Facilitating positive communication

OT looked at the different ways that practitioners engage with patients according to individual needs and gathered their top tips for success.

Use of language

Discussing the role of communication in practice, Dirk vom Lehn, professor of organisation and practice at King’s College London, told OT: “Optometrists are very skilled in dealing with patients, and very sensitive to patient needs.”

“Communication and interaction are key to the optometric consultation. It starts once the patient calls to make an appointment, to when they come into the practice and communicate with the practice staff,” he said.

“While the examination itself in textbooks is largely described as a technical exercise, and requires a lot of technical skill, it also needs communication skills,” he added.

Vom Lehn explored how optometrists interact with patients in a study that analysed video recordings of 62 eye examinations.  

The research identified key ways that the optometrists’ choice of language or use of gestures facilitated the smooth-running of the consultation.

An example identified in the study was, during routine appointments, a patient might be asked if they had any problems with their vision.

“Very often in those cases we noticed that the typical answer of patients was no, which leads to problems later on because as the consultation continues the patient may identify problems,” vom Lehn said.

Rephrasing this into neutral language, such as asking about changes in vision, led to descriptions of how patients experience their vision.

Vom Lehn explained: “This is a medical encounter at the centre of the consultation and examination. From entering the practice to the examination, the patient needs to feel that they are in good hands, with people they can trust, where they are treated with respect, and where, in the end, they receive a diagnosis that they can work with and that is a good solution for them.”

He acknowledged the tension between retail and health in optometry practices on the High Street, brought about by the funding decisions of policymakers.

“It is important that patients don’t feel they are in a commercial environment. As soon as people lose trust in the medical element, the most important part of the consultation is lost,” he said. “Creating trust and respectful relationships with patients can only be achieved through communication.”

It is for this reason that communication skills should be embedded in training, and included in continuing professional development, he suggested.

While the professor’s research looked at the interaction between optometrist and patient, considering the role of communication as a whole in practice, vom Lehn said: “A personal view is that it would be good if the entire practice team has a communication policy.”

Creating trust and respectful relationships with patients can only be achieved through communication

 

Training and acclimatisation

“No one is too disabled to have an eye test,” is the core message of the team at SeeAbility.

Lisa Donaldson, SeeAbility’s head of eye care and vision, explained that the organisation is investigating barriers that people with learning disabilities experience in accessing eye tests.

“One of the hypotheses we are testing is that people tell us they can’t get an eye test because they get turned away,” she said.

SeeAbility intends to find out why this is, and whether misconceptions or assumptions – such as that a patient needs to be able to read the letters on the test chart for the appointment – are perhaps having an effect.

The organisation also hears from some parents and carers that they don’t attempt to book appointments because, having experienced their own eye tests, they fear their loved one will not be able to cope with the tests.

 

Understanding autism and learning disability

With the support of the Thomas Pocklington Trust (TPT), SeeAbility’s employed lived experience eye care champions are offering free Tier 1 Oliver McGowan training for everyone in the eye care sector.   

The training is named after Oliver McGowan, whose death highlighted a need for training in health and social care staff on understanding autism and learning disability. The standardised training is mandatory for all Care Quality Commission regulated health and care providers.  

As optical professionals are regulated by the General Optical Council, the profession was not included in the requirements for the training. SeeAbility is working with City, University of London, on a project funded by TPT to see whether the optometry profession could benefit from the training.

The training is divided into two tiers. Tier 1 includes a two-hour e-learning module providing an introduction to learning disability and autism, plus a live webinar hosted by a person with lived experience of autism, a person with lived experience of learning disability, and a facilitator.

SeeAbility has added tailored elements to the training, covering how practices can better support people with learning disabilities and autism.

Tier 2 training is a requirement for professionals providing significant care and involves the e-learning module and an in-person day of training with accredited facilitators.

Donaldson shared: “We feel the Tier 1 training will be really useful for practice staff, whereas part of our research is to see whether registrants agree that they tick the box in terms of who should be doing that Tier 2 training."

SeeAbility plans to add more dates for the training, which can be booked for free on the website. The training is accredited for one CPD point, but the organisation is keen to highlight that the training is open to every member of practice staff.

Reassuring the patient and loved ones

At Tuite Opticians in Coatbridge, North Lanarkshire, every member of the practice team has undertaken Dementia Friends training.  

Optometrist Stephen Kirley, explained: “I’ve been a member of the practice for the last three years and I encouraged everybody to become Dementia Friends when I joined. I’ve worked in domiciliary settings for nearly 15 years and at various points I’ve been encouraged to undertake CPD in this area, so I think I’ve been a Dementia Friend since the programme launched.”

Run by Alzheimer’s Society, the programme was launched to change perceptions of dementia and help individuals to learn more about the condition and ways to help.

“The programme gives you a much better understanding of the condition and how to communicate,” Kirley said. “This not only gives you a helping hand in discussing the condition and how this affects the eyes with the patient, but it reassures families, next of kin, care staff and nursing support teams.”

It is important to be aware that dementia is not part of the natural ageing process, Kirley said. He added: “It is not as simple as losing your memory. Dementia encompasses a wide group of diseases and can come as a secondary effect to brain injuries or vascular accidents.”

“It is important to recognise that because the communication you use with a patient with dementia might be quite different than you might typically use,” he shared.

Family members appreciate seeing us wearing the Dementia Friends badge whether they come into practice or we go to them

 
Discussing the role of the practice team in supporting a patient with dementia, Kirley said: “It is important that the journey is consistent; they see a smiley face, someone who recognises their needs and can effectively communicate in a way that is understandable to them, using language that will not be confusing or add to their difficulty.”

“I would encourage every practitioner to get involved in a programme like Dementia Friends, and I think more CPD or personal development plans should be centred on dementia awareness,” he continued.

According to the World Health Organization, more than 55 million people have dementia worldwide and there are nearly 10 million new cases each year.

“These are patients we are going to be seeing for a long time to come. Demographics are changing as we all live longer. We are going to encounter dementia more,” Kirley said. “Dementia Friends is a simple, easy programme to get involved in. It takes maybe an hour of your time to watch the videos and answer a few questions. I think it’s a terrific initiative – I’m a strong advocate for it and would encourage all practices to get involved.”

Commenting on the effect of becoming a Dementia Friend, Kirley shared: “Family members appreciate seeing us wearing the Dementia Friends badge whether they come into practice or we go to them.”

Think outside the box

Cirta Tooth works as a low vision specialist at Princess Alexandra Eye Pavilion in Edinburgh and in practice at Cameron Optometry.

Discussing how the whole practice team can support positive communication, the optometrist explained that she appreciates a morning briefing with the team.

This provides time to go through the patients booked in for the day, with particular attention paid to any requirements patients might have and what needs to be prepared to support them.

“I understand not every practice might be able to do that, but I think it is a really nice thing to do as everyone is then aware of all the patients that are coming in,” Tooth said.

Supporting patients with hearing loss

According to the Royal National Institute for Deaf People (RNID) 12 million people in the UK are deaf or have hearing loss. 

Tooth recommended that when patients book an appointment, they could be asked which format they prefer to have information provided in, and how they wish to be communicated with. Would they like the appointment letter in a larger font, for example? Or do they need to have things written down during the consultation.

The optometrist emphasised that handovers are especially important to ensure the patient feels looked after.

“For a patient who is hard of hearing, you want to make sure that the patient knows the optometrist is aware of their requirements,” Tooth said. “You could direct them to a seat in the waiting area from which they can see the door that the optometrist will come out from, so they feel comfortable they are not going to miss their name being called.”

Tooth also emphasised: “When a patient comes with someone else; an interpreter or supporter, for example, that patient must remain at the centre of every communication.”

“At the beginning I will introduce myself to the accompanying person and let them know that I will primarily be talking to the patient,” she added.

Members with questions about reasonable adjustments and interpreters should contact the AOP’s clinical and regulatory team for guidance.