Initial Points to Consider Final year clinic training Pre-reg. reg. Survey Patient concerns and complaints Hospital concerns about information

Transcription

1 Mind Your Language NES Glasgow 2014 Bill Harvey Optician Journal/RNIB/City University

2 Initial Points to Consider Final year clinic training Pre-reg. reg. Survey Patient concerns and complaints Hospital concerns about information

3 >15% Referrals Asymptomatic Glaucoma (>50%) Retinopathy Amblyopia Naevi

4 Patient Understanding Terminology Amblyopia - 71% "Long sight"- 9% Hypermetropia - 58% "Short sight" sight"- 9% Myopia - 43% Squint - 5% Astigmatism - 40% Bifocals - 4% "Lazy eye" - 10%

5 Case 1

6 Case 2

7 Case 3

8 Case 4

9 Case 5 Px has low water content lenses Wears up to 15 hours per day Has no glasses Wants to continue as present

10 Case 6 Never thought contact lenses were possible Has been told contact lenses impossible

11 Case 7 Does not understand instructions

12 Contact Lens Myths I m too old My eyes are not suitable I cannot touch my eyes The lens will go round the back It will be painful My prescription is too strong Etc.

13 Consider this 14 out of 15 GOC disciplinary cases concern poor communication or record keeping

14 Good Communication Increases patient understanding Encourages good rapport with practitioner More likely to return More likely to recommend you Improves compliance Enhances patient satisfaction Always high score

15 Compliance Blepharitis Dry eye Convergence insufficiency Contact lens work Referral/health issues

16 What may influence the interaction? Preconceived ideas Environment Verbal and non-verbal behaviour Influence on recall

17 Patient Health Beliefs Family and Friends Society or Community School or Workplace Previous healthcare experience Previous experience of practitioner Cultural and religious beliefs Socio-economic and educational status

18 Health beliefs Shickle 2013 why do over 60s not get regular eyecare Fear of hard sell Fear of something wrong being found Previous poor experience

19 Communication begins even before the patient meets you Practice environment Orientation

20 Environment Marketing Awareness

21 Environment

22 Social Techniques Orientation (practice design) Formal v informal

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25 Initial meeting Stereotyping

26 Social Techniques Contact Proximity Personal Space

27 Public space Social space Personal space Intimate space

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31 Appearance

32 Body Language Posture Gestures Head Nods Facial Expression Eyes (pupils, contact, movement)

33 Eye Contact Speaker 35% Listener 90% This can be exploited to your advantage

34 Eye Contact Speaker 35% Listener 90% This can be exploited to your advantage

35 CLOSER Control distractions and interruptions Lean forward slightly toward patient Open and non-defensive posture Squarely face the patient Eye contact as appropriate Respect the patient s personal space

36 Paralinguistics - How not What Intonation Rate of Speech Pitch Volume Pauses Speech Errors

37 Social Techniques Synchrony Pacing Speech

38 Eye Examination Initial meeting History and Symptoms Clinical Investigation Conclusion and Summary

39 Dispensing Intial meeting Gauging how they use their eyes Check for understanding - summary

40 History & Symptoms Reason for Attendance Current ocular and optical status Symptoms Ocular History (Family) General Medical History (Family) Lifestyle and Occupation

41 Funnelling Relate to personality Open poor for inhibited Closed poor for getting full picture Mix appropriately

42 History & Symptoms Cognitive Affective

43 Clinical Investigation Memory Ability to generalise Understanding of concepts Ability to communicate

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45 Communication of Findings Concise and Clear Specific Non-verbal Reinforcement Categorisation Primacy and Recency effects Call for Commitment Summary Body Language

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47 Content Analysis Software Anecdotal

48 Non-Content or Process Analysis Bales Korsch Roter Stiles

49 Combination Method Liverpool Medical School CIA

50 Interaction Analysis of Eye Examinations N=200 Intervention 4 optoms post-test test satisfaction scoring info changes behaviour repeatable behaviours affect satisfaction

51 Accommodative SOT

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53 Case 3 presbyope

54 Case 10 Oculocutaneous Albino Age 19 Photographer Aesthenopia at near No tints used (hates glasses) Bright field mag Dist Rx no improvement

55 VM 6/36-6/36-6/24 binoc Head tilt forward N6- R&L R:+2.00/-2.25x x180 L:+2.00/-1.25x170 VA 6/24+2 N6- binoc SOP with slip

56 Head tilt (video)

57 Contact Lenses CIBA focus toric soft R: /-1.75 x 180 L: /-1.00 x 170 Distance minimal improvement Near N5- (subjective improvement)

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