Our careers working as an optometrist or dispensing optician will have us see many thousands of patients, each with their own preferences and individual needs. As a healthcare professional, we will need to be adaptable and make sure the information we provide is communicated effectively to everyone that we deal with. In most cases, this comes naturally with our daily encounters with the general public; but on occasion, we will encounter those that can have restrictions in how they communicate and/or understand things or may even mis-lead us in what they communicate. It is our duty to ensure that the needs of everyone under our care are catered to and this blog post will look at ways to navigate such encounters accordingly.
From time to time, you may encounter patients that you cannot communicate with verbally. This can take shape in several forms, such as in a language barrier, hearing loss or in some disabilities. In cases of a language barrier, body language is key, and you may need to adapt your routine to obtain the relevant answers (such as letter matching for visions, hand gestures to indicate eye movements etc.). It may be beneficial if you have a translator present and/or subscribe to a translator service – although this may not be possible. Document on the records that a language barrier was present.
With patients that are hard of hearing, then it is worth establishing the level of hearing loss. If they can hear, speaking loudly and clearly (not shouting), will increase the chances that you will be heard and understood. If the patient is deaf, then ensure you face the patient as much as possible and keep your mouth visible – as lip reading may be possible. I found that using your hands to direct gaze can be extremely useful as well as learning some basic sign-language that relates to the eye examination. Again, note on the record card of the difficulties in communication.
A large proportion of my patients are elderly and with this increases the chance that they may have reduced cognitive skills and/or dementia. This can be the most challenging of encounters as the information you provide may often be forgotten soon after delivering it and/or be miscommunicated later by the patient to relatives or friends.
I find in these cases, that I ask if the patient has anyone, they would like to attend the consultation with (remembering to respect their wishes if they decline) and ensuring each test is explained and advice given is repeated clearly. I often find leaflets or hand-written copies of the advice provided is helpful in re-emphasising the key points of the exam and these can then be shared with relatives should the patient choose to discuss the test with them later.
Special care must be taken with patients that are confused, as they can be considered vulnerable. Allow plenty of time for questions to be asked, be prepared or offer to discuss with present relatives/carers any management plan and document what has been said and why. Accusation of selling an elderly lady some varifocals in designer frames at a cost higher than expectation from the family not only has potential for a complaint but can also make you feel guilty – even if you’ve done everything honestly and correctly.
A reticent patient is one that doesn’t reveal very much about themselves and is not very forthcoming with information. This can be due to anxiety or someone who doesn’t quite understand why we need the information we ask. In these cases, it is advisable to put the patient at ease and really focus on building a rapport. The more open and honest you are with them may let them feel more comfortable and answer the questions you ask more freely. I also find that with patients that are reticent because they think we are being nosey are more likely to lower their guard if you explain why you need the information – such as “we need to know if you are on any medication as certain medication can cause ocular side effects”. This is often well backed up if there is a chief complaint – as you can mention a drug that may cause that symptom.
You will encounter a misleading patient at some point in your career – be it in the form of a child that wants glasses or someone that wants documented proof of visual loss for a compensation case or for fraudulent purposes. Of course, the first two may have a valid reason to prescribe or document, but you should be aware there are patients out there that intend to mislead you for their own wants.
Most tests in optometry are objective and can be done without requiring a subjective input. Explain each test that you are doing to the patient and listen for their answers – if the tests provide a subjective result that does not seem possible – take note of it and proceed. If several tests start to give unreliable or unlikely results, proceed with caution and confirm your suspicions. Document and continue to trust your objective measurements and then explain to your patient (or parents) the findings. Do so concisely and be prepared for kickback (especially from children that really want glasses…) and questions. Often reassurance is enough for the parents, but ensure you document the encounter fully and the reasons you have come to the conclusions that you have.
In conclusion, there are many scenarios where communication may be difficult. The main key is to work with the patient to find out what is best for them and try to adapt your approach accordingly. Make sure to make notes on what you did differently for the patient and why – as this can help both practitioner and the patient in future appointments as well as provide you protection in the event of a complaint.
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