The College of Optometrists

Looking at a recent GOC case - the practitioner was asked why he didnot ask all his patients if they had recently been beaten-up.(!).

Equally, we can't ask every mortal question and - hence- we must leave something in and something out! I notice that the American Acadamy of Ophthalmologists don't suggest you ask much more than -- 'anything else?'

So should we plough through a list of possible complaints - well do YOU get diplopia - or is it only when yr drinking?

I notice locums often record that they ask kids about family history of glaucoma and miss out squints in the family.

It's not just locums, as a locum I notice all sorts of inappropriate stuff on history and symptoms!

:-)

That it's not important !!

The most Important is that you are safe to practice, the questions can be minimal but Relevant to the problem concern, and what do you do with the findings ??

you can ask everything and do nothing !!!

hmmmm.. but picasso, that is the problem. If you don't ask random questions - then you won't record them.Later, they will say you avoided writing them down- so your test was off the point. I was wondering what minimum questions could be asked. like - any floaters? any diplopia? any aching or strain? How can you be safe if you don't have the secondary problem sorted 'cos the px was muddled?

I think there probably is a happy medium between interrogating you patients on everything from dry eye to CVAs. The point at which you want to stop is up to you, there must be some onus on the patient to tell you what is wrong, unless telepathy is now taught to undergraduate?!!!

How or if you appropriately follow up the answers to the original question is where most of the useful information is gleaned from and maybe more important should you end up in front of the GOC!

I agree with all of you, Of course the more you ask the more information you get, and in a perfect world would be 45 min appointment time to ask & write everything, But let's be realistic in today's world 20-25 min appoitments time you must go directly to the point of the problem concern,Full history, some clinical some general and random questions, it's depent of the situation there is not hard-soft rule for this and everyone has a different aproach, then make sure you happy with the test(s) done, think in solutions/advice and explain to the px what will happen next, included referal or treatment.and write all this as you go.

Remember you are the professional encharge of the test so you can ask what you want in order to find out about the problem concern.clinical record must show the main points clear and NOT thousands words that is not helpful.

yes -i have to agree with you both. But I wish I knew the magic question that would cover everything! i had a lady today who revealed she was diabetic for ten years -previous records didnot show this as she never said (and was not asked) - the GOCwould have had a field day! I personally think the onus is squarely on the px - but they like to dump it on the optom if there is claim!

Palfi don't believe everything the Px says, We had a recent one, I've seen for % years, and she has been regularly asked re diabetes, and only Confessed when nurse rang up to ask why they haven't got her screening form. First she says ; thought we knew, then she says ;its only a little bit, i'm just on tablets you know. We ask that every time too but she never told before!

thats the trouble samadd. I was reading the transcript of a GOC case where the px alleged he had told the optom he had symptoms/signs of det ret. (His retina detached 5 months later). The optoms notes didnot mention anything abt flashes/ floaters etc. Yet they bust him on not asking the correct questions - and not testing for ret det (ie not dilating). So here is a case where the optoms notes didnot save him from proscecution. He got off as his noted were first class - and the GOC said it was UNLIKELY he would have omitted things deliberately. The case has not yet finished.

But it does lead to the idiot point - of whose eyes are these anyway?

And in yr case - the GOC and the NHS would have hammered you for not complying with regulations. Whack Whack!! Scary stuff! Palf