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Introduction - A Fantastic Life

It is a fantastic life being an optometrist!

I start the book with this statement because I really think it is!

Over the years that I have been practising, every day has been different. New patients with different personalities (some inspiring, some not so); new clinical challenges with patients presenting with various pathology (I found a very large malignant choroidal tumour about one year after passing my professional qualifying examinations which at the time was quite exciting).

I have been able to help people improve their golf, get better performance at work, enjoy a fantastic wedding day, make less mistakes when crocheting and scuba dive in the Red Sea.

I was humbled to feel a bit like Hans Christian Andersen one day when by simply advising high index lenses with a smaller frame and contact lens wear (She was a -7R and -5 L) I helped a 21 year old girl make the transition from a shy ugly duckling to a confident beautiful swan. I can still see the smile on her face now!

Optometrists have the opportunity to help people with ARMD, cataracts, diabetes and detached retinas, and to reassure people with floaters and migraines that they are not going to lose their sight – well not because of the reasons they thought anyway.

We also have our fair share of extraordinary situations. I tested a young guy with a bruise on the side of his face who had just come back from Canada. He had been travelling, and was attacked and chased by a bear! Sitting in a test room in Wakefield, England at the time, which is not that well known for indigenous bears, you can imagine this seemed quite surreal.

Bradford University was fantastic, and graduating with a 2.1 honours was a real thrill.

I started work straightaway with one of the large UK multiples, where I was lucky enough to be supervised by a very good clinician from Yorkshire, England. If he is reading this he will know who he is, (and you still owe me a pen for passing first time).

As you have (or will depending on what stage of your career you are at) I slowly became more confident with the clinical responsibility of being an optometrist. My refractions became quicker and more refined and my decision making became more confident as I increasingly began to trust my own judgement.

However, despite all of this, there was something that was missing from my learning curve as an optometrist; something that I was completely unprepared for; something that if it was taught in university I missed it.

OPTOMETRY IS A PEOPLE FACING BUSINESS and, not only that, it is a highly commercial and competitive one!

The number of people applying to university to study optometry has risen enormously in the last ten years. In the UK there are literally thousands of independents practising in their own businesses, and five big multiples that vie for position on the high street. Add into the mix some of the large independents and it becomes increasingly hard to find any town without three or four opticians as a minimum.

Some retail analysts in the UK believe that the market is probably over subscribed – meaning too many practitioners for the number of patients. This of course means that each and every patient that comes through a practice door is vital to the success of the practice.

This is also the case all over the world, with optometry becoming an increasingly attractive career and business opportunity.

Furthermore, most everything you can buy in an optical retailer’s store, you can now buy on the internet, and even the big supermarkets are giving over their precious shelf space to contact lenses and spectacle frames.

As for the global market; suppliers are more plentiful, better organised and less expensive than they have ever been, causing prices and margins to be squeezed the world over, whilst footfall decreases as it is shared out amongst the number of players offering their wares.

The challenge is, it wouldn’t be unusual for qualifying optometrists to have difficulty explaining the concept of ‘operating margin, and footfall’, and I know many people with ten years’ plus experience that wouldn’t be far behind.

So, if it is a business and a people facing business, what must you be good at to succeed as a modern day optometrist?

Whether you practise in New York, Johannesburg, Auckland, Sydney, London or Toronto, what is the common denominator?
“Being a good clinician with the patient’s eye care of paramount importance” you all shout together...and you would be right. I would agree wholeheartedly. In fact, we all work hard every day, both pre and post graduation, to ensure that is the case, and so we should. However, as do some other optometrists, I found very quickly in my early days that it was not enough.

Other skills are required to become a good optometrist.

Other skills are required to keep the patient from walking out of your practice with their new prescription whilst throwing an “I just need to shop around a little” over their shoulder. Other skills are required to keep the dispensing ratio at a satisfactory level in order to pay the bills, or keep the wolf from your employer’s door whilst repaying their faith in you.

Other skills, which are commercial, behavioural and communication based, not just clinical.

However, the fascinating thing (or incredible depending on your view) is that these skills are rarely taught in university with a commercial focus, nor are they commonly offered by employing optometric companies. Universities in the UK predominately offer a BSc in optometry, not a BSc in optometry and retail, but unfortunately in the real world the two go hand–in–hand.
Some more enlightened organisations are beginning to train their ophthalmic and dispensing opticians in these areas, but most are not. Most let you loose on the public without giving you any help with how to recognise a buying signal, over come an objection, deliver bad news, recognise agitated non verbal communication, or control your own behaviour in order to get the best out of your environment

DOCET (The Directorate of Optometric Continuing Education and Training in the UK) have produced some work books on communication skills in optometry, and they are a start. However, my experience was that they did not really go far enough with regard to understanding the behavioural psychology of patients (or colleagues). Nor do they give an insight into the commercial pressure put upon a practising optometrist to succeed, and how mastering behavioural and communication skills is integral to that success.
A recent book search on Amazon revealed over 100 clinical text books to help the optometrist, only two or three on business practice, and none appearing to cover the following in any great detail:

Communication skills (nonverbal and verbal)
Questioning skills (to explore desires and needs)
Listening skills (we often hear but how often do we listen?)
Influencing skills
How to meet and greet patients with empathy and enthusiasm
How to hand the patient back to the dispensers
Opportunity exploring skills (How can I optimise the dispensing and satisfy the patient at the same time)
Dare I say It, objection handling and sale closing skills (No change in the prescription again Mrs. Smith).
Complaint handling skills
Conflict handling skills
Personal motivation techniques
People management skills

So what happened to me?
I was very lucky on three counts.

Firstly My PQE supervisor was not only a first rate clinician, he was also a very experienced optometrist with a great understanding of people and the commercial needs of the practice. He was able to balance perfectly the clinical needs of the patient with their often hidden desires and needs to do with lifestyle. By uncovering these, he was able to help the patient make more informed choices that served their jobs, sports, or lifestyles. This had an obvious impact on the dispensing ratio (I will talk about uncovering hidden desires in detail later on in the book).

Secondly, after passing my PQE’s, I chose a mobile position within the large multiple who gave me the initial opportunity. My area was enormous (Scotland down to South Yorkshire), and it meant that I was literally in a different branch in a different town almost every day.

The advantages of this were threefold;

The patient demographics were different in each town which was an opportunity not to get ‘stale’ testing the same social, economic type.
I was able to emulate the best practice of really good branch managers, dispensing staff and other optometrists. If they were successful, I watched, listened, asked and replicated whilst developing my own behavioural style and technique.
I was able to repeat this practice when visiting lower performing branches. If the patient volume was high, and the economics of the area stacked up, yet the dispensing ratio was lower than average, I was curious to find out why, and make sure I did not fall into the same traps.

Thirdly, my husband is a training consultant specialising in human behaviour, communication and sales. I have been able to pick his brains and share ideas with him since my college days. It is a bit like having your own management guru on the sofa every evening, so to speak.
He helped construct a specialised behavioural communication training programme for optometrists in the UK*, has trained a number of opticians and optometrists, and has an excellent knowledge of the industry. If you are interested in more information about training courses and skills workshops, details can be found at the back of the book.

Consequently, and with his help, I decided to share my experiences and some tips and tricks. I hope that a combination of my encounters in and around the test room, coupled with over double digit years of practising optometry, will help you with the challenges presented by modern day optometric retailing, regardless of how long you have been practising.

*Krauthammer International Optometry Development Programme

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