3 Practice Mistakes I Fixed That Improved Care and Profit

After 19 years running my single-OD practice, I’ve learned that growth doesn’t always come from new technology or expanded services. Some of the most meaningful improvements have come from recognizing habits that weren’t serving my patients or my business—and having the humility to change them. These three corrections happened at different points over the years, but each one fundamentally shifted how we operate.

1. RUSHING THROUGH THE CASE HISTORY

Early on, my staff treated the case history as a formality—something to get through before the “real” exam began. Over time I recognized that those first few minutes with a patient set the tone for everything that follows.

Now I’ve trained my entire team to understand that the case history forms the pillar of the entire exam. My technicians know to slow down, make eye contact and ask open-ended follow-up questions when something sounds noteworthy. When a patient mentions “tired eyes,” my staff knows to dig deeper—is it end-of-day fatigue, morning dryness or something that happens during specific tasks? By the time I walk into the room, I have a clear picture of what matters most to that patient and where to focus my attention.

This shift has made exams run more smoothly because I’m not discovering critical details halfway through. Patients consistently tell us they feel genuinely listened to, which shows up in our online reviews and referral rates. That investment in a thorough, unhurried case history has become the foundation of the care we provide.

2. ASSUMING PATIENTS UNDERSTOOD THEIR OPTIONS

I used to present lens and contact lens options like a medical recommendation rather than a conversation. I’d say something like “I’ve prescribed progressives” and move on, assuming the patient would ask questions if they had them. Most didn’t—they just nodded, went to optical and often left with whatever was covered by their plans, cheapest or most familiar.

When I started asking what frustrated them about their current glasses, what activities mattered most, and what they’d tried before, everything changed. A patient who “just wanted basic glasses” would reveal they struggled reading menus in dim restaurants or couldn’t see their golf ball land. Suddenly we weren’t selling upgrades—we were solving problems they actually cared about.

Capture rate climbed, average sales increased and remake requests dropped because patients understood what they were getting and why. More importantly, they left with solutions that genuinely improved their daily lives.

3. NEGLECTING STAFF TRAINING ON THE “WHY”

My team knew what to do—run the autorefractor, check pressures, verify insurance—but I’d never explained why any of it mattered clinically. They were going through motions without understanding how their work connected to patient outcomes.

When I started spending fifteen minutes in monthly meetings explaining conditions, showing what I see through the slit lamp, and describing how their measurements influence my decisions, something shifted. Technicians started noting observations that helped me. Front desk staff could answer patient questions with confidence. Everyone took more ownership because they understood their role in the bigger picture.

Staff retention improved, patient flow became more efficient and the overall energy in the practice changed. Investing in my team’s understanding turned out to be one of the highest-return decisions I’ve made.

THE IMPACT OF FIXING THESE PRACTICE MISTAKES FOR IMPROVED CARE

I’ll be honest—I don’t have a single metric that draws a straight line from any of these changes to profitability. Practice economics are complex. When capture rate improves, is it the better case history, the deeper conversations about lenses or the more knowledgeable staff reinforcing recommendations? When a patient refers a friend, which touchpoint made the difference?

The reality is that these improvements work together in ways that are difficult to isolate. What I can say with certainty is that our practice is healthier now than it was before these changes—financially, operationally and in terms of patient loyalty. Sometimes the most important improvements resist easy measurement, and that’s okay.

One way to measure the impact, of which I’m super proud of, is in our online reviews. As can be seen, a single doctor practice has more than 800 reviews on Google.

I ask politely at the end of the exam and phrase it like this: “YOU can help others find good care, as opposed to saying, “Help us grow.”

When they write a review, we thank them online and my staff send a personal text informing them that they are rewarded with a $10 gift for their time. How does one measure the benefit to the practice? I have no idea. But, the impact is felt in our growth.