take multiple histories at every patient visit. The practice gathers the following histories:

  • Chief Complaint
  • Demographic
  • Medical
  • Vision
  • Lifestyle

The history most often missed is that which can be determined through the lifestyle questionnaire. Since people do not know what they do not know, the purpose of the lifestyle questionnaire is to uncover potential areas of improvement using services or products your practice offers.

A lifestyle questionnaire should probe the following areas:

  • How do use your eyes at:
    • Home
    • School
    • Work
    • Play

It’s better if the lifestyle questionnaire is completed at home before the patient enters the office. If not, then have the patient complete the lifestyle questionnaire before seeing the doctor. (Create a lifestyle questionnaire with the minimum number of questions possible.) 


  • Present everything the patient needs to improve their quality of life at home, school, work, and play. Let the patient choose what they can afford.
  • Prioritize your case presentation. What brought the patient into the practice today becomes your number one priority and should be addressed first. If the patient came in because they are having trouble with itchy eyes and you found a retinal nevus that you are worried about, resist the urge to talk about the nevus first. In this case, address the itchy eyes first, then the retinal nevus.
  • After identifying the number one priority for case presentation, prioritize all other issues based on what the doctor views is most important.  
  • During the case presentation, always present the information in a “problem/solution” format. For example, say, “Mr. Jones, you told us today that you get headaches driving to work in the morning due east directly into the sun. Because of that problem, I am prescribing polarized sunwear.
  • At the end of the case presentation, give the patient an opportunity to add to what was said.  The conversation could go like this, “Mr. Jones, we want to make sure that we are thorough and have answered all your questions. Is there anything else that you would like to add to or change about what we’ve talked about?”

By prescribing everything the patient needs, you are helping patients improve their quality of life at home, school, work, and play as well as adding at least $600,000 per year per full-time equivalent doctor.

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