Like many optometrists, it was Rohit Narayan’s first eye exam as a teenager that inspired him to go into the profession. He couldn’t see the board at school but he says after collecting his first pair of spectacles, he started ‘seeing the world.’
Narayan tells Optician: ‘I was just amazed that the clinician was able to help me see and impact my lifestyle in a very positive way and allow me to do things like be at school without squinting and struggling.’
Narayan says although his first eye exam provided a ‘wow’ moment where he could see, he still did not understand what was going on because no one explained anything to him. ‘I felt elated yet vulnerable at the same time because this was a completely alien environment to me. When I realised optometry was for me, I wanted to make it a comfortable experience for my patients. I wasn’t aware what I was thinking about would become known as patient-centred care.’
Narayan graduated from Aston University in 1989 and completed his pre-reg at an eye hospital. After working for a number of years in independent practices, Narayan turned his attention to how he could improve the patient experience clinically. Narayan wanted to offer a more medical optometric experience and he knew going to the US would enable him to practise optometry the way he felt it should be done. ‘I wanted to be able to offer a “one-stop shop,” which was full scope optometric care.’
He took an opportunity to study a conversion programme for the opthalmic doctor course in the US and qualified in two years instead of the usual four. Narayan sought the medical emphasis and therapeutic optometry parts of the course. He knew it would put him ahead of his peers at home and when, after qualifying, he saw that therapeutics had still not fully arrived in the UK, he stayed to practise in the US.
An American education
Narayan was based in Pasadena, Los Angeles at a family practice with 25 exam rooms and a drive thru dispensing collection service. It was open 8am-10pm every weekday. ‘It was just an incredible experience and it was all about customer care. That’s what really impacted me.’ This was to be the foundation of Narayan developing a holistic, patient centric approach to eye care. He was told by a business partner that the only KPI he had to worry about was the patient. ‘You figure out a way to engage and get all of the information you need from the patient because if they aren’t engaged then you won’t know everything about them. How can you provide the best recommendations if you don’t know they’ve got loads of hobbies?’, Narayan explains.
From his time studying and practising in the US, Narayan developed an appreciation for how the eyes form part of the bigger healthcare picture. ‘The beauty is you can look in and discover that what’s going on here will be an implication of what’s going on elsewhere. I found that wild and I love that,’ he says.
Guided recommendations
Patients can mistakenly see optometrists as a means to an end product, Narayan says, so it is about offering them an experience where they feel like their eyes have been looked after and they have learned about their general health. He explains that preventative care is about raising awareness, which means providing patients with context and explaining why it helps.
‘A healthy lifestyle will reduce the risk of lots of general health ailments, which will do them good and reduce the risk of quite a few eye problems, such as macular degeneration,’ Narayan says.
Narayan learned that the more you inform patients, the more engaged in their eye care they became, which improves patient compliance and outcomes. ‘I’m always talking and, for someone with a stammer, it’s not the natural thing to do, but I will tell them everything because I want them to make an informed choice. When they tell me more about themselves, I can set up things much more clinically. I can tell them a story from their history and symptoms and lifestyle to what I find, to my recommendations. I’ll tell them a story that’s flowing and my recommendations will always be guiding. You want to guide the patient.’
Narayan’s process revolves around the history and symptoms, as well as looking at the patient for any obvious tell-tale signs of anything that could be related to eye health issues. He shares an example of a patient who lives with rheumatoid arthritis and struggles to walk. Narayan says if he gave them too large a prescription change then there’s a chance of them tripping. ‘All of this gives me information I can use at the end.’
He adds that this information is not always gleaned from a rudimentary history and symptoms and are important to know. Technology can assist in the education process too. ‘By showing them an image and informing them with technology, you educate them, and get their buy-in, and then they are more likely to be compliant,’ he says.
Awareness of opportunity
Narayan has practised in a variety of settings during his career and experienced the opportunities and challenges each one offers. ‘If your fundamental goal is clinical excellence and patient care, it results in improved patient outcomes. You can trim certain things down, so if you are in a big, busy high street practice where time is a premium, you can still touch on a few of these points and you don’t have to go into lots of detail. You can briefly inform the patient, give them a leaflet and record the advice you’ve given. You are involving them in the decision-making process, which is key.’
Clinical excellence means understanding your worth as a practitioner, Narayan explains. He believes the US model of charging for everything is the right approach and thinks there is an opportunity in the UK to offer more services. ‘You’re paying for my expertise, my time and I’m worth it. I’m not apologetic about that. Once you accept that opportunity is there, then you have to upskill. Clinical excellence implies an awareness of opportunity. Upskilling to build upon the patient-centric approach from the front of house, right the way through to when they leave.
‘That might mean upskilling your staff. It might mean extra training, getting them on board, talking about a champion within your practice for certain things and delegating where appropriate. We can keep improving constantly. As soon as you start to get complacent, you fall behind,’ he says. Narayan adds that the profession needs to break out of the shell of being perceived by the public as refractionists. He says this is changing rapidly and many optometrists already understand the potential but putting the patient first is paramount.
For Narayan’s own upskilling, he admits he’s late to the party when it comes to medical retina but aims to undertake the qualification soon. He also wants to conduct more research on his holistic approach, specifically looking at pre-clinical diagnosis of certain ailments.
In Narayan’s current role at Anglia Ruskin University, where he lectures and oversees students in the eye health clinic, he wants to close a gap between university and pre-reg. He wants undergraduates and pre-regs to feel confident about practising and realise the opportunities available to them. He explains: ‘I want optometrists to become the optometric doctors that I think they should be. The landscape for young practitioners is changing so quickly and there’s opportunity clinically and business wise. In order to take it, you have to prepare yourself and be ready for that challenge.’