“I like to know what makes things work”

Right now, on my work bench I have a set of bike pedals stripped to their individual pieces that at the moment I sort of regret unscrewing – more pieces than I was expecting fell out and there are a couple of tiny bearings somewhere in my garage. However, the consequences of that are minimal – I’ve read the manual, and I have the replacement bearings, so with some time and patience they should be back in full working order and give me a few more years of smooth pedalling. Perfection can be the enemy of good in that scenario – perhaps all they needed was to be cleaned and lubricated, but instead I decided to completely refurbish them. Like I said, I like to know what makes things work.

Reflecting on your practice and using that information to improve what you do is part of being a professional

In my clinical practice though, what I’ve described isn’t an appropriate way to work – the consequences of getting something wrong could be significant, so trying things you’re not experienced in isn’t safe.

I qualified as an independent prescribing optometrist over a decade ago, and in that time the way I treat eye conditions has changed – but that doesn’t mean I know everything, and it is still important for me to reflect on treatments provided – especially when it hasn’t gone as I expected it to.

I try to keep in the back of my mind the thought that my whole purpose as an optometrist is to protect my patients’ eyes and vision – and when you stop and think about it there isn’t much that is more important than that, which is why we spend so much time and effort on what is only a small part of the body.

I have seen a few patients recently where the treatment required had to be changed after a few days. I struggle to say that those treatments were a ‘failure’ – but it is very important to know what you don’t know and seek advice if you’re not sure. Sometimes, with the benefit of hindsight, I would have initiated that treatment sooner, but sometimes it was just the natural course of the condition when what was reasonable treatment, using my experience and guidance like the CMGs, needed to be escalated. It isn’t appropriate to just ‘have a go,’ but reflecting on your practice and using that information to improve what you do is part of being a professional.

One of the main benefits of more experience is that I am a huge fan of telling patients what to expect because I’ve often seen it before – for example, “I’m giving you these eye drops which I expect will relieve your symptoms over the next few days – but if they don’t, and particularly if ‘xyz’ happens, I want to see you again,” (and I write that down). That way you are able to modify the treatment at an early stage if its required – and you’re also telling the patient that the future can be difficult to predict, but this is how we’ll manage any issues. It’s similar advice to what we give for a patient with a PVD – “I’ve checked and can’t find any signs of a retinal detachment, but if things worsen seek help…” and that is extremely helpful in avoiding criticism and being able to intervene at an early stage.

I hope that I spend the rest of my career, not making mistakes, but reflecting on all aspects of the treatment I provide and using that learning to improve what I do.

About the author

Kevin Wallace is an optometrist, practice owner of KD Wallace Eyecare and AOP clinical adviser. He is also an AOP Councillor, representing Scotland.