This week's letters

Booking problems
A colleague and I were recently discussing that thorny old problem of what to do about people who fail to show up for appointments despite having an appointment card and a telephone call on the day before to remind them.

A practice I know of displays a notice declaring that anyone who fails an appointment with less than 24-hour notice will be charged, but I have no knowledge of how successful this is or whether they do send an account for the broken appointment, nor if indeed it is paid.

During this conversation he suggested adopting the approach used by all hotels when one makes a booking, ie requesting a credit card number and I wonder if others out there have tried this approach or have any other method that is successful.
Richard S Morris
Great Sutton, South Wirral



Civil liberties
We read that the General Optical Council has started a consultation about which standard of proof <2212> criminal or civil <2212> should be used to judge the truth of facts presented at disciplinary hearings.

The standard at the moment is the criminal standard. The guilt of the defendant must be proved. He must be found guilty beyond reasonable doubt. No one has ever defined the percentage of that standard; but it probably varies between 80 and 100 per cent. If the people trying the case are not sure that the accused is guilty, then they must find him not guilty.

The civil standard is lower; as the accused has to be found at fault if he is more likely to have committed the offence than not. On a purely arithmetical basis, the accused is about a third more likely to be found guilty, if the civil standard is used.

The GOC may well feel that the lower standard of proof will cause practitioners to be generally more careful and, as a result, patients will have more confidence in the system. As the system will find more cases proved, and hence, more innocents found guilty; the public may well lose confidence. If, for example, this particular standard applied to say, rheumatologists, and the public read that a third more rheumatologists were found guilty of unprofessional conduct, would this increase or decrease confidence in someone about to have a hip replacement?

The whole initiative seems a little strange. Why does the consultation only last until March 31, when practitioners will be busy with end-of-year accounts? Why us? The doctors, dentists and pharmacists use the higher standard of proof, as do lawyers and barristers.

What is perhaps somewhat relevant is a quote from a book called Errors in Medicine written by someone from Harvard University called Lucian Leap about 10 years ago. The slide was only shown for a moment by the local health board so I didn't get more information.

Myth - Punishing practitioners for their mistakes means they make fewer of them.
Truth - Punishing practitioners for their mistakes gives a strong incentive to others to hide their mistakes.

One very good reason for civil law with its lower standard of proof is that it is not of sufficient public concern to justify the intervention of the state. Most of us feel that our professionalism is such that we need to have sufficient public regard and that this requires a high standard of proof. After all, if it's good enough for the GPs, it's good enough for us.

From the comments made by the president of the GOC, they are concerned about the confidence that patients have in us. Please make your feelings known to the GOC.

May I respectfully suggest that the greatest confidence can be obtained by the trust and respect we earn from the public. Very often there is a relationship between length of training and confidence. Doctors and dentists train for a longer time than we do and are respected for their knowledge. The training for pharmacists is now four years. Is it not time we were trained for four years to get our basic degree?

These aspects will merit discussion at our next LOC meeting. It is essential that this is so, because if the lower standard succeeds, it will be easier to find guilt in an optometrist than in a thief. This surely is not natural justice.
R H Gray Morris JP,
Chairman North Wales LOC



Addressing issues
Though we sympathise with the plight of your correspondent ('If undelivered', February 10), the GOC is obliged by law to keep sending communications to registrants at the contact address they provide. Until, of course, they fall off the register for failing to renew their registration. I would like to remind all practitioners that retention forms must be completed and returned with the retention fee by March 15. If you haven't received your forms, please contact us to make sure your address details are up to date.
Phil Ireland
Director of Corporate Resources
Kate Fielding
Communications Manager
General Optical Council



Apache hunt
One of our disabled patients is most attached to his last spectacles and would like a duplicate pair. Unfortunately the frame is a discontinued Dunelm Apache Col 2 (mottled brown) 46x18. Can anyone help? Contact 0114 270 1423 or email: info@jcbird.co.uk
JC Bird
Sheffield