Patient Management in the field of Optometry

2. "Always listen to the patient, they
might be telling you the diagnosis."
Attr. William Osler

3. Patient Management:
A description of the interaction, from intake to discharge,
between the patient and the health care team.
It includes:
•Communication
•Empathy
•Examination
•Evaluation
•Diagnosis
•Prognosis
•Intervention (Treatment)

4. •The case history is usually conducted at the beginning of the
examination, and is the time for the clinician and patient to
become acquainted.
•The clinician must present himself to the patient as a caring
and empathetic individual if he expects the patient to comply
with his advice.
•At the same time, the clinician begins the diagnostic thought
process by asking the patient appropriate questions to
determine the potential causes for the patient's
symptoms.
•The information is then used in deciding which procedures
the clinician will use to confirm or rule out each potential
diagnosis.
•During the case history the clinician also has an opportunity
to begin educating the patient about his visual function and
about his ocular and general health.

6. Elaboration of the chief complaint (FOLDARQ)
For each complaint, the clinician asks about:
Frequency: How often does this occur?
Onset: When did the problem begin?
Location: Where is the problem located?
Duration: How long do your symptoms last?
Associated factors: What other symptoms do you
experience with this problem?
Relief: What seems to make your symptoms go
away?
Quality: How would you rate the severity of your

8. •Empathy involve internal process of experiencing what is
perceived from the outside world through our senses leading
to imaginations and projections, so that such experience will
turn the belief of “I and you” in to “I am you” or at least “I
might be you”.
•Empathy let us understand the patient with an intention to
help by alleviating pain and suffering.
•The affective nature of sympathy leads to spontaneous
reactions causing distress and deterioration of the efficacy
leading to confusions and vicarious trauma. Therefore
sympathetic reactions are not productive for health care
professional.
•Empathetic optometrists are less liable for malpractice suits.

10. •Not all examinations need be carried out on every patient:
examination should be based on the history, the possible
diagnoses and, therefore, the signs you are looking for.
•Eye examination involves both anatomical examination and
functional evaluation. Both are possible in primary care,
although some conditions cannot be excluded without
recourse to secondary care equipment such as slit lamps and
tonometers.
•Visual acuity testing should be carried out in all eye
assessments, since even if no alteration is reported by the
patient, it may be there. (MONOCULARLY)

11. Patient may come with:
•Red or painful eye
•Foreign body (FB)
•Reduced vision
•Double vision/orbital problems
•Headache/problems suggesting neurological cause in absence of red eye
Anatomical Examination:
•Lids
•Lacrimal System
•Conjunctiva
•Cornea
•Anterior Chamber
•Pupils
•Lens and red reflex
•Fundus

12. Functional Evaluation:
•Visual Acuity
•Visual Fields
•Intra Ocular Pressures (IOP)
•Pupillary Reactions
•Optic Nerve Functions
•Macular Functions
•Lids
•Extra Ocular Movements

13. “We ought to remember one
thing. Whether the patient is a
patient in real life, or a patient
in an exam, they are a human
being.
A person.
At some point, they'll be you."

14. •Diagnosis has been described as both a
process and a classification scheme, or a
“pre-existing set of categories agreed upon
by the medical profession to designate a
specific condition”

15. •When a diagnosis is accurate and made in
a timely manner, a patient has the best
opportunity for a positive health outcome
because clinical decision making will be
tailored to a correct understanding of the
patient’s health problem

16. •The diagnostic process is a complex,
patient-centered, collaborative activity that
involves information gathering and clinical
reasoning with the goal of determining a
patient’s health problem

17. • an opinion, based on medical experience, of the likely course of a
medical condition.
"it is very difficult to make an accurate prognosis“
• a forecast of the likely outcome of a situation.

18. •In the 1980s, handing over a prescription indicated
the end of the consultation. It is now recognized
that educating the patient in their condition and
involving them in management decisions is likely to
both improve patient satisfaction and clinical
outcomes.
•Management is more than just a prescription. It
includes health education and advice. This is not
simply a move away from paternalism but aids
compliance and may reduce unnecessary

19. When considering what to include and leave out when
writing your records, ask yourself three things:
•Will the next optometrist who sees this patient follow my
train of thought and understand my management plan?
•Would this stand up in a court?
•Would I be happy for the patient to read these notes?
RECORDS

20. POTENTIALLY TRICKY SITUATIONS
•The 'difficult historian’
•The child
•Relatives
•The angry patient
If you feel that there is a real threat of violence, get
away or use the panic button.

21. Bad news
•gauge from the patient quite what they are prepared to hear; as a rule of thumb,
honesty is the best policy.
• Make sure that when you are explaining the problem, you frequently check the
patient's understanding.
Avoid:
•Not doing it or leaving it to somebody else.
•Putting it off ("Let's do a few more investigations").
•Baffling the patient
Surgeon: "I'm sorry Mrs. J, we found a mitotic growth."
Grateful patient: "Thank goodness, doctor, I thought you were going to tell me I had
cancer!"
•Deliberately not picking up on patient cues.
•Excessive solemnity or gloom. Do not remove all hope.
Somatising patients
•What are you going to do about my [symptom], optom?
HANDLING SENSITIVE ISSUES