Like many others across the country, I received a letter this week letting me know that a long-awaited hospital appointment was cancelled. That was all it said.

In the final three months of last year, there was a 39% rise in people self-funding treatments compared with the same period before the pandemic. Many of these new customers are uninsured and are taking out loans, using credit cards or resorting to crowdfunding to pull together the money. Thank goodness none of the squabbling Tory hopefuls are considering cuts to the taxes or national insurance that fund the health service.

On a lighter note, I heartily recommend a new broadcast on BBC iPlayer called The Expectation Effect in which science writer David Robson discusses the impact of state of mind upon physical health. The placebo and nocebo effect should be of great interest to ECPs. As I have said many times before, perception is not just what the eye sees and, contrary to the view that vision is merely about refractive error correction (take note, GOC and autorefractor manufacturers), helping our patients involves listening and, most importantly, managing expectations.

Whether dealing with pre-operative patients or working with those with vision loss, explaining the likely outcome both realistically and in detail will always improve the outcome. Indeed, this is sometimes a benefit believed by the patient, despite there being no evidence for its actual effectiveness. This might be the case with with bilateral vertical prism specs for AMD or tints for patients with reading challenges, and would not be denied to the patient unless the prescriber is unduly profiting from this sleight of hand. I also wonder how much of a nocebo effect results from ECPs, when first fitting multifocal contact lenses and describing the likelihood of blurred vision. A good example of a clinical outcome being influenced by mindset.

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