We continue our weekly look at the GOC core competencies by expanding our argument over the significance of good communication skills for accurate history and symptoms taking
For the purposes of guiding the pre-registration optometrists through their year in practice, the GOC suggests a list of competencies within each core subject which need to be achieved as the year progresses (the first quarter requirements were outlined in this series - optician July 1, 2005). In the last of these features looking at Core Subject 1 for optometrists, we look at some issues regarding communication skills in contact lens practice. It is important to remember that the competencies overlap somewhat. For example, core subject 7 for optometrists deals with contact lenses, where category 7.4 refers to 'the ability to advise on contact lens materials and care regimes'.
REASONS FOR WEARING CLs
Whether a reactive or proactive approach has been adopted, once the practitioner has decided to go ahead with a consultation regarding contact lenses, it is important to understand the reason for a patient wanting them. This will not only dictate the choice of lens but also have an important impact upon the patient's compliance with the lenses.
Very often patients will say that the reason they want contact lenses is to avoid wearing glasses for cosmetic reasons. Some studies of self-perception of attractiveness, often aimed at women, have demonstrated reduced self-rating scores in spectacle wearers. Anecdotal and observational studies would strongly suggest a clear psychological advantage in such patients.
In the more unusual situation where a cosmetic contact lens masks an underlying lesion, such as a heavily scarred cornea, the psychological benefits are clearly measurable.
Many young patients attend for contact lenses, often accompanied by a parent or guardian. One situation that needs careful handling is when the practitioner suspects the contact lenses are the wish of the parent rather than the patient themselves.
This needs clear discussion with the patient as to the nature of contact lens wear, and reinforcement to the parent that lens success will depend on full compliance of the patient themselves.
If any doubt as to the motivation of the patient still exists, ceasing to continue with the fit needs to be considered.
DISCUSSION OF CL CHOICE
With the wide variety of lens materials and wear regimes available, a clear description of all the options appropriate to the patient's needs must be given.
This usefully includes information about payment, hygiene regimes and the potential time in the consulting room that may be needed to get the patient successfully wearing the lenses. The provision of literature outlining these points has a significant effect upon subsequent patient understanding and compliance.
PATIENT PERCEPTIONS
Before continuing with the fit, it is absolutely crucial that any other points relating to the wearing of contact lenses are clarified at this stage. 'Is there anything else about contact lenses you wish to know?' seems an innocuous enough question but may lead to a torrent of concerns and fears about lens wear, often based on irrational hearsay and myth.
'What if they get stuck at the back of my eyes?', 'What if I can't get them out?,' 'Will wearing a correction all the time make my eyesight worse?' are just a few of the many possible fears most practitioners are familiar with.
It is important to dispel any myths and to reassure a patient as to their concerns. However, this should not be done in a patronising or dismissive ('Of course not, silly!') manner. It is perhaps useful to remember that, far from being totally irrational, some of these fears and misperceptions may be founded in the same health beliefs that may influence other patient issues.
AFTERCARE QUESTIONS
Obviously, an in-depth discussion about the practical aspects of contact lens aftercare are outside the scope of an article discussing question technique.
However, at the outset of the aftercare, there are several points that need to be addressed: