15 June 2025
A patient attended the practice complaining of new and concerning symptoms and is now in the chair, waiting to hear what the next steps will be. Or perhaps it was a routine appointment, but something doesn’t look quite right, and alarm bells are ringing.
How do you communicate to the patient that they will need to be referred, particularly if the case is urgent?
OT asked previous contributors to the An Optometrist Saved My Life series, to share advice on communicating referrals, and heard from experts at the AOP on where to find more resources.
“I am certain that I made mistakes”
Read more on the topic of breaking bad news to patients
Making a referral
Katherine Williams, lead optometrist and practice owner at Eyedeal Eyecare in Bromsgrove, told OT: “In practice, we provide a very varying degree of referrals, from same-day sight or life-threatening situations, to routine letters to other health care professionals.”
Patients will differ in their response to news of a referral, Williams noted, highlighting: “We have to learn the fine art of assessing the type of patient."
For some patients, practitioners will need to emphasise the importance of the matter, so that they are motivated to attend their appointment. Other patients, Williams said: “Could have sleepless nights worrying about their referral if things haven’t been explained properly.”
It is important to be clear about why the referral is being made, who it is being made to, and when the patient should expect to have an appointment.
“When discussing a referral with a patient, it is always important to explain the reason for the referral in a way that is easy to understand without using jargon. The explanation needs to be clear and concise,” she shared.
Hamza Mussa, lead optometrist at Specsavers Banbury and creator of The Crazy Optom social media pages, advised avoiding jargon and technical terms and asking open-ended questions periodically to ensure the patient understands.
Recognising the emotions that can come with the news is also important. Mussa said: “It can be easy as an optometrist to fall into a trap of not recognising the emotional impact of a referral on a patient because it is pathology we see almost daily and is considered ‘routine.’ Make sure you treat every patient as an individual and address all concerns.”
He added: “As a previous supervisor told me: ‘Although that patient is the 10th person we have seen that day, we are likely the only optometrist that patient will see for two years, and that experience will stick with them.’”
Highlighting urgency and discussing waiting times
Williams highlighted: “Once you have explained your diagnosis, it is important to explain the degree of urgency and the importance to the patient. I would explain how soon I would like the patient to be seen and for them to contact the practice if they have not been seen within a specified time frame.”
Knowing the local waiting times can be important for providing these time frames, Williams added.
She continued: “If necessary, then I will often ask the patient if they would like me to explain their reason for referral to a family member too.”
When highlighting the significance of a referral, there is a fine line between conveying urgency and scaring the patient
Mussa shared: “When highlighting the significance of a referral, there is a fine line between conveying urgency and scaring the patient.”
“I will be clear and honest with the patient when faced with an urgent or emergency referral,” he continued, adding: “Yes, we have found something which is sight-threatening, but reassure them that it is a good thing they have come for an assessment, that they’re in the right place and we are going to refer them for management.”
Mussa highlighted that reluctance to be referred may come from a reason beyond the referral itself: “I find with patients who are reluctant to be referred, it has little to do with themselves and actually more that they’re worried about people who are reliant upon them.”
“Take the time to listen to what these concerns may be, for example, the patient may be a carer or sole driver for the household. Make the patient feel heard but be clear that the patient attending the hospital is in their best interest,” he added.
Farah Topia, clinical and regulatory adviser at the AOP, also noted: “It is really important that the patient understands the urgency of their referral, and when they might expect to hear from the hospital.”
“Giving the patient a timeframe and counselling them on what to do if they don’t hear anything within this time acts as a safety net for patients whose referrals may not have been appropriately actioned for whatever reason,” she said.
Depending on the nature of the referral, Topia noted, the patient may need to be advised on what to do if their symptoms worsen or the condition progresses in the meantime.
Providing information
The optometrists each recommended providing written information for the patient.
Topia shared: “This can be lots of information for the patient to digest at one time, so providing leaflets and putting your advice in writing can be very helpful.”
The AOP has extensive guidance on referring patients safely and ensuring this is done with the correct degree of urgency and to the appropriate place. Find the resources here.
Words of advice for early career optometrists
Williams acknowledged that there will be times when practitioners are uncertain about whether to make a referral, especially in the early career stages.
“In cases where you are unsure of the exact diagnosis then providing ophthalmologists with as much information from our eye examination as possible, including OCT scans where appropriate, will help the ophthalmology service to triage the urgency of the referral,” she said.
Williams added: “Sometimes you do just have to use your ‘gut feeling,’ and if in doubt, refer.”
Mussa highlighted: “In your career there will always be moments that may panic you. As a pre-reg or newly-qualified optometrist you have this natural apprehension about managing the patient correctly.”
It is important to be calm when discussing referral or breaking bad news, Mussa noted, and advised considering: “If this was a family member receiving the news – how would you speak to them?”
“With every referral, as you build experience, you will improve,” he added.
Leaning on the experience of other optometrists in the practice can also be beneficial if feeling nervous, Mussa said: “Ask supervisors and fellow optometrists to listen to you and give you hints and tips.”
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