Low Vision Care: Selling the Concept, Selling the Solution

By: Dr. Thomas Porter

In our “politically correct” culture the term “selling” is often frowned upon when we discuss eye care issues.  Selling often brings to mind being “tricked” into purchasing a used car or high-pressured into buying swamp-land in Florida.  But in one sense, attending a CE lecture is a form of buying and selling.  The speaker is trying to “sell” his idea or point of view and if he is successful you “buy” that information and incorporate it into your practice.  In low vision care we may like to call it “counseling and education” as we “guide” our patient through the exam process and on to a meaningful decision but for simplicity throughout this article I’m going to call that process “selling”.

In order to be successful in low vision “selling” is a great part of the process.  Our first challenge is to “sell” the patient the basic concept of “irreversible” vision loss.  Patients need to both understand and accept that traditional solutions like surgery, medicine and glasses are not options any longer.  The next challenge is to transition on to the solutions we do have available for their problems and how we can achieve various visual goals.  The final challenge is to get the patient to get out their checkbook and “purchase” the appropriate devices.

No one would argue that low vision products are just a normal part of providing low vision care.  In the past I’ve been quoted as saying in LV we don’t sell products, we sell solutions to problems….  but in order to solve problems patients usually have to purchase low vision products. How we transition from the examiner of a patient to the supplier of devices is a skill that is uncomfortable to some but one that you can certainly learn and fine tune. 

Most consumers don’t like surprises when it comes to money.  When a patient asks the price of a device or service don’t immediately think they are asking the questions because they think it is too expensive.  For this reason I think it is very wise to discuss the financial aspects of low vision care in general and as well as your particular office policies prior to the first appointment.  In my office we accomplish this by means of a “triage telephone interview” with patient.  This gives us an excellent opportunity to help establish specific and realistic visual goals and outline what is involved in low vision care.  We like to discuss things we can do as well as what we can’t do and discuss finally, financial issues.  Although it may seem harsh, it is often better not to see a patient in the office that has unrealistic visual goals or attitudes.  An example might be the illiterate patient with advanced AMD that just wants a pair of glasses that “makes me see better”.  All patients deserve a careful explanation of why this may not be possible as well as what assistance we can more realistically offer.  Counseling over the telephone can help our patient decide if the area of strength in low vision care matches the goals of the individual and this also gives you better insight about the patient.

Try and prepare your patients for the concept of multiple LV devices and plant that seed early!  During our telephone discussion and again later in the examination we ask for a list of visual goals.  We are all taught to have the patient prioritize these goals.  When I review this information in the very beginning of the examination I often say, “I think I can help you achieve these goals and it shouldn’t take us more than 3 or 4 different low vision aids”.  Early in the exam you need to form the idea that there is no “Swiss Army Knife” in the low vision world.  Each task may require a different tool.  Here’s an idea that I use everyday.  After the clinical phase of the examination I review the visual goals that we initially discussed.  I take each low vision aid that we learned through examination will help the patient achieve that particular goal and line it up before the patient.  When I have finished my presentation the patient and their family can see why I am prescribing multiple aids and where each aid fits into the overall plan.  Later if there is a question about why a certain aid is needed we can relate the aid to the goal the patient had established for themselves.  If a decision is made not to purchase a certain type of aid I stress that this means that one particular goal probably won’t be fully met at this visit.

Another consideration you need to come to grips with is how valuable you feel your services are for your patients.  Personally I love providing low vision care and get tremendous personal satisfaction from helping my patients.  I also have a family that I need to provide for and this means that my services must be done in a manner that makes economic sense to both my family and patients.  Many new practitioners need to be reminded that our obligation to our patients is to provide the best possible treatment plans and materials to our patients.  We are the patient’s eye care provider, not their banker.  This means the best solution, not necessarily the cheapest!  I would certainly hate to learn that my doctor had decided provide me with the cheapest medicine for a life altering disease rather than the best because he or she was uncomfortable with financial aspects of my medications.

Over the years I’ve been fascinated in watching new LV providers discuss and treat various devices as if they were all generic drugs.  They’re not!  Brand X looks just like Brand Z but it costs ½ as much!  Some of the “knock off” brands are intentionally manufactured to look identical to more established brands for a reason.  My personal experience is that the cost differences in LV products usually goes far beyond the country of origin and related labor costs.  Have you done your patient a favor when you provide a device that has durability issues, compromised design, or a low quality of optics?  Each brand of low vision aid, from the most expensive to the cheapest has strengths and weaknesses.  It is our obligation to learn all the variables and determine the absolute best product that will solve our patient’s problem.

I look at education as a high and sophisticated form of sales.  Meeting the patients objections “head-on” and guiding them to the best solutions is a skill you will enjoy learning and fine tuning.