Bill Harvey: Master of puppets
Harvey accepts delegating refraction only when suitably supervised
Author: Bill Harvey
When deciding the first topic for the new series of clinical practice primers that starts in this week’s issue, I decided to select pupil assessment after being asked the following question by a trainee: ‘According to my supervisor, you don’t have to do a pupil assessment as part of a routine eye test. Is that right?’
This weekend is the last chance you have to make your views known to the GOC about the need for changes to the Opticians Act. Even its name is anachronistic, and so most ECPs should welcome the opportunity for an update to the law that reflects the expanded roles we all play and are likely to embrace as advances in technology continue. I hope there will be similar consensus in disregarding attempts to separate out a refraction test from a health test. To suggest that anyone is able to assume that changes in vision are completely due to refractive error, and so ignoring influences from binocular and accommodative status, physiological changes due to age and functional and anatomical changes due to disease, is obviously madness. I am sure some business heads might see the appeal of using underpaid staff to operate an autorefractor, but I fail to see how this can in any way reflect any form of vision assessment.
Now, that is not to say that most individual tests within a routine eye check might not be delegated. I would happily take responsibility for a suitably trained staff member undertaking refraction for me, along with much other data gathering. I would, however, insist on maintaining the right to look at all the information acquired, ask for repeats where I was not happy, and deciding, with the patient, upon what best to do with the results.
So, my answer to the trainee’s question was: ‘You should do a pupil assessment if I say so.’
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