“No matter how good you are, sometimes things go wrong”

An optometrist reflects on being the subject of a fitness to practise case – and shares his thoughts on what others can learn from his experience

gold gavel

I failed to refer a patient for keratoconus. Traditionally, keratoconus patients were managed in practice as much as possible, but in 2013 corneal crosslinking was approved by the National Institute for Health and Care Excellence. I was unaware of this until I completed a CET on keratoconus in 2017. I had seen a patient with keratoconus twice since 2013 and didn’t refer him. The patient was seen in 2018 by an optometrist at another practice when his vision had deteriorated to the point where it was too late to have corneal crosslinking done.

I became aware of the complaint when the patient’s mother called my practice just to get the clinical records. I changed the record cards on two occasions – when I first learned about the complaint and a few months later when the patient’s mum threatened legal action. Shortly afterwards, she complained to the General Optical Council (GOC).

It was a real shock when I got the letter from the GOC. I thought ‘This is judgement day. I’m in really big trouble here.’ The GOC knew about the keratoconus and the clinical failings but they didn’t know about the record card changes. When I sent through the information they requested, I typed up a letter saying that I had made changes to the record card.

At both points when I changed the record cards, I thought erasure was the inevitable consequence of missing pathology. That is not true. It highlighted the fact that I had no clarity about the fitness to practise procedure and how the GOC works. I made the situation worse by doing something that potentially could get me struck off the register. 

It was a real shock when I got the letter from the GOC. I thought ‘This is judgement day. I’m in really big trouble here


I urge every optometrist to take their professional development seriously. The whole problem stemmed from my lack of clinical knowledge on this particular subject – keratoconus. I thought I was committing sufficient time for my professional development. Clearly it wasn’t enough. This whole experience has highlighted this.

CET keeps optometrists in the know about what is going on and recent developments. It is vital. I ensure I commit at least a few hours every week to professional development. This would include, for example, gaining at least one CET point and reflecting on recent clinically challenging sight tests I may have conducted. I would subsequently search and read current or previous CET and watch online presentations on the knowledge and skills I feel I can enhance or refresh. One can’t eliminate the risk of being subject to fitness to practise proceedings, however, with the myriad of clinical information and resources easily available, this risk can be minimised.

No matter how good you are and how much professional development you do, sometimes things do go wrong. It is important for optometrists to realise this and ensure they are prepared. Unfortunately, most of my learning has been done in retrospect through experience.

I didn’t share what had happened with anyone when the complaint first came in, out of embarrassment and pride. That was a big mistake. I only told my wife when I got the GOC letter so it was a complete shock to her as well. It is important to establish a support network – whether that be family, friends or colleagues – who you know you can go to no matter how small the issue is. It makes things so much easier and means you’re less likely to do something silly.

You have that reassurance saying ‘Don’t panic. Whatever happens, we will get through this.’ In my case, my emotions got the better of me. I think I would have greatly benefited from sharing what had happened with anyone – a colleague, my wife or family. When I told the people closest to me about what had happened, they were all sympathetic and extremely supportive.

Throughout the experience, the AOP has been really understanding. They have been honest and frank with me. They have been kind and I have felt that I haven’t been judged. I felt that they genuinely wanted to help.

What I have come to realise and what I would urge optometrists to understand and appreciate is how important ethics are. Being dishonest cannot just harm yourself and your qualification – it is about the harm you are doing to the patient potentially and to the reputation of the profession; all the colleagues who work so hard to become optometrists and continue to work hard to serve their local communities. It has far-reaching consequences.

It is really important to keep in mind the GOC’s Standards of Practice. These are a set of values that are the cornerstone of our profession. Every decision that we make, every action and reaction, needs to be aligned with these principles. When things go wrong, you can’t deviate from those values. What I would say to all optometrists is that if you find yourself in the position that I was in, consider these standards and hopefully you will do the right thing. I never thought I would find myself in the position that I did. 

  • As told to Selina Powell.