Last week we began to consider the second competency area for dispensing opticians; the core subject 'professional conduct' includes various aspects of patient management, referral, record-keeping and awareness of legal responsibilities. The same subject is the second competency area for DOs, although the competency subject breakdown issued by the GOC is a little more detailed in nature
Professional conduct
Last week we began to consider the second competency area for dispensing opticians; the core subject 'professional conduct' includes various aspects of patient management, referral, record-keeping and awareness of legal responsibilities. The same subject is the second competency area for DOs, although the competency subject breakdown issued by the GOC is a little more detailed in nature
Core subject 2: Professional conduct states: 'In fulfilling his/her duty of care a dispensing optician must have an understanding and working knowledge of the relevant legislation and civil laws, as well as codes of conduct and professional guidance to be able to care for, respect and protect the rights, dignity, privacy and confidentiality of patients.'
CRITICAL COMPETENCIES:
The demonstration of the ability to manage a patient's care in a safe, ethical and confidential environment
The demonstration of the ability to keep clear, accurate and contemporaneous patient records, which record all relevant findings and decisions made.
APPLIED KNOWLEDGE AND SKILL:
Demonstrate the ability to interpret and respond appropriately to patient records and other relevant information. Demonstrate the ability to work within a multi-disciplinary team and within the guidelines and codes set of the profession
Demonstrate an understanding of the importance of their legal and ethical responsibilities in relation to the publication, advertising and broadcasting information of services, facilities and goods.
DUTY OF CARE
It is often forgotten in some quarters that the dispensing optician has a significant duty of care to a patient regarding visible pathology. After the changes to the GOC rules in 2000 (SI 1999/3269) The General Optical Council (Rules relating to Injury or Disease of the Eye) Order of Council 1999, several points are clarified:
If it appears to a registered optician that a person consulting him is suffering from an injury or disease of the eye, the registered optician shall refer that person to a registered medical practitioner
When referring a patient the following procedure should be followed:
Advise the patient to consult his or her medical practitioner
Wherever practicable, provide the registered medical practitioner named by the patient with a written report of findings indicating the reasons for thinking the person may be suffering from injury or disease of the eye
Where action appears urgent, practitioners shall take measures as are open to them to inform a registered medical practitioner immediately (by telephone).
If a person who appears to a registered optician to be suffering from injury or disease of the eye is unwilling, on conscientious or other grounds, to consult a registered medical practitioner, or that it would be impracticable or inexpedient to do so, the registered optician may at their discretion decide not to refer that person on that occasion. In such an event the practitioner must record:
A sufficient description of the injury or disease from which that person appears to be suffering
Their reason for deciding not to refer on that occasion
Details of any advice given to the patient
If appropriate, and with the consent of the person consulting, inform the patient's general medical practitioner of the actions and reasons.
As an exception to the duty of a registered optician to refer a patient to a registered medical practitioner, a dispensing optician may refer the person consulting them to an optometrist; and in that event, they shall record that they have so referred together with details of the injury or disease from which that person appears to be suffering and of any advice tendered to that person
None of the regulations regarding referral shall prevent a registered optician from rendering in an emergency whatever services are in the best interests of the patient.
It is very occasionally the case that a patient who a practitioner feels may benefit from referral to a medical practitioner refuses to accept this and, further, refuses to consent to personal medical information being sent to the doctor. In such cases they have every right to do so.
However, a practitioner may in certain circumstances justify overriding the patient's wishes and make accurate notes as to this decision on the records. One example is where the practitioner feels that refusing the medical attention may result in danger either to the patient themselves or the public at large.
An example here may be where an eye condition is suspected that may clearly interfere with the patient safely carrying out an activity or driving. On rare occasions it may be suspected that the patient is of insufficient sound mind to make an appropriate decision about their own wellbeing and consultation with a medical practitioner without consent might be justified.
Case Study
Thankfully, malignant lesions of the lid and face are rare in practice, but all practitioners should be aware of basal cell carcinomas. These may present on the lower lid, but also may be found on the lids and occasionally on the face where they may be mistaken for 'friction' lesions due to poorly fitting spectacles.
Any recurrent elevated sore lesion on the side of the nose, especially if localised and with a central scab, should be considered for referral and not automatically assumed to be due to spectacle wear.
Useful Reading
Keirl A. Dos and don'ts in pathology. A guide for dispensing. OPTICIAN, 2003; February 14, No 5888, Vol 225, p20-25.
