We continue our weekly look at the GOC core competencies by expanding our argument over the significance of good communication skills for accurate history and symptoms taking
So far we have concentrated on core subject 1 for the optometrist but the GOC has also listed the competencies for the dispensing profession. It might be argued that both optometric and dispensing professionals have a similar responsibility to adopt adequate communication skills for the good of the patient. The breakdown of the competencies issued by the GOC shows a slightly different bias for dispensing opticians.
CRITICAL COMPETENCES
APPLIED KNOWLEDGE AND SKILLS
An understanding of the importance and significance of family history, signs and symptoms including a recognition of the importance of the
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| The DO must be able to deal effectively with a patient's concerns |
A breakdown in communication between the practitioner and patient is often a major cause of patient dissatisfaction in practice. With regard to spectacle dispensing, this may impact directly on several areas including:
It is essential that the spectacles dispensed are functionally suitable for their intended use. It is not uncommon to establish at a later date that the patient would like to use the spectacles for a task that was not discussed at the initial dispensing. The common example is single-vision reading spectacles that are not suitable for intermediate tasks and vice-versa. At dispensing, the practitioner must always establish the occupational needs of the patient to identify the most appropriate lens and frame option and advise them of the optical and functional limitations.
Ideally, the working distance for each task should be measured and the dioptric equivalent determined to assess the clear range of near focus available to the patient. If the range required cannot be achieved with single-vision lenses, then an appropriate multifocal design should be discussed.
Be flexible in your approach to the patient's visual needs; in other words, consider the value of bifocal forms with an intermediate and near correction for occupational use, but always check with a colleague that you have calculated the correct powers to use on the order.
Always make sure the frame eye size depth is adequate for the intended multifocals, otherwise the patient may not be able to maintain a comfortable head posture for extended periods of close work. The importance of full and correct instruction on the use of multifocals should not be underestimated, especially in first-time wearers, as this often leads to complaints and intolerance.
Patients regularly do not adhere to the instructions given regarding proper care of their lenses and this is particularly challenging when the lenses are MAR coated. Failure to care for the coatings will reduce the optical performance and may result in an apparent reduction in visual acuity, which is always worrying for the patient.
An automatic cause of intolerance will result from an error in writing, or typing to computer, the prescription to be ordered. The final order will always match the completed spectacles in this case and the cause of error initially overlooked. This prolongs patient-practitioner anxiety, unless the prescription is traced back to the patient record, which may not be directly available for external prescriptions. This is often time-consuming, costly and embarrassing for the practitioner. Again, it may be useful to have a second member of the practice team double check the prescription details on the order before glazing.