It's just past sunset and you're alone in the back room. There's a single light burning above your head; a cold sweat rolls down your face. You try to calm yourself, but it's no use; the worst thing that can happen in a dispensary has just happened to you: A patient has asked for their prescription and walked out the front door. The choices from this point forward are clear: Shutter the office and turn to a life of crime… or read this article for insight into keeping patients.

In the 1960s, Canadian philosopher Marshall Mcluhan theorized that, one day, technology would link every man, woman, and child in the world, reducing our massive civilization from a disconnected array of people to an interconnected society he dubbed "The Global Village." Today, we live in that village. In an age when there's a Starbucks on every corner and a UPS dropoff in every cell phone store (and a cell phone store in every gas station), there are also dispensaries in every grocery store, strip mall, and yes, as we all know, on every intersection of the World Wide Web. Like all individuals conducting business today, we must realize that we live in a more competitive marketplace than has been experienced in several generations, if ever. As a matter of fact, this competition for business has resulted in creating new business itself, as consultation firms have begun popping up to help individuals develop a competitive edge (In case you're wondering, the trade firm for the optical world is called Power Practice; they have an online presence at So where's the edge? How do you get a leg up on the other guy? The simplest answer is to figure out one question: Why are patients leaving in the first place?

Many of the answers are obvious; one only need work a week in a dispensary to know patients often don't know the value of the product or services they are receiving. Indeed, it's part of our job as opticians to inform them of these things. However, there are other, less obvious, perhaps more controversial answers—answers we'd probably rather not discuss or acknowledge. Having worked in a dispensary for about two years now, and having been a longtime patient myself, I'm going to take a look at some of these answers with one foot planted firmly on the consumer side of the fence, and the other on the optical side.

Above all else, when a patient walks, it means quite simply that he or she does not like us. It's a tough pill to swallow, to be sure, but it carries more than a grain of truth. As a matter of fact, a McKinsey survey indicated that 70 percent of sales were motivated by how well the customer thought they were being treated, with the majority of lost sales being due to customer dissatisfaction with the way he or she was treated.

Whether we like it or not, opticians have earned a reputation in the lay world, and it's not a nice one. You know all of those online optical advertisements that refer to brick and mortar optical as "The Greedy Middleman"? We may not want to face it, but that term didn't arise out of a vacuum, and it isn't being used in advertisements to try and change anyone's mind; it speaks to patients because it's something they already feel to be true.

Just as "used car salesman" has become synonymous with questionable ethics and sales tactics, "optician" summons up notions of arrogance, bossiness, and, like car salesman, questionable sales practices. Part of this is unavoidable: Inevitably, once enough people have had negative experiences with members of one particular sales profession, a stereotype will develop. However…

Having been on both sides of the dispensing table, I know that opticians with low capacities for frustration are all too common. I also know that working a job that permits you the power and influence that being an optician does can very easily lead an otherwise decent individual down the path of developing a demigod complex. Opticianry is unique in that, with little to no prior experience, individuals can find themselves in the position of making very high dollar sales while also determining a person's physical appearance and how well that person will see. It's easy to see how such a position could be alluring for the wrong type of individual; and unfortunately, that type of individual all too readily flocks to the profession. It's too frequent for me to encounter a colleague who suffers the optically ignorant poorly and approaches his or her daily life with an unhealthy dose of cynicism. In their world, patients are idiots and should gladly hand over three figures or more for the privilege of being allowed to purchase eyeglasses in his or her dispensary. The sad thing is that many of these individuals very infrequently hide their contempt for their patients, and many have even gone so far as to publish their thoughts and feelings on public internet forums for all the world to see; public internet forums that, I will add here, quite frequently come up in routine searches for information on eyeglasses. If we, as a profession, are to retain our patients, we must reform our image; and while it's tempting to view national certification as the first step in the process, the real starting point is to quite simply be nicer people; and if there are elements in the industry who are incapable or unwilling to change their attitudes, they need to be sent along to browner pastures.

With precious little space in your dispensary, choosing what frames you'll have for your patients to select from is key. Various individuals will tell you different rationale for picking the frames they have on display, from name recognition to cost to what terms they were able to get from their rep. If patients don't see frames they want to see on their own faces, though, they're going to walk. Trendy name brands in an area with little brand recognition won't fare well; hipster glasses in an area largely composed of elderly people will flounder. Conversely, frames geared towards an elderly contingent won't do well if most of your patients are in their twenties and thirties. Identify your patient demographics and provide accordingly.

Just as key as selecting frames your patients will like is keeping those same frames in stock. Too often, a dispensary will order a limited number of a particularly popular frame and then allow that frame to go out of stock. This is one time it's appropriate to take a page from the car salesman's handbook: You'll never find a Dodge dealer without at least one Charger on the lot.

You knew it was coming. Yes, it's a touchy subject to discuss, especially among independents, but given the topic at hand, it's unavoidable. Patients are walking out of your dispensary because of cost.

The knee-jerk response I've encountered usually has to do with an anecdote about a patient who drove a Hummer and carried a Louis Vuitton handbag but only wanted what insurance would cover. We've all had this patient, and I think we like to meditate on him or her because it's the sales version of the Just World Fallacy, a logical fallacy that states bad things only happen to stupid or bad people. Similarly, we can convince ourselves that prices aren't too high, our patients are just too stupid to see the value or too greedy to shell out good money on something they don't perceive of as a status symbol. Again: We have all encountered these individuals. Still, the fact remains that we are living in a drastically different economy than many of us have ever done business in. Yes, there was once a time when the average consumer would pay a little bit extra for that personal service; a Defaqto Research poll once indicated that number was around 55 percent. However, if the customer doesn't have extra money, they aren't going to pay it.

The current economic state of the country is the worst it's been since the Great Depression, and as a result, consumers across the socioeconomic spectrum have become more cautious with how they spend their money. This is especially true for the emergent twenty-something demographic, which is finding itself with fewer job opportunities for lower pay than their parents or grandparents ever encountered. A disappearing middle class and growing lower class means that for every cheapskate with a Rolex who wants CR-39 lenses in a Medicaid frame with no AR, there are three more patients who make that choice—or the choice to walk—out of necessity. We must realize the online boom did not occur solely as a matter of convenience: it arose in response to an existing need. For many individuals, a pair of glasses in the triple digits would mean a choice between eyesight and paying a bill or feeding mouths; for these individuals, the choice between those same glasses and a pair of $20 glasses online isn't a question, it's a Godsend.

All right, so, maybe this is one of the obvious ones, but I came across some numbers as part of my research for this article, and I felt compelled to spotlight them for your consideration—as well as to illustrate how negative perceptions of the optical world are spreading. The White House Office of Consumer Affairs discovered that, on average, customers who leave a business following a negative experience will tell between nine and fifteen people about that experience; conversely, satisfied customers will recommend that business to only four to six people. At first glance, this means that, on average, you would need to satisfy two patients simply to nullify the negative word of mouth generated by one patient. However, the reality is far more sobering: 13 percent of patients who walk will tell upwards of twenty people about their negative experience. Friends; neighbors; coworkers; parents at PTA meetings; our global village is highly interconnected, and with a few keystrokes or the push of a button, that patient who strolled out with his or her RX can steer a multitude away from your office.

In the Mcluhan inspired 1983 horror film Videodrome, about a television station that kills those who tune in to its' gristly programming, a character theorizes that in the future, wars won't be fought on conventional battlefields, but on the technological front. (Coincidentally, the film's villain is an evil optician turned frame rep, and the climactic showdown takes place at a Vision Expo. So, it's pretty much required viewing for any sci-fi/horror fans reading this). As of the writing of this article, this theory is becoming a reality in the optical world, as patients take their RXs to the "front" of online optical. No longer can we rest on the laurels of simply dismissing online optical, be it on a legal, ethical, moral, or quality basis; patients have spoken, and the continued success and proliferation of onliners makes their feelings loud and clear. If we are to maintain our patients' business, it is imperative that we step back to honesty and objectively analyze ourselves. Though it may be a painful process, the act of thoroughly analyzing our failures will allow us to prevent ourselves from continuing to fail, and stop our patients from making any further walks of shame.