In our practice we have been looking at the new GOC standards for business registrants to ensure that we all understand and can continue to meet them. As part of this we held a training session recently on the importance of consent and safeguarding so that all members of the practice team could understand their roles and responsibilities.
Safeguarding was never talked about when I first qualified, perhaps because there was less need for it with patients coming from closer knit communities. Because there was less awareness, there were fewer cases reported from which to learn. As we discussed our safeguarding duties and thought about those who might be more vulnerable, we all became much more aware of what to look out for.
Colleagues who initially said they would be offended if a query was raised over the way they handled their child when he or she was misbehaving, began to realise that in general this was something that needed to happen. Even though they were unlikely to be at fault themselves, if this approach saved a young or vulnerable person from harm, it could only be a good thing.
I remember a very snowy day years ago, when few patients could make it to the practice for their eye examinations, a lady in her 40s who was a wheelchair user did attend because her seven-year-old son pushed her all the way in the snow. It was in the 80s when little was known about safeguarding. While at the time we were impressed, now I wonder whether that child had any support in place, so that he could have some protected childhood. Nowadays I am often asked questions about a child’s attendance at appointments, or whether spectacles have been collected, particularly as part of the child shared care pathway we participate in locally.
When we got on to the topic of consent, it was an interesting discussion as we had to consider who would have the capacity to consent and how we would judge that. This naturally led to not treating patients differently and not assuming that they could or could not do something.
As our practice is over two floors, should we assume from just a date of birth on booking whether someone can manage the stairs? As we discussed disability, it became apparent that it is very easy to see someone with a physical disability and assume they may not be able to do something, perhaps because we don’t want them to feel embarrassed. However, we all know that there are patients with a mild illness or disability who, when asked how they are, will list everything that is wrong with them, and there are patients at the opposite extreme who quite clearly have health issues and yet when you ask how their health is, they tell you everything is fine.
We recognised that if we assumed a patient who seemed to have a lot of health issues could not undergo a particular test or manage the stairs, this was discrimination. I remember the young man who walked upstairs with me for an eye test and as he did, explained that he was slower than he would like as he’d fractured his spine in an army expedition – he would have been most offended if I had treated him any differently.
From a personal viewpoint, I have been classed as disabled since a serious skiing knee injury many years ago. Once I’d gone through the initial periods of grief then acceptance that things would be different for me, it challenged me to achieve and to prove that I can do most things, both personal and career-wise. I am always mortified if a hotel puts me in a disabled room (not least because they are usually next to the noisy lift). I am incredibly grateful that I have found a career path where no one has assumed I cannot do something, and where I have received the same support as all my able-bodied colleagues. If anything, I have probably given more and developed more because I see it as a challenge to prove that I can do the same as everyone else (or better!). Yet if the assumption had been made that I wasn’t able, I certainly wouldn’t have worked to my full potential and would have felt demoralised and lacking in self-confidence as a result. As an intelligent consenting adult, if I choose to do something that leaves me in pain after a long day, that’s my choice.
After I shared my personal take on this, we all agreed that it was better to allow each patient their own decision to consent and be involved in their care and to stop making assumptions. I’m maybe going to give the Christmas ice rink a miss... though then again…?
Merry Christmas!
Judy Lea is optometrist director of Specsavers, Longton, Staffordshire.