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Friday / August 19.
HomemiprofessionEarning Trust as an Early Career Optom

Earning Trust as an Early Career Optom

Earning the trust of patients and other healthcare professionals is a challenge for any young optometrist, yet it is integral to facilitating excellent patient care.

Dispensing spectacles (and paying bills) is an integral facet of optometry but it’s not hard to do a great refraction and pick a great lens. This certainly does not define a good optometrist. What constitutes a good clinician, for me, is the capacity to identify, diagnose and manage peoples’ problems. Some of these will be optical like presbyopia and others will be sight or life threatening like giant cell arteritis. Many of these issues will require timely and appropriate co-management. So how do we gain the trust of our patients to come to us with their problems and how do we earn the trust of ophthalmologists, other optometrists and GPs to better co-manage? We need to facilitate a symbiotic relationship with other health care practitioners to benefit our patients.

Demands of an Ageing Population

With an ageing population and increased burden on the public health and ophthalmology sector, it will become increasingly important economically and practically to co-manage patients. According to the Australian Bureau of Statistics in 1960, life expectancy for males at birth was around 68 years. Today it is 78 years, and in 2042 the Inter Generational Report projects it to be around 83 years. Similar increases in life expectancy have occurred for females. At the same time, growth in the number of people of workforce age is rapidly declining. In 2002 there were more than five people of working age to support every person aged over 65. By 2042, there will only be 2.5 people of working age supporting each person aged over 65. This projection indicates more people requiring pensions and less people working to finance the demand. Consequently, the finite financial government resources must be distributed amongst a larger proportion of the population requiring assistance (and bulk billed medical care).

An aging population brings higher incidence of ocular diseases and an amplified burden on the already-at-capacity public health system. In my experience, most public hospitals in Sydney have a two-year wait for non-urgent cataract surgery. It’s not just cataracts, macular degeneration and glaucoma that increase in incidence with age. It is sight/life threatening things like giant cell arteritis, vascular occlusions, diabetic retinopathy, retinal detachments, nerve palsies, ocular melanomas, thyroid disease, iritis… the list is endless. Obviously the majority of these are far outside our scope of management and require urgent ophthalmologic referral. It is however, the timeliness and accuracy of our diagnosis and referral that can make a huge difference. If a patient has a huge superior macula involving retinal detachment they shouldn’t be seeing a general ophthalmologist, nor should they wait eight hours in an emergency department to be triaged. Too often we hear patients say “my left eye has been blurry for a month” or “my GP gave me these drops for my red eye and it’s getting worse”. It is unreasonable to misuse a GP’s time triaging a problem that should have been presented to us. Additionally we must consider the unnecessary financial burden on our health care system.

any patients referred from a GP receive a reply to build their confidence in my skills and better facilitate co-management of future patients

Developing Professional Rapport

We need our patients and the general public to trust us and present to us with their ocular related problems. We also need to develop rapport with our local GPs and pharmacies (and their reception staff) to refer patients to us. As a young optometrist it is sometimes challenging to encourage people to take you seriously. In the four short years I’ve been practicing, I have been asked “do you know what you are doing, you look so young” and one morning I was temporarily at the reception desk and was asked “are you here on school holidays working with your mum?” (I wish I was kidding).

I have found that if you are knowledgeable and genuine, patients respect and appreciate your management and advice. I am lucky to have amazing ophthalmologists across many subspecialties in close proximity. They run excellent CPD events, welcome co-management and are accessible for advice. It did however, take time to establish these relationships. I feel it was facilitated through my succinct and informative referrals. I generally include a tentative/differential diagnosis, detailed clinical findings and remain mindful of word count. Likewise any patients referred from a GP receive a reply to build their confidence in my skills and better facilitate co-management of future patients. One particular local GP refers all of her diabetic along with other patients per week (and sometimes per day). Some of these are just a single consult, foreign body removals or red eyes, however, we have retained many as returning patients who have purchased spectacles and gained others by referred friends.

In particular I resent using the pre-printed referral pads ophthalmologists provide. They are only useful for imparting patients with the practice location and contact details. I would argue hand scribbling a two line referral does not constitute professional or adequate communication of your clinical findings. Every patient deserves our time to accurately document information and liaise appropriately with the required specialist (and CC in their regular GP). Ophthalmologists also deserve our effort to facilitate their timely and appropriate management. Without accurate information they will unnecessarily use time administering simple tests we can, and should, be providing. This is highly apparent in the public health sector with increased wait times and escalating patient numbers. We are all busy, but the ophthalmology sector in a public hospital is busier. The bare minimum we should be providing in our referrals are; presenting complaints, best corrected visual acuity, IOP and important clinical findings.

I consider, with trepidation, the future of graduating optometrists who enter the work force and, restricted by time constraints or KPIs, fall into lazy practice. Every graduating year should be better educated than the last, and more knowledgeable with increased exposure to diagnosing diseases and providing superior clinical care. It is our duty of care to our patients to keep up with research and technology. The optometry degree I received from UNSW in 2013 was far different from the one my mum graduated with, from the same school, in 1986.

There are certainly things you can only learn with experience, so each generation should supplement their predecessors’ knowledge with advice gained through years of practice. This shared knowledge helps establish rapport with patients and continue relationships with local ophthalmologists and GPs.

Although good co-management and well written referrals may not initially correlate with increased financial gain, long-term they build credibility for an optometrist and a practice. If patients feel you’re knowledgeable and trust your advice, they will be more likely to follow through with your recommendations – whether this is to see an ophthalmologist or purchase good quality optical products.

Rebecca Pyne graduated from UNSW in 2013 and currently practices at Ian Cleaver Optometrist in Gymea.

References
Australia Government Treasury. Australia’s Demographic Challenges.
https://demographics.treasury.gov.au/content/_download/australias_demographic_challenges/html/adc-04.asp

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