I chose optometry as a profession because I wanted to make a difference. In domiciliary, while it is challenging, I feel I’m making a difference every day.
Recently, my dispenser and I visited a young man with learning disabilities for the first time, who was being looked after in a wonderful, small care home. I sat down to talk to him and found the chair where he had been sitting was a little damp. When we tested his eyes we found he was extremely short-sighted, and the only reason he wet himself was that he couldn’t always find the toilet. Despite the challenges, there is much job satisfaction in helping vulnerable people who can’t leave their homes. Being able to help someone in that way makes it all worthwhile.
I know that domiciliary isn’t for everyone though. You have to have a particular knack of caring for people; it’s almost a vocation. We do offer locums the opportunity to do a paid shadowing day so they can see if it is for them as it’s emotionally demanding. Some optometrists choose to do home visits just one or two days a week, then work in store the rest of the time, a particular benefit for us at Specsavers where we work on the high street and in people’s homes.
I personally find it has made me a better clinician and with better patient handling skills. The number of patients with communication difficulties means that I have to work on my objective methods of assessing prescriptions.
The first thing to do is to find out if there is a time of day that is best for the patient – particularly those with learning disabilities. Some people are better in the morning, and some more co-operative in the afternoon. There’s no point going at a time of day when you know you’re not going to get any co-operation.
You’ve got to be an excellent communicator and be adaptable. Most individuals with a learning disability are encouraged to go to a store as a visit will help with socialisation outside their home. So the people that I see tend to be at the far end of the spectrum of learning disabilities. We often find they can be quite frightened by new environments or strangers. I had to sing and dance with one lady who had a fine voice before she’d let me test her eyes.
This month I went to see an elderly lady who lived with her brother, both are in their mid-90s. They live in the middle of nowhere, they didn’t have any close neighbours and they couldn’t drive. While I was there I noticed that the brother was wearing three pairs of glasses, one on top of the other, to read the newspaper. He hadn’t had his eyes tested for nearly 30 years because, perversely, he was frightened that he was going blind. So I did an eye test for him while I was there and was able to tell him that he wasn’t going blind, he just needed new glasses. He cried, and I nearly did as well.
The longer I do this job, I enjoy it more and become even more resilient. A good sense of humour helps me – I can’t take myself too seriously doing domiciliary work. Some days I find I’m not viewed with much respect. In a care home my status is below the monthly hairdresser visit, because while a new pair of glasses can lift the spirits for a little bit, at least the hairdresser makes the patient feel good. I have been inadvertently insulted a lot but because I know I am helping them, it’s like water off a duck’s back to me now. There are laugh out loud moments too – we see all sides of life out on the road.
I used to spend half my time in the car checking my map or turning around, but sat-navs have changed all that. Thankfully though, the volume of patients we cover and the skills of my scheduler means that distances between patients are normally between 15 and 20 minutes. Some people think I’m in a car all day but with seven or eight appointments near each other that’s not the case. It is still more of a physical job than being in store, and I do have to keep myself healthy. While we go out in pairs, I do carry equipment up and down stairs, sometimes up to nine floors if a lift breaks. As well as 180 frames, there are portable versions of most equipment. Luckily I have avoided colds and coughs this winter. Long may that good health continue.
Tina Dickinson is an optometrist and domiciliary director at Specsavers.