It is that time of year where there has been a flurry of trainee optometry assessments. As always, certain patterns come to light.

Some are familiar, such as poor retinoscopy skills. Indeed, some trainees question the need for retinoscopy on all patients, something their practices seem to encourage. Another is the urge to prescribe ocular lubricants for the symptomatic relief of people who have no symptoms.

One area where, perhaps not surprisingly, there seems to be the greatest confusion or variation is with regard to referrals. The old distinction between same day referral (pain, sight or life threat), urgent (to see a specialist within two weeks) and routine is becoming quite muddied. For example, urgent referral via a GP has to be of questionable reliability, while long waiting times for routine referral appointments (over a year in some areas) might be shortened by offering a private option. The rise of private medicine is definitely well under way. I note that private health firms have donated more than £800,000 to the governing party over the past 10 years, coinciding with the government handing out more NHS contracts to the private sector.

This seems to be a practice inherited from our US friends. For example, many hi-tech companies have announced they are to adopt, not just a net-zero policy regarding environmental impact, but a carbon-negative policy. However, their investment in lobbying congress is insignificant compared with that of the oil lobby and hence legislation to protect the environment is met with resistance at all turns.

We can thank the US, however, for the excellent satirical publication The Onion1 which, this week, featured a story about a woman suffering cardiac arrest being given an appointment for CPR in six weeks’ time. Alas, ‘sources confirmed the hospital had charged the patient $15,000 for dying without cancelling her appointment in advance.’

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