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Providing clinical advice

Guidance for practitioners acting as clinical advisers, mentors or expert witnesses

Optometrist at practice

You may be asked to perform a role which involves commenting on the actions of other practitioners, such as acting as an expert witness in a legal case, working as a clinical adviser, sitting on an investigatory panel, or mentoring another practitioner. If you are asked to perform a role such as this, it’s important to understand your professional obligations, and the correct standards to apply.

Registered practitioners should be judged against the standard expected of a reasonably competent practitioner, and it’s important to always bear this in mind when being asked to comment on another practitioner’s actions. This is especially important if your advice is going to be relied upon by individuals who are not familiar with the optical sector, because their decision-making is likely to be influenced by your opinion. If your advice is misleading, incomplete or unclear, it may lead to an adverse outcome for the practitioner concerned and could even lead to professional misconduct proceedings or civil action being taken against you.

General principles

1) You must apply the correct standard

Registered practitioners should be judged against the standard expected of a reasonably competent practitioner.

Your view should be based on recognised clinical evidence, guidelines and standards relevant to the time of the incident. It’s especially important to be mindful of ‘hindsight bias’, whereby knowledge of the outcome of an incident influences your view on whether a practitioner’s actions at the time were reasonable. A practitioner’s actions may have been reasonable at the time, even if the outcome for the patient was poor, and conversely, a patient may not have come to any harm, despite the practitioner’s actions falling below the standard expected of a reasonably competent practitioner.

It’s important to remember that healthcare practitioners are expected to exercise their professional judgement, and you should not assume that a practitioner hasn’t met the standard expected of a reasonably competent practitioner simply because you may have done things differently yourself.

2) Your opinion should be unbiased and neutral

You must not allow your personal views about a person, circumstances or situation affect your opinion. If you are acting as an expert witness in a legal case, you must remember that your duty is to the court, rather than whichever party instructed you to provide your opinion.

3) You must not omit information if you believe it is relevant

In many cases, you will be able to identify factors which support the practitioner’s actions, as well as aspects for which they could be criticised. You should highlight the relevant factors on both sides of the case, before arriving at a balanced view. You should not speculate beyond the facts, and if you believe relevant information is missing, you should make this clear.

4) You should not misrepresent your expertise

You should ensure the issues you are commenting on are within your professional competence and that you have relevant knowledge of the standards and nature of practice at the time of the incident. If there are issues which are outside your competence, you should make this clear.

5) You should declare any conflicts of interest

You should declare any potential conflicts of interest at an early stage, to allow other parties the opportunity to raise any objections they may have.

Auditing records

Investigatory proceedings often involve concerns about poor record keeping. When commenting on another practitioner’s record keeping it’s important to remember that clinical notes are inevitably an imperfect reflection of what took place during an examination, and studies have shown that a reasonable body of practitioners both over-record and under-record what took place1.

Auditors who are reviewing records made by practitioners in England may be assisted by the record keeping audit tool contained within the ‘Quality in Optometry’ website. This allows auditors to quickly review a sample of ten sight test records, to assess whether the practitioner is consistently recording key information. This can be helpful in identifying areas for improvement, and for ensuring any learning is embedded and maintained over time, but it’s important to remember that this kind of audit only assesses whether key information has been recorded, rather than whether tests were carried out adequately, or the practitioner’s clinical-decision making was reasonable.

References

  1. How well does record abstraction quantify the content of optometric eye examinations in the UK?
    Shah R, Edgar DF and Evans BJW (Ophthalmic & Physiological Optics, 2009 Jul;29(4):383-96)