We continue our look at GOC core competencies by addressing the second of the core subjects which relates to professional conduct. As can be seen from the list below, the categories relating to optometry are quite broad and less specific than those for the second core subject for dispensing opticians as will be seen next week
We continue our look at GOC core competencies by addressing the second of the core subjects which relates to professional conduct. As can be seen from the list below, the categories relating to optometry are quite broad and less specific than those for the second core subject for dispensing opticians as will be seen next week
Core subject 2 relates to an understanding of professional conduct and the legal aspects of professional practice:
The ability to manage patients in a safe, ethical and confidential fashion
The ability to create and to keep clear, accurate and contemporaneous patient records
The ability to interpret and respond appropriately to existing records
The ability to make a judgement regarding referral and an understanding of referral pathways
The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist.
To expand on these points there are two areas that are key: the ability to make a clinical judgement and convey this, and the ability to record this adequately.
PRESCRIBING
The optometrist is legally bound to issue the patient with a confirmation of their refractive correction, if any, and a note as to the need for any further medical assessment if the eyes were found to be less than healthy.
This 'prescription' needs to be dated, signed and have details of the prescribing practice on it. It is important to remember that the final prescription might be adapted in some way from the final refractive error measurement, for example:
Where a patient is used to a slightly over-minussed correction used primarily for distance viewing and prefers the extra minus
Where the refractive error is helping to stabilise binocular state (over-minus to compensate for an exophoria, maximum plus for an accommodative esophoria state and so on)
Where a reduced post-cycloplegic correction has been decided upon to improve compliance with an isometric hypermetropic refractive error.
The optometrist should also be able to offer advice (and record such on the notes) about the best methods of correction, whether it be contact lenses or a particular spectacle lens form or design.
This may aid the subsequent dispensing, particularly if the advice is relayed verbally to the practitioner carrying out any subsequent dispense.
COMMUNICATION OF FINDINGS
The delivery of information based on the findings is the culmination of all the preceding verbal and practical techniques. If the presenting problem of the patient is to be addressed and perhaps resolved then the recommendations should be delivered in a meaningful way to the patient. To some extent this will depend on the nature of the underlying problem and the person dealt with and specific examples will be dealt with later. However, general considerations might include the following:
The recommendation should be clear and concise. After a lengthy summing up and appraisal of the situation it is quite soul-destroying to hear the words, 'So, do I need glasses then?'
The recommendation should be specific: 'You need to wear your glasses for driving. You should make an appointment with your GP in the next two days'
Non-verbal cues help to reinforce the information given, of particular importance if emphasising an issue with possible health consequences
Categorisation or presenting information in manageable 'chunks' makes information easier to understand and easier to remember, so improving compliance. 'You do require new distance glasses. Your current readers are absolutely fine to continue with. Your eyes appear to be healthy. There is no significant change in the health of your eyes since the last examination. I shall want to examine you again in one year.' Be very careful not to overload the patient with information as this may decrease subsequent recall of information
Where there is a greater amount of detail to be imparted, it is a useful technique to repeat any information of particular importance.
Furthermore, if a sequence of information 'chunks' is delivered, the patient will tend to remember most the first thing said to them (the primacy effect) and the last thing said to them (the recency effect) and this can be exploited by the skilled practitioner in conveying information
The patient should be given ample opportunity to question or respond to any particular points. This will also have the advantage of signifying their understanding of a particular point, so allowing the practitioner to reinforce by repetition or clarification
The patient should be made aware of the opportunity for future contact in cases where there may be a problem arising from consideration of the results
Some practitioners give written reinforcement in particular situations where advice may be technical or specific - for example with regards to a particular lens material or contact lens solution regimen.
