As I settled at my desk with a steaming coffee on a bleak Monday morning, my phone rang.
Early indications suggested to me that a worried member was following up on an incident at work over the weekend.
She explained that during the weekend, a patient had attended the practice and made a complaint against her. Her manager was urgently requesting a statement detailing the treatment she had provided to the patient. Matters had been made worse because the patient had made the same complaint three weeks earlier and had been assured that he would receive a quick response. Unfortunately, the member had been out of the country and was not told about the complaint until that Saturday. The patient, angered by the lack of a response, was threatening to refer the member to the General Optical Council (GOC).
I could tell, not unreasonably, that the member was extremely anxious, not only by the complaint, but by the threatened involvement of the GOC. Over the weekend, she had felt increasingly isolated and anxious. She explained to me that she was not sure what to do and urgently needed the AOP’s help.
Here to help
I reassured her that, first and foremost, the AOP would assist her, and would do so in a number of ways. I explained that this included providing a statement for her employer, which the AOP was on hand to help the member to prepare. She needed to inform her employer that she was being assisted by the AOP, and that she would provide a statement. She also needed to seek the employer’s permission to send the AOP the copies of the records and details of the complaint.
The AOP team would obtain an opinion from our clinical adviser to identify the clinical strengths, as well as any weaknesses and proceed from there.
I also spoke to the member about the AOP’s confidential Peer Support Line which was started last year and has already proved valuable to members who are able to discuss any anxieties in complete confidence with a fellow professional.
"Faced with this scenario, I reassured her that, first and foremost, the AOP would assist her with the complaint"
Taking a view
Once the documents were with the legal team, the AOP was able to establish the details of the case (see Case notes).
The complaint related to an alleged failure to refer for what turned out to be wet age-related macular degeneration (AMD).
The AOP’s clinical adviser reviewed the records, noting that the retinal photos did not show blood and/or exudates at the macula, and the patient did not present with symptoms that were strongly suggestive of wet AMD. The patient did have reduced visual acuity in the eye that was subsequently diagnosed with wet AMD, but as the patient was thought to be amblyopic in this eye, it would have been more difficult to link this finding with the condition that later developed without the benefit of hindsight. The view was that, although the wet AMD was detected at the time of the hospital visit, this did not necessarily mean it could have been detected at the time of the original sight test.
The clinical adviser did comment that the record entries could be more detailed, particularly in relation to the oral advice given to the patient.
Armed with this supportive clinical evidence, I assisted the member in drafting a robust account of her examination, diagnosis and management. This, in turn, enabled the employer to provide a reasoned response to the patient’s complaint. Following submission of the employer’s response, nothing further was heard from the patient – a very welcome result for our member and her employer. Furthermore, by heeding the AOP legal and regulatory services team’s advice to improve her record keeping, the member emerged from this experience with greater protection against any future complaints.
The AOP member first saw the patient, aged 71, in April 2017 for a routine appointment. The patient complained of a longstanding reduction in the acuity of his right eye, and wondered if it could be improved. His last spectacle prescription suggested that his right eye could be amblyopic through meridional amblyopia, although, being his first visit to the practice, his previous acuity was not available. His right eye acuity was 6/24 and there was no improvement with pin hole. A Volk examination without dilation was unremarkable. The member took the view not to dilate due to narrow angles. Amsler in his left eye was good, but he was unable to fixate with the right eye. The AOP member assumed the right eye was amblyopic.
The patient returned 10 days later and was still concerned about his right eye. To reassure the patient, the member carried out another fundus check, which presented the same as the previous visit. The patient mentioned that his right eye seemed slightly cloudy, but he was not sure when it started or for how long it had been like that. The member decided not to advise a same-day referral because she considered his right eye was amblyopic, and found no signs of active disease. She made a routine referral via his GP, and told him if there was further deterioration in his symptoms he should attend the hospital eye service immediately.
The GP subsequently referred the patient to hospital. Three months later, the patient saw an ophthalmologist, who diagnosed wet age-related macular degeneration, and arranged treatment. According to the patient’s complaint, the ophthalmologist told him his optician should have referred him immediately. The patient made a complaint against the AOP member and demanded to know why he had not been referred.
For information on the AOP legal and regulatory team, visit the website.
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