Letters : October 28

 Guidance for the time-pressed OO

I refer to Bill Harvey's review of our book Practical Ophthalmology: A survival guide for doctors and optometrists (Optician, May 27, 2005).
Book reviews are by their very nature subjective opinions and not subject to peer review prior to publication but should at least represent the facts correctly.

As co-author of the book I was pleased to note that he found the main sections on diagnosis, referral and management useful, but was disappointed to see that he felt 'readers might wish to avoid the first two chapters which explain the fundamentals of the eye examination at a very basic level. One can only hope that the patronising tone of these chapters is more aimed at our GP colleagues'.

This book is aimed at primary care and junior doctors, medical students and optometrists. The back cover concisely explains that it will be a 'practical and accessible guide to a wide variety of readers' this includes 'medical studentsÉconcisely describing anatomy, physiology, eye examination techniques and eye diseases assuming no previous knowledge'.

The 'patronising' second chapter is therefore clearly aimed at medical students and first-year optometry students.
At the start of the book on page ix are specific instructions on how to use this book. 'Optometry students - first year: read the chapters in order....Optometrists and senior optometry students: skip Chapter 2 (the 'patronising' eye examination chapter) and 11: Short of time? Read Chapters 1 and 10 then have a look at the overview, flowcharts and photographs in the other chapters. Keep the book handy for quick reference in clinic'.

Harvey has incorrectly stated that the first chapter is related to eye examination. The first chapter is the key 'staying out of trouble chapter' with summary critical points and is probably the most important in the whole book and has been completely ignored by the reviewer.

Practical Ophthalmology: A survival guide for doctors and optometrists has other features aimed at the time-pressed optometrist. As well as the instructions on page ix on how to use the book, there are colour-coded symptom-based chapters for easy reference and a list of diagnostic flow charts on the inside front cover. In fact, I doubt there is a more concise guide for the time-pressed optometrist.

Peter Simcock and Anthony Pane


We have brought about this situation

 The proposed 'tendering' to provide General Optical Services (GOS) worries me, as it should all opticians, but probably for a different reason. However, before I go into that, I feel there is another point worth discussing. It can be argued that we have brought this situation on ourselves by providing 'cut price', or even free, private examinations.

The Government is obviously sick and tired of the protracted negations which take place annually and is determined to cut costs. The argument, I assume, is that if we can provide cheap private eye examinations, it must be feasible to provide cheaper GOS work.

Taking this one step further, it can also argue that the increases in GOS fees that we initially demand are artificially high so as to subsidise our cheaper private work.
Anyway, having raised a few hackles with that idea, I now put forward my concerns about the proposed tendering. The problem that I envisage is that we will not be told what it is that we are tendering for exactly.

In other words, are we tendering to see the same number of patients as at present, or are the PCTs going to limit the number of contractors and thus increase the 'market share' for those that achieve this hallowed status? To my mind it is akin to asking a builder to tender to build houses, but refusing to tell him how many. Quite obviously, the more he builds, the lower the unit costs and hence the lower the tender.

So, are we tendering a fee to continue to see the same number of patients, or fee on the proviso that we will in future see twice as many because the number of contracted practitioners will be halved?

Martin Edwards
Brixham, Devon