I always keep a floor-standing spot lamp by the side of my consulting room chair. When I have found the best reading lenses for my patient (using a trial frame, of course – is there any other way?), I then turn on the light and ask if it’s any better. Of course, it usually is. I then ask what sort of reading light they have at home and it is usually just a centre light or a ‘standard lamp’ (whatever that is).
I then say: ‘Why not go for one of these?’ Two years later I find out that some do; some don’t. Why is this? I never worked in another optician’s practice equipped with such powerful diagnostic equipment.
Roger Skidmore
Newport, Isle of Wight
I have never before felt compelled to write to any of our professional publications. However, after reading the latest piece of correspondence from the College of Optometrists, I feel I must express my concerns and dismay at its contents.
I draw your attention to the questionnaire which has been sent to us as part of The College’s 2007 Clinical Practice Survey and in particular question 7 which starts the section relating to checking for glaucoma.
I quote from the question ‘For each of the following categories of patient how often do you assess the patient’s optic disc?’ I consider this to be quite a worrying and somewhat insulting statement. I have been qualified for five years and now wonder what has changed within our profession in that time if it is now considered that optic disc evaluation is optional. I consider that every time ophthalmoscopy is carried out on each eye the health of the optic disc should be considered. This was something that was instilled in me and I suspect every other optometry student before or since.
Surely as a profession we should be moving forward and not backward, a direction in which we may be going if ocular examination is becoming so vague. The College is supposed to be an organisation that promotes advancement of optometry, yet if it feels it is necessary to question if disc assessment is carried out I wonder where the profession currently lies.
As The College is the only examining body for optometrists in this country, surely every one of us has had to ensure the optic disc is examined at least once in order for us to pass our PQEs. If there are practitioners out there who do not routinely carry out such an examination, then surely they are failing in their fitness to practise and their GOC registration should come into question.
The College’s own Code of Ethics and Guidelines for Professional Conduct is also somewhat vague when specifying the requirements for a routine eye examination. Section 02.16.02(h) gives a very basic description of an internal and external examination, so is it possible that each separate ocular structure need not be considered in isolation?
I have a number of colleagues who are pre-registration supervisors and this issue with poor ocular examination appears to correlate with the situations they describe where their students are not performing to the standards we should all aspire to. Could this be a reflection of the quality and also the possible excessive number of people who are entering the profession in recent years?
My other issue with the document in question is that the letter that accompanies it states the questionnaire is entirely anonymous. However, I note on the first page there is a specific six-digit ID number. Could it be that the College has kept a list of these members and to whom the specific questionnaires were sent?
Name and address supplied
I was recently assaulted while working at a mental health unit by one of the clients, I was able to resolve this due to my martial arts training without injury to the client and a small scratch on my hand.
This raised a number of issues which I thought I had covered, I have had all hepatitis A, B, C, tetanus and pneumococcal injections.
The unit manager had to fill in an incident report and needed to know that I was up to date with my inoculations, which proved quite difficult to get from my GP.
I had to reassure him that I only used reasonable force to restrain the client and he asked me had I undergone control and restraint training which is provided by the Mental Health Trust, which I had not.
The issue here runs with current legislation change being brought in by the Home Secretary with regard to the use of reasonable force. If I had over-reacted and the client needed treatment or died as a result of my actions, I now stand a better chance of not being prosecuted. However, I was expected to be able to control the situation by means of effective training, and unreasonable use of force is still unacceptable in the eyes of the law.
The unit staff have an obligation of duty of care to me as much as to the client, which due to the fact the nurse left the examination room meant that they were failing in this.
So make sure the staff stay with you at all times with mental health patients (even low risk as this client was), keep up to date with all recommended inoculations and take up judo.
It would be interesting to know what ABDO and insurance companies for optometrists have set up for this type of situation.
John D Snelgrove
St Albans, Herts