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General principles of
good communication in
the optometric practice
Good communication skills are at the foundation
of the modern optometric practice. They
contribute to a successful practitioner-patient
relationship, to better healthcare but also to an
increased cooperation between team members
responsible for our patients' well-being. The
purpose of this article is to present general
elements of patient -practitioner and inter-
professional communication in the optometric
practice.

Patient-practitioner
communication

'You must make the care of the patient your first

and overriding concern' states the first

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Patient-practitioner
communication

'You must make the care of the patient your first

and overriding concern' states the first
recommendation that the College of
Optometrists (CoOJ makes in their
'Communicating effectively with patients'
document.1This principle is of the utmost
importance; however, without good
communication skills, even the most skilful
clinicians will fail to offer their patients the best
care. Indeed, year after year, the annual report
of the Optical Consumer Complaints Service lists
that one of the most common causes for patient
complaints is the quality of customer service. In
addition, poor communication between
practitioners and patients is one of the reasons
mistakes occur in the healthcare system,
including optometric practice.

Communication skills are at the core of

healthcare practice and contribute to the
ultimate goal of achieving the best care for our
patients. Communication includes language, but
also perceptions, feelings, empathy, honesty,
collaboration and appropriate use of technology.
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also perceptions, feelings, empathy, honesty,
collaboration and appropriate use of technology.
In addition, beside face-to-face interactions, the
practitioner should also be aware of other ways
they send messages to their patients, including
the appearance of their practice and team
members. Effective communication also
extends to patient education via educational
brochures, telephone communication, handling
complaints, patient surveys and follow-up
systems. If communication is right then our
patients are more likely to feel satisfied, follow
advice, be compliant to treatment and
recommend the practice.

General elements

The following are key components in generating

a good inter-relationship between clinician and
patient:

A clean, neat and modern practice -

very important as a first impression.
Little things such as availability of
drinking water and printed educational
materials, short waiting times and the
appearance of dispensary can play a
crucial role in establishing patient trust.

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Appearance of staff - along with
personal hygiene, this will make a crucial
impression.
Physical layout of the consultation room
- enhances a permanent contact
between the patients and practitioners,
is also important.
Language.

Language

One of the most important elements in patient-

practitioner communication is language. From
the initial greetings and small talk, to gathering
and transmitting information, language is a
powerful tool that practitioners can use to get
the patients on board. In addition, correct use of
questions to establish reason for visit and
patients' history, will help to move the
consultation forward. The language should also
be appropriate for each patient. Although some
individuals will be able to understand medical or
optometric jargon, most of our patients will not
understand specialist terminology and will rely
on easy to process information in order to
understand their diagnosis and management.
'Ill-informed patients tend to neglect timely
treatment which can lead to very bad -
sometimes disastrous - outcomes,' said Dr

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X i Optician Online - ... ••

opticianonline.net •

Language

One of the most important elements in patient-

practitioner communication is language. From
the initial greetings and small talk, to gathering
and transmitting information, language is a
powerful tool that practitioners can use to get
the patients on board. In addition, correct use of
questions to establish reason for visit and
patients' history, will help to move the
consultation forward. The language should also
be appropriate for each patient. Although some
individuals will be able to understand medical or
optometric jargon, most of our patients will not
understand specialist terminology and will rely
on easy to process information in order to
understand their diagnosis and management.
'Ill-informed patients tend to neglect timely
treatment which can lead to very bad -
sometimes disastrous - outcomes/ said Dr
Sidney Eisig of Columbia University's College of
Dental Medicine in New York. The struggle is reali
explaining medical concepts to patients is a skill
that improves with practice and gets refined
after every patient encounter. A few tips to help

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with communications medical jargon in lay
language, include:2

Practice explaining various terminology

to family and friends.
Ask the patient to repeat the
instructions back to you.
Use analogies; cataract is often
explained as looking through a 'dirty
window'.
Draw pictures to help patients visualise
what you are talking about.

Most optometry textbooks emphasise the

importance of eye contact when
communicating with patients. Maintaining eye
contact reassures the patient that we are
paying full attention to their concerns and
needs. In the 'Practical Work of the Optometrist'
project (published in the 'Communication Skills
Development Portfolio for Eye Care Practitioners
and Trainers', a collaboration between the
College of Optometrists and King's College
London) it has been shown that removing eye
contact is perceived by the patients as a
negative gesture and triggers various
responses, including a halt in conversation and
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Development Portfolio for Eye Care Practitioners

and Trainers', a collaboration between the
College of Optometrists and King's College
London) it has been shown that removing eye
contact is perceived by the patients as a
negative gesture and triggers various
responses, including a halt in conversation and
making gestures to attract the attention of the
practitioner. It has been suggested in this
document that withdrawal of eye contact can
have a negative impact not only on
communication but also on patients'
satisfaction.

Patience and honesty

Patience and honesty are also essential when

communicating with patients. Optometrists have
to be prepared to answer various questions, to
explain certain points, as well as to listen to the
patient's worries and empathise with them.
There has to be trust between the practitioner
and the patient and this can be maintained only
if practitioners and patients 'have open and
honest communication in the management
process'. 3 A study carried out in Nigeria
explored the degree of patients' honesty in front
of their optometrist. 3 The participants involved

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satisfaction.

Patience and honesty

Patience and honesty are also essential when

communicating with patients. Optometrists have
to be prepared to answer various questions, to
explain certain points, as well as to listen to the
patient's worries and empathise with them.
There has to be trust between the practitioner
and the patient and this can be maintained only
if practitioners and patients 'have open and
honest communication in the management
process'.3 A study carried out in Nigeria
explored the degree of patients' honesty in f rant
of their optometrist. 3 The participants involved
included patients and eye care practitioners
(with minimum five-years' experience) f ram
various age groups. Many of the patients
included in this study admitted to lying to the
doctor by either leaving important details about
their condition out (eg time of onset) or about
medication they had used previously. Some
patients also complained that practitioners 'do
not give their patients enough time to explain
their complaints before interrupting them'.3

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Optometrists cannot control whether a patient

lies to them or not but they can make sure that
the patient is not put in a situation where they
feel that they cannot trust the optometrist or
fully open up to them about their health
problems. The conclusion of this study was that
honesty 'should be the rule of thumb in the
doctor-patient relationship, where
communication is key' and that 'both parties
should relate truthfully with each other'. 3

Empathy

It has been demonstrated that, as we become

more accustomed to medical practice, we tend
to lose empathy. 4 'The patient will never care
how much you know until they know how much
you care', stated Terry Canale, the vice-
president of the American Academy of
Orthopaedic Surgeons. Indeed, all our patients
entrust their health to us. When they arrive to
our practices, they have lots of uncertainties
and apprehensions. Empathy, defined as 'the
ability to understand and share the feelings of
another', plays and important role when trying
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ability to understand and share the feelings of
another', plays and important role when trying
to build trust, to calm anxieties and make the
patient adhere to management. The practitioner
should acknowledge and validate patients'
feelings. He or she should make the patient feel
understood and justified in their behaviour and
also explain how their management plans are
chosen for their individual circumstances. All
these can be done with the help of tools such
as mindfulness, increased awareness of the
patients' verbal and body language and
refraining from judgement. 5

It was recommended that affective

communication skills should be taught during
undergraduate taught programmes.6J Gross et
al 8 also emphasised that students should be
taught communication skills that ensure
'empathetic, easily understood, culturally
competent and compassionate' interactions
with patients.

A video that presents the importance of

empathy in patient care went viral on YouTube
and can be watched here: httgs://v.outu.be/cDD_
~ j__g-08.

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A video that presents the importance of

empathy in patient care went viral on YouTube
and can be watched here: httgs://v.outu.be/cDD
~j__g:Q.[

Collaboration

The practitioners should always encourage the

patients to voice their concerns, thus
contributing to a collaborative communication. In
this way, practitioners can avoid making
recommendations based on general
assumptions and ignoring the individuality of
each patient. Ways to ensure individuality
include addressing the patient by name,
personalising the conversation, encouraging the
patient to express their own concerns, listening
actively and acknowledging what the patient
says, informing the patient about management
and always addressing the patient, even when
they come with their carer (adapted from
College of Optometrists' Guide to
Communication, Topic 6: Understanding patient
concerns 1- treating the patient as an
individual). In addition, the results of tests as well
as management plans should always be

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as management plans should always be
discussed with each patient, taking into
consideration expectations, outcome
preferences, risks and costs, thus sharing
management responsibilities with them. 9

Education

Patients' education is also a very important

element of communication. Often compliance to
a certain management plan is linked to the level
of education that the patients receive f ram
practitioners. This starts in the waiting room by
having available a large variety of printed
materials; it then continues in the consulting
room though verbal advice and providing written
instructions. Finding out what are the patient's
beliefs and correcting any wrong information is
also part of education. Lectures, open days,
video and audio tapes and online materials, all
can be accessed and can contribute to
informing our patients about their conditions.
The choice of one method or another depends
on the patients' demographics and access to
various technologies.

Communicating with patients

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Communicating with patients

training

Not everyone is born a good communicator;

these skills can be learned through a good
understanding of the main concepts, practice,
motivation, self-awareness and monitoring.

Currently, there are no GOC requirements for

specific undergraduate communication skill
courses. Nevertheless, providing our students
with such skills is very important. One method,
that is quite successful in helping students
develop their communication skills and prepare
them for various clinical scenarios, is role
playing. The effectiveness of this method was
tested in a pilot study where students 'were
recorded during encounters with actors.10 The
actors portrayed five common clinical scenarios
that included retinal detachment, age-related
macular degeneration and various ocular
complications related to the use of contact-
lenses. Students who took part were then split
in to two groups. An enrichment group, who
experienced all five clinical scenarios, received

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1n to two groups. An enrichment group, who
experienced all five clinical scenarios, received
immediate instructor feedback and had the
opportunity to view their video-taped sessions
and a non-enrichment group who only did the
first and last clinical scenario, did not receive
any instructor feedback and did not have the
opportunity to view any video-taped sessions.
The results from the study showed that, despite
all the students showing improvement from the
first scenario to the last, the performances of
the enrichment students, were 'rated more
improved' compared to those non-enrichment
students.

The use of videos and role-plays, as well as

being effective in developing the
communication skills of students, is also
considered effective by qualified optometrists.

Another way that universities try to offer

communication skills practice/training, is by
providing hospital placements. These are very
useful as they allow the students to be exposed
to patients with various pathologies. Students
can gain a lot from these

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can gain a lot from these

experiences by observing how practitioners

communicate with patients with various
pathologies and backgrounds. They can witness
various type of responses and interactions and
use these observations to modify and improve
their own communication skills.

Inter-professional
communication

A good proportion of our patients are co-

managed by a team of two or more healthcare
professionals. Most optometrists do co-manage
patients with ophthalmologists or general
practitioners (GP). When the patient needs a
referral, it is invaluable that the information
provided by the primary eye care provider is
comprehensive. Similarly, when the patient is
referred to the optometrist by their GP, it is very
important that the optometrist gets a complete
set of data regarding that patient and is able to
translate it into the best possible care.
Nevertheless, it has been reported that
communication sometimes breaks after the

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translate it into the best possible care.
Nevertheless, it has been reported that
communication sometimes breaks after the
referral was made and feedback on patients'
progress is not always received.

The Royal College of Ophthalmologists and the

College of Optometrists have, since 2015, a joint
agreement on sharing patient information and
providing optometrists with feedback after
referral.11 However, it is still reported that this is
not always the case. The report on patients is
sent most of the time to their GPs by the
hospital's electronic system that automatically
generates such letters. These electronic
systems are not built to send letters to the
patients' optometrists.12 In order to be able to
send feedback to optometrists,
ophthalmologists need to make this part of their
routine practice and give special instructions.

Communications with other professions is

mostly performed through referral letters. A good
referral letter will allow an optometrist 'to triage
the referral effectively into the right specialist
clinic in the most appropriate
timescale'. 13 Therefore, it is important that this

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timescale'. 13 Therefore, it is important that this
document receives careful attention as 'poor
referral letter writing is seen as a significant
reason as to why ophthalmologists are reluctant
to work with community based
optometrists'.13 The College of Optometrists
recommends a good referral letter should
contain all the necessary information, such as
relevant details and findings from the patient's
eye examination, reason for referral, details of
discussions with the patient as well as the level
of urgency. A good article on interprofessional
communication by Whitley published in the
Review of Optometry 14 also suggests that when
writing referral letters, practitioners should
implement the 7Cs of business communication:

Conciseness - short and to the point

referral letters.
Correctness - use good grammar and
give accurate information.
Clarity - write information that is easy to
follow and understand.
Completeness - include all the essential
elements.
Consideration - for the receiver.
Concreteness - use specific and
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elements.
Consideration - for the receiver.
Concreteness - use specific and
confident language.
Courtesy - strengthen professional
relationships.

Another issue is the communication with

patients' GPs. Difficulties are encountered in
cases where practitioners do not have
established relationships with GPs within
communities. As the belief that optometrists
only deal with eye conditions still exists, it is
important that practitioners reach out and
outline their expertise to the community's
healthcare teams. If GPs refer non-urgent issues
to community optometrists, the patients will
benefit by receiving attention much sooner than
if they were to be referred to a hospital and wait
for weeks, if not months to be seen by an
ophthalmologist. An interesting study performed
by Storey et al in 2016 15 looked into the effect of
written communication between an
ophthalmologist and a primary care physician
on patients' adherence to diabetic eye care. The
results of this study demonstrated that written,
two-way communication between the two
categories of healthcare professionals was
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if they were to be referred to a hospital and wait

for weeks, if not months to be seen by an
ophthalmologist. An interesting study performed
by Storey et al in 2016 15 looked into the effect of
written communication between an
ophthalmologist and a primary care physician
on patients' adherence to diabetic eye care. The
results of this study demonstrated that written,
two-way communication between the two
categories of healthcare professionals was
associated with increased adherence to follow-
up eye examination. This one example can only
emphasise the importance of team work when it
comes to the patients' best care.

Conclusions

Having a good patient-practitioner

communication helps our patients in so many
ways, f ram feeling valued and understood, to
getting the best possible care and seeing that
they are still in charge of their lives. Poor
communication, on the other hand, can lead not
only to patients' dissatisfaction, but also to poor
health outcomes, compromise of patients'
safety and could have even economic
consequences.16 The importance of teaching
communication skills to optometry students is
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Conclusions

Having a good patient-practitioner

communication helps our patients in so many
ways, from feeling valued and understood, to
getting the best possible care and seeing that
they are still in charge of their lives. Poor
communication, on the other hand, can lead not
only to patients' dissatisfaction, but also to poor
health outcomes, compromise of patients'
safety and could have even economic
consequences. 16 The importance of teaching
communication skills to optometry students is
well understood and, at the moment, all
universities are offering specific modules that
are customised to prepare undergraduates and
postgraduates for a large variety of patients
encounters in their future clinical practice. This
training, however, should not stop at the
university level and all of us should make sure
that good communication skills are deeply
engraved into our professional persona.

References

1. The College of Optometrists:

Communicating effectively with patients.
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