As optometrists we are very tuned in to our senses. We are very good at using our own eyes to have a detailed look at our patient’s eyes and these days to scrutinise photos and scans to refine our diagnosis too. Yet how good are we at using our hearing in order to gather vital information and to put what we hear into context?
Listen upAs a low vision practitioner, I tend to elicit most relevant information from my patients by listening to them. I ask them a series of questions and listen carefully to their responses. These include: ‘How do you experience your vision?,’ ‘How do you feel about your treatment?,’ ‘How does you vision affect daily life?,’ ‘What things would you like to be able to do if your vision had not been compromised?,’ ‘What impact has your visual impairment had on mobility, social interaction and access to information?,’ and much more.
In a nutshell, I could not do my job without my hearing. But what about in community optometry? Are we listening to our patients in order to shape our eye examination and to help diagnose conditions as effectively as possible?
Personally, I recently had a series of hospital visits as a patient, which made me think again about the importance of listening to our patients, not only in the low vision practice, but also in general optometric practice.
“In a nutshell, I could not do my job without my hearing. But what about in community optometry?”
Technology is great when it is used in the right way, but it can be misleading when used in the wrong way. Imaging with optical coherence tomography and fundus cameras is only an advantage if the correct images are taken and the optometrist takes time to study the image and to interpret it in the context of history and symptoms.
In my particular case, various images were taken, from ultrasound scanning to computerised tomography scans and venograms, but the diagnosis was overlooked because the practitioners did not listen to the history and symptoms carefully enough and did not observe the clinical presentation in front of them. This led to the wrong area being imaged and good images being misinterpreted, ultimately leading to unnecessary health risks.
This experience made me think about my own practice. I asked myself: ‘Do I listen to my patients?,’ ‘Do I observe my patients?,’ ‘Do I ask the right questions?,’ ‘Do I take that information into account when I plan the tests during the eye examination?,’ ‘Do I take time to look at the images carefully?,’ and ‘Do I take time to explain things to my patients and treat them with respect?’
“I believe that listening to the patient can substantially narrow down the differential diagnosis and can help the optometrist manage their time and resources more efficiently”
Many systemic conditions are associated with presentations in the eyes. Rheumatoid arthritis, high blood pressure, diabetes, thyroid disease and multiple sclerosis, for example. These conditions may not have been diagnosed in a patient previously and the history and symptoms that the optometrist takes may provide the only clues.
For example, if a parent presents worried about their child being clumsy, falling over obstacles, struggling to find toys in a toy box and not seeing large objects pointed out in a distance, do we think about the possibility of cerebral visual impairment, especially if the symptoms are not explained by ocular findings alone?
I believe that listening to the patient can substantially narrow down the differential diagnosis and can help the optometrist manage their time and resources more efficiently. Listening carefully and addressing the patient’s concerns also creates a relationship of trust, which benefits the patient and the optometrist.
Image credit: Getty/natasaadzic