Ethical dilemmas for the practice team

Optometrist and AOP clinical advisor, Kevin Wallace, discusses scenario-based assessments of ethical dilemmas

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How do we navigate through some of the trickier patient scenarios that can present in practice? And what should we do to deal with them appropriately? Test your knowledge with the following scenarios.


CASE NOTES: A patient entitled to an NHS sight test has lost their glasses and it is six weeks before their next test is due. Do you:

A.  Say that they can have their sight test and date the form for a few weeks’ time?
B.  Offer a private sight test?
C.  Tell them that they have to wait until the practice can claim another GOS1?
D.  Get more details as to whether they have been having any problems with their sight?

The answer could be B, C or D. It is absolutely the case that you cannot postdate a form to validate a claim as this is clearly fraud. If the patient is only entitled to an NHS sight test and not a voucher (for example, due to a family history of glaucoma) then a private test may be a reasonable option if the patient does not want to wait. For a patient entitled to a voucher this does not particularly help as they would then not be entitled to a GOS voucher following this private test.

In most parts of the UK you can see a patient for an NHS sight test one month early – other than in Scotland, where this option was removed in 2018 – so if the patient does not have any symptoms, they may only have to wait a few weeks for their next test. If they are having symptoms, then an early test is reasonable using the appropriate code to validate the claim.

Should you tell them that they have to wait until the practice can claim another GOS1?



CASE NOTES: A patient presents with a pair of safety glasses missing one of the lens screws. He asks if you can just ‘pop one in’ as he has to be back at work. Do you:

A.  Replace the screw at no charge?
B. Replace the screw and charge a small fee?
C.  Provide new glasses?
D.  Send the safety glasses back to the manufacturer to have the screw replaced?

Unfortunately in this scenario the only correct answer is D – anything beyond a simple adjustment must be carried out by the manufacturer as the glasses are only certified as safety equipment as a whole – if a non-approved screw is used and the glasses fail causing an injury, the patient could make a claim against the practice for supplying a non-compliant device. Although inconvenient, the glasses must be sent back to the manufacturer where they can be repaired, and a new certificate will be supplied stating that they still meet the relevant standards. 

Do you send the safety glasses back to the manufacturer to have the screw replaced?



CASE NOTES: The son of an elderly patient who used to attend the practice presents with her glasses with the lenses missing. She is not well enough to attend the practice and has not had a test for three years. He would just like new lenses to her old prescription, so she is able to read. Do you:

A.  Replace the lenses?
B.  Insist on the patient attending for a test?
C.  Recommend a home visit to get an up-to-date prescription?
D.  Speak to your optometrist to see if they will approve using the old prescription?

In this scenario the only immediately wrong answer is A – the patient does not have an up-to-date prescription so you cannot just make new lenses. It may be reasonable to ask the patient to attend but, in this case, they are not well enough, so this is not possible. It may be appropriate for the patient to have a home visit and then she will have an up-to-date prescription, or your optometrist can approve use of an old prescription if it is in the best interests of the patient. It is not possible for an unregistered supplier to make up lenses to an old prescription.

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