“Make eye contact with patients, and stay calm”

Thinking back, an experience I recall was in my pre-registration year. I had a young patient, about 21 years old. They had malignant hypertension, and severe haemorrhages and disc swelling.

The patient presented with mild blur after looking at bright lights or the sun. I had never seen anything like this before and had to leave the patient in my testing room to seek my supervisor for guidance. I probably muddled through the conversation about going immediately to the hospital, and didn’t really consider the patient’s emotions or anxieties as the pathology was my main focus.

Over the years I have developed new techniques to deliver bad news to patients. Firstly, I don’t prejudge what my patient may feel is bad news. Whilst some patients may be very relaxed to hear that they have cataracts, others may be petrified. I utilise the SPIKES pneumonic: Setting, Perspective, Invitation, Knowledge, Empathy, and Strategy, with emphasis on the knowledge and empathy sections. I sit face- to-face with the patient and speak clearly and calmly to them. I use personal experience to reassure them that they are not the only ones in this situation. For example, I will use sentences such as, “When my dad had his cataract operation...” or, “I had a patient last week whose eyesight was worse than yours.”

Treat every patient as if they were your family member and ask yourself: what would you want for your relatives?

From a knowledge point of view, I have developed my descriptions of eye conditions to better explain what is wrong with their eyes in layman’s terms. I feel frustrated when patients have been told there is nothing more that can be done by the hospital. There is always something that can be done, it just requires thinking outside the box. I will consider: Is there a charity or support group for this patient? Can their home be adapted to help them in everyday living? As optometrists, we are not just fixing two eyes on stalks, but are dealing with people with feelings and emotions.

As I have gained experience as an optometrist, and in these conversations, my nerves have subsided and I am confident now. My sight test routine has evolved over the years, so I am able to confidently build trust with the patient. I start with an initial greeting, before working through their history and symptoms, and I go through a description of the tests I am about to perform on the patient. This makes breaking any bad news easier if it is needed at the end of the examination.

As optometrists, we are not just fixing two eyes on stalks, but are dealing with people with feelings and emotions

My advice for newly-qualified practitioners when it comes to breaking bad news is to firstly, try to find patient-friendly descriptions of eye conditions that will help patients understand when these conversations are required.

Secondly, treat every patient as if they were your family member and ask yourself: what would you want for your relatives? And finally, be sure to make eye contact with patients, and stay calm –it is ok not to know everything early on in your career, as long as you know what your back up strategy is and can deal safely with patients.

About the author

Simon Raw is a domiciliary optometrist at the OutsideClinic. He also joined AOP Council in June 2024 as a Councillor representing North East England.