“Some people want to know everything, and others want to know very little”

The problem you have when you are an optometrist dealing with somebody sitting in front of you is that you may not have seen the patient before and as our transactions tend to be one at a time and not recurrent, we don’t have a lot of preparation time. You have to hit the ground running.

In addition to this, no two patients are the same. You might have someone who has presented to practice because they think they have something trivial causing them a problem, and during that conversation, you suddenly find yourself having to get them fast-tracked into a macular clinic, while explaining: ‘The hospital is going to call you in seven to 10 days and they may decide that they need to be treating this problem, and the way that the problem is treated is with an injection.’

Communication is therefore key for optometrists. For each patient sitting in my chair, I look at them, observe and try to work out during our interaction how they want to engage with information. Through this I am trying to determine if a patient is verbally articulate – they hear what you are saying and they understand what you are saying – or are if they visually articulate – they respond better to images. This allows me to adapt my communication style accordingly.

There is absolutely nothing wrong in saying to a patient that you are not entirely sure about what is going on and that you are therefore going to make some enquiries or ask a colleague. Stepping away and looking something up is fine too

Generally, I tend to describe things by drawing a picture. I will always have a notepad on my desk. I have also found that using software, such as Optimed’s Captiv8, to describe conditions to a patient is effective.

For most optometrists, in these situations, we are largely not going to be in a position where we are going to be initiating treatment, so you have to be very aware of how you present the situation and ensure that a patient’s understanding of what you are telling them is accurate.

I would encourage newly-qualified optometrists who are between two to three years qualified to use the support network around them in practice. They should be reassured that there is absolutely nothing wrong in saying to a patient that you are not entirely sure about what is going on and that you are therefore going to make some enquiries or ask a colleague. Stepping away and looking something up is fine too. This builds quite a lot of empathy with the patient as they may expect you to have many answers, but they never expect everybody to have every answer.

The hardest news of all for most practitioners to give a patient, I think, is telling someone that they have to stop driving

What is bad news?

Remember, bad news will be different for different people. During my time practising, I have come across patients for whom a cataract is a shrug on the shoulders, and for others it is terrifying. You have to colour your explanation with what a patient knows and what their anxieties are. You could ask a patient if they know of someone else with cataract or age-related macular degeneration (AMD), for example, to give you an understanding ground to build from.

It is also important to work out what level of detail a patient might want you to give them. Some people want to know everything, and others want to know very little.

The hardest news of all for most practitioners to give a patient, I think, is telling someone that they have to stop driving. You are very rarely telling someone in optometry that they are going to drop dead – I’ve never come across that. You might be saying that they have lost some vision and they are unlikely to recover that vision, or that you believe they may have a sight-threatening condition, such as glaucoma, that needs to be investigated and treated.

However, in terms of driving, this conversation can be very difficult, particularly when it hasn’t been broached with a patient in the lead-up.

I will often see someone in primary care practice who has been going back and forth to the hospital for treatment, and I will ask, ‘What have they advised you about driving?’ and it will not have been mentioned, despite them having received injections for AMD for the past year.

I am a strong believer in raising this message as early as possible so the person has the time to process it before their vision deteriorates enough that they should no longer be driving. This affords the person the time to process, prepare and start to build a life around them for a future when they will not be able to drive.

It is really hard for a patient when they are told that should no longer be driving. I often hear responses such as, ‘There are no busses where I live and I only drive to Tesco on a Tuesday as it is.’ As the optometrist I have to emphasise and explain that the UK driving licence is absolute, and you either pass the driving standard or you don’t.

Preparing patients for the news that you may have to break in the future is as important as when you are delivering the news itself.

• As told to Emily McCormick.