Last week, I saw a patient who wanted me to confirm her self-diagnosis of iritis and sell her some artificial tears that people on her Facebook page have recommended for her. I’m no clinician but her symptoms didn’t sound like iritis to me. Besides, if it was iritis, Hypromellose wouldn’t help much.
I could have told her that iritis doesn’t usually present with sticky, gunky eyes but thankfully it’s not my place to say any of that so instead I triaged her and gave an appropriate appointment with someone who could confirm, or rule out, a diagnosis. That balancing act of background knowledge, teamwork with clinical colleagues and communication with patients has followed me throughout my career.
My first optical role was in a busy multiple. I was employed as a receptionist, but I spent all my time doing fields screening because nobody else wanted to do it. I hated it. I wanted to be downstairs with my colleagues, not upstairs with the constant beeping of the Humphrey Field Analyser.
One day, I saw an interesting field plot. The locum optometrist explained the patient had a stroke a few years ago, and how a stroke can cause hemianopia. Later (after he had made certain that I was not ever going to repeat any of what I was about to learn to a patient), he showed me a reference book with more field defects and explained how they may have been caused.
When he told me about negative scotoma and how the brain ‘fills in’ an image so a patient may not know they have a field defect, I was amazed and although I knew I didn’t want to stand by that fields machine every day for the rest of my working life, I knew my job was a small but important piece of an examination and I became happier at work.
A while later, I was chatting to one of the other locums about my new interest in perimetry. I was surprised when he told me the other optometrist was wrong for showing me a reference book because I may try to assess a fields result and give that information to a patient. It felt unfair to completely restrict access to learning when a simple chat to make sure I was aware of boundaries in delegated tasks would have sufficed. Also, surely a bit of background understanding relevant to my job is a good thing?
A little later, he apologised and said on reflection, since I knew not to offer clinical advice to patients, maybe I should be able to learn about conditions that I was helping to monitor for. He kindly even offered to show me other interesting fields plots and tell me about the conditions causing the defects.
Time for lunch
Twenty years have now passed, and I haven’t done a fields in many years, but my busiest practice is located within a medical centre so as well as a fully booked standard clinic, we see many patients experiencing eye problems and I have to triage them to appropriately arrange appointments. Years of experience, a course from Health Education and Improvement Wales many moons ago, and access to the Wales Eye Care Service handbook means that I am now pretty good at it.
I have an optometrist friend in a practice about 50 miles away. He tells me he often works through part of his lunch. Recently, it was to see a man that had been squeezed in for an emergency appointment because he’d had watery eyes for the last month or so. Non-registered and support staff are such an asset to a busy practice, especially if they are not trained only within the specific confines of their immediate tasks.
If they have relevant, background knowledge they can make the practice run more smoothly and be such an asset to a busy clinician. So whereas I understand the frustration my friend felt, I also wonder why the management at the practice didn’t train effective triage? Are the other clinicians scared in case shopfloor start giving incorrect advice?
My advice to non-registrants is always to ask about things you come across that interest you, even if it doesn’t seem relevant to your task at hand, soak up as much information as you can. Optometrists and managers, encourage staff to ask questions about things that interest them and see where their optical interests lie. It’ll make your life easier.
Back then, a simple understanding of perimetry gave me a much more rounded knowledge of why it was needed; making me more interested and meaning that I could be relied upon to perform that delegated task diligently. I’m still in no way a clinician, but simple triage training means I know who may have iritis and who probably has conjunctivitis (as well as dry eye syndrome exacerbated by cold weather) and ensure that our clinics run well. We leave on time, and nobody here works through lunch.
- Francesca Blackmore is owner and practice manager of Pearce & Blackmore Opticians in the Cardiff area.