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 - ABDO College

How to have the willpower to say no in practice

Mark Nevey graduated from Northampton University with a degree in English and a keen desire to write. Seven years ago, he unexpectedly found himself on an optical career path. The former ABDO College student is now a qualified dispensing optician and a practice manager at Specsavers. In this feature, Mark shares his advice for dealing with the difficult situations that often arise in practice.

The position of dispensing optician carries a lot of responsibility, and through professional guidance and advice, we know what we should be saying to a patient. However, in practice this can often be difficult. When we are dealing with paediatric patients our sense of responsibility should be at the forefront, yet children can often put us in the most difficult positions.

We’ve all been in situations such as when an irate parent wants their six-year-old daughter’s glasses repaired now while she is at school. It can feel all too easy to just satisfy the parent’s demands by agreeing to diffuse a difficult situation, yet it’s in this kind of situation that we need to have the willpower to say no.

Strict guidelines from the NHS state that a child must be present when we carry out any repair, dispense or final collection of spectacles. It is important for us to make sure that the spectacles are fitting correctly, that they are positioned in the right way and that child is seeing clearly through them. This is especially important with a repair, since the reason the spectacles have broken could be as a result of a poor fit.

Many of us have also found ourselves in the situation where a child has chosen a frame that is too small for them, but is insisting that this is the one and only frame they want. It’s in situations like this that we need to have the willpower to say no. We might upset the parent or the child, and we might even lose a sale, but we have a responsibility to say no when it is in the patient’s best interest.

In these circumstances, it can be useful to tactfully explain to the parent the professional guidelines that we have to follow as dispensing opticians. The easiest way to highlight the importance of a good-fitting frame is to discuss the potential ramifications of dispensing ill-fitting spectacles. All you need to point out is that their child is still growing and that a frame that is too tight may inhibit that growth somewhat.

Additionally, you could emphasise that such a frame would tend to slide down their nose, which would result in the child looking over the top and they would therefore not get the benefits of wearing glasses. You can also point out that if the frame is uncomfortable, the child probably won’t even wear their glasses. Never forget that as a professional, you owe it to the child and their parent to provide the most suitable advice and guidance.

Another common situation where adult patients can become frustrated and angry is when being refused a copy of their prescription upon request. One reason for this can be that their eye examination wasn’t carried out in your practice.

If there is no feasible reason why the patient can’t request it from the practice in which the exam was carried out, we must have the resolve to refuse them. It’s not uncommon to face backlash from the patient we have inconvenienced, but once again, we can cite the reasons for not fulfilling their request. In most cases, this should convince the patient to respect our decision.

Contact lens patients are notorious for wanting things to be done extremely quickly, but there are frequent circumstances when it is impossible to avoid inconveniencing them.

It is not uncommon to have to deal with at least one contact lens wearer a day who wants to buy their contact lenses right away, but whose check-up is at least a year overdue. A difficult conversation often ensues about how they require a check-up before we can supply them with more contact lenses. Again, there is potential for this to be overcome by explaining to the patient why it is in their best interest to have a check-up and why we have a responsibility to follow the guidelines set out for us regarding the supply of contact lenses.

A clean break?

Staying with the topic of contact lenses, there are also times when saying no must be used as much to protect ourselves as it is to safeguard the patient. In the past, I have experienced patients whose general hygiene, cleaning regime and overall handling of contact lenses have been so poor that they’ve been at high risk of severely endangering their sight.

Where no amount of guidance or advice will improve their habits, it is important for us as healthcare professionals to safeguard their eyesight by emphasising the dangers of them wearing contact lenses and strongly advise against it. We know that it could be us who finds ourselves in trouble if such a patient returns with a severe, sight-threatening eye infection.

From the above examples, it should be clear that often the best way to diffuse a difficult situation is to be confident, undaunted and candid with the patient. It’s simply not good enough for you to know the right approach in your own mind, but then fail to take that approach with the patient. The overall aim is to help them to understand why your no response is in their best interest. If you can justify your response in terms that the patient understands, there is no reason why it should be difficult for you to say no.