The Gas-Permeable Strategies column at Review of Cornea & Contact Lenses has been my little corner of the world now for more than three years, but as we all know, all good things must come to an end.

This will be my final GP Strategies column; a successor will pick up the mantle beginning in January.

I have enjoyed the opportunity to relive some of my favorite cases over the last three years and, at times, express my opinions. I hope that you have found some value in these columns, and that they have benefited you and your practice in some fashion.

I debated what to do for the content of this final column and, ultimately, decided to have some fun with it. If it reads more like a Monty Vickers column, well, that was the intent.

Speak Like a Local
I practice in Minnesota, and anyone who has seen the movie Fargo will know that some of the people that live up here speak a little funny.

There is a classic book that discusses this unique dialect titled, How to Talk Minnesotan: A Visitor’s Guide, by Howard Mohr. I personally enjoy the book, but I am not sure that anyone not familiar with our Upper Midwest dialect would fully appreciate its humor.

While the book exaggerates for humorous effect, there is much to it that is close enough to the truth, which makes it one of my favorite books to read when I need a good laugh.


You may be asking yourself what this has to do with contact lenses. The truth is, not much. But I suggest you try learning some of our favorite phrases in the context of gas permeable lens fitting, and maybe, just maybe, you’ll find yourself using some of our native sayings in the office this week.

Handy Words and Phrases
“You bet”—an expression of pleasant agreement.


A 46-year-old patient with a prescription of -6.00 sphere, +1.25 add.

Patient: “My friend said you fitted her with some new bifocal lenses. Can you fit me with those lenses too?”

Doctor: “You bet."

“That’s different”—a blanket reply on neutral ground.


A patient wearing scleral lenses says, “I’ve been filling my scleral lenses with a new solution I got from the health food store. It’s a combination of muskmelon juice and 12 natural herbs.”

Doctor: “That’s different…”

“Whatever”—expresses emotional turmoil of many varieties.


Patient: I love these new soft keratoconus lenses. My vision is great, and I can wear them all day long. But I just found out that my insurance won’t cover them, so I want to return them.”

Doctor: “Whatever…”

The Use of Negatives
The Minnesota way is to generally not overdo things, to not get too excited about anything and to express positive feelings through the use of negatives.

Here is an example:

You are running an hour behind in clinic, you have a pounding headache and you just walked in on a new patient that was overbooked for a routine exam. They are holding a bag full of contact lenses and wearing a pair of “Coke bottle” glasses.

You greet the patient and they reply with: “How are you?”

You answer: “It could be worse.”

The Minnesota Deal


The word “deal” is used to express a range of feelings and emotions in Minnesota.

Here are just a few examples:

Patient calling your office: “I was in there yesterday for an eye exam and I think I left my contact lenses there. If you can’t find them it’s no big deal.”

Office staff: “Actually, we do have them. Mrs. Larson found them sitting by the sink in room one. She thought they were hers, put them on and fell into the planter by the front door. It was quite the deal.”

Patient: “Good deal, then. I’ll come get them this afternoon.”

Office Staff: “Well, when she fell into the planter one popped out and got lost, so she is going to pay for a new lens for you.”

Patient: “That’s a heckuva deal.”

Phrases of Indirectness
Minnesotans don’t like to be too direct.
There are many indirect phrases and statements they use. Here is a comparison of two patients:

Doctor to patient: “So, are you happy with your new scleral lenses?”

Non-Minnesotan patient: “I can’t see clearly and the left lens is irritating.”

Minnesotan Patient: “Well, the vision is not too bad. I can see alright. Though if it’s not too much trouble, it might be nice to see if a guy could get things a little sharper. Also, I think they feel good; I think a lotta guys could probably wear lenses like this all day long without any problems. I think that maybe I would get used to the feel, too, though if you feel like it, you might see if you can see if there is anything you can do for the left lens—it kind of pinches in the inner corner…”

The Long Goodbye
One final thing I should mention about Minnesotans: They have trouble saying goodbye.

We call it “The Long Goodbye,” and it is the clearest measure of affection that we can show. In many cases, it is what causes us to run behind in the clinic, and limits the number of patients we see in a day because we have to plan time to say goodbye to each patient. It causes us to continue to try to adjust the lens fits so we don’t have to say goodbye to our specialty lens patients.

In this case, it is me having a hard time drawing this column to a close knowing it is officially goodbye.

I wish you all happy GP lens fitting for years to come. If you have any comments or questions—or are interested in lessons in speaking Minnesotan—feel free to email me at [email protected].