Moneo writes: Give them what they want
I recently spotted a report of a survey carried out by Optos into various patient attitudes and knowledge of eye examinations. Optos manufacture ultra widefield retinal imaging systems used in primary care and hospital eye clinics throughout the world and have been increasing in complexity and ability over time until the latest versions are now capable of ultra widefield OCT imaging anywhere in the retina where the imaging device can capture a retinal image.
I am not here to advertise Optos, rather to highlight some fascinating points that come out of its survey. This survey clearly blows out of the water some of the myths about patient’s attitudes held within optometry for too long. It also presents something of a quandary for the professional regulator and those offering clinicians professional indemnity. Something which both should seriously take note of.
The survey used a sample of 2,500 people, which is a good number and hence the results can be considered reliable and acceptable. The survey showed that the majority of respondents considered their eye health as ‘very important’ to them. However, a low, but significant percentage had never had any eye examination. This is something that we should address as part of an ongoing public information strategy. The current methods, it would suggest, may well not be effective at reaching some areas of the population.
The important finding was that nearly 60% saw use of the most advanced imaging technology as the most important aspect of their eye exam and nearly half wanted a trustworthy experience when with their optometrist. Interestingly, the least important was options for low-cost products at their appointments. This reinforces the fact that people put the level of clinical care as their highest priority. Two thirds of those surveyed stated their willingness to pay extra charges for enhanced examination techniques because they value the health of their eyes and want the best that is available to ensure that health.
So, what this survey shows emphatically is that those optometrists who say their patient’s will not pay more for better examinations are wrong. When confronted by a colleague who says this, I have always asked for the survey they have carried out within their patient base to uphold this view. Of course, there never is one. It has always fascinated me that we are prepared to charge patients upwards of £600 for a pair of varifocal spectacles without batting an eyelid, expecting the patient to fork out willingly. Yet when it comes to charging a few pounds more to check the health of their eyes we seem to think it is an impossible task. This survey shows how wrong we are. It also shows that those that maintain this stance are denying their patients something they want and, sadly, it also probably shows a great lack of understanding by that optometrist of their patient’s needs. What’s more it shows that those who think they have to give these additional tests away free ‘because the patient won’t pay’ are also wrong.
Dumbing down the value of our clinical skills has always been wrong and this study goes a long way to show that. It is time that we all realised that the public value, and will pay for, high quality clinical services and that we do not need to pin everything we do on to a retail base. This is not what the public want and for some reason we seem to be the only people that think it is. What the public want is for us to invest in high quality, cutting edge technology that will ensure they receive the most complete clinical service when they visit us. And they are willing to pay for that investment and service.
The other very important point to come out of this survey, the one that the regulator and indemnity insurers should be looking at is the result that shows what people think we are doing when we look in their eyes. Most people responded that they thought we could see two thirds of the retina, but among those who needed a prescription this rose to 75% of the retina. It is clear that the public believe we see far more of the inside of their eye than we actually do. Therefore, when we tell them that ‘your eyes appear healthy’ they are mistakenly thinking we are basing this on an opinion that we have seen far more than we actually have, whereas to a large extent we are merely guessing.
This is not acceptable and this deliberate misleading of the patient needs to be stopped as it is both wrong and laying the practitioner open to litigation for misleading that patient. It is important that when pronouncing a clinical judgement, the patient is made aware of what parameters we are basing our judgement upon. Maybe the time has come to review this. While the regulators and indemnity companies consider this, let us review our attitude towards our patients and assess whether we are giving them what they want or just what we think they will tolerate.