2. communication skills

Why are communication skills important in optometric practice?

1. It puts the patients at ease

2. It helps to attend to patient concerns

3. Relevant information can be obtained from the patient throughout exam

4. Relevant information can be effectively delivered to the patient (e.g. making diagnoses, reporting findings, delivering treatment advice)

5. Informs patient decision making in patient-centred care

6. Boosts practice reputation (and in consequence practice success)

What approaches can we make to make a patient comfortable and relaxed, while building a good rapport with them?

• Provide information about the exam prior to the appointment
• Provide a comfortable welcoming setting in the practice waiting room
• Have a formal professional appearance
• Be aware of first impressions when you meet the patient
• Beware of making the examination room frightening to the patient
• Change chair height to ensure you are a similar eye level as the patient
• Chat about non-clinical issues (brief)
• Have a relaxed posture and style but remain attentive
• Start your case history with an open question
• Provide a brief explanation for each part of the exam

What are the three levels of listening?

• Language: the words that people use is the starting
point of understanding what they say. The first part of
listening is attending to what they are telling you.

• Paralangauge: this comprises the intonation that
people use, the pitch and the volume. Paralanguage
can completely change the meaning of what people
say, for example saying things in a sarcastic tone of
voice, or which words in a sentence are emphasised.
The second part of listening is attending to how they
are saying things.

• Body language: aspects such as gestures, eye gaze,
and facial expression also give us important information
in interpreting what people are telling us. Body
language not only helps us understand the message,
but also gives us clues about how that person is feeling.

How do you build a rapport with your patient?

• Show that you are interested in them and the health
of their vision, and you want to listen to them and
understand them. You can do this through eye
contact, posture and encouraging gestures such as
nodding and smiling

• Enable the patient to give their own account, for
example through asking them to describe their
experiences or expectations. Listen to what they say
with an open mind and do not judge them or indicate
that you do not believe them

• Show respect for the patient by acknowledging their
viewpoint and making empathic statements that
indicate that you have understood their position,
and by identifying common beliefs or values

What are the signs of anxiety?

• Either going pale or flushing
• Sweating
• Trembling hands
• Plucking at clothes or other objects, e.g. buttoning and unbuttoning clothes, playing with a pen, watch, or jewellery.
• Changes to the voice, such as talking very quickly, or a shaking voice
• Tense posture
• Avoiding eye contact

What are some examples of problems you encounter when soliciting information from the patient?

• The difficulty of over-talkative patients who take up valuable time giving lengthy, perhaps irrelevant, answers.
• Some patients may provide insufficient detail due to discomfort, anxiety or a lack of understanding.
• Patients can at times appear overly concerned with providing the ‘correct’ answer to certain questions.

1) Selection of question type

What is an open question?

Open Questions are those in which the patient can give any response, such as “how has your general health been over the past year?” or “which situations do you find it’s more difficult to
see clearly?” Open questions are useful at the beginning of a consultation to get a good understanding of the patient’s needs and expectations

1) Selection of question type

What is a closed question?

Closed Questions are typically those that have yes or no answers, such as “Have you had more difficulty reading small print over the past year or so?” or “would you like me to explain that again?” Closed questions are good for checking your understanding of a situation.

1) Selection of question type

what is a focusing question?

Focusing questions are useful to focus the patient’s attention on a particular area, and so help
you explore something in more detail. They are open questions, but direct the patient’s
answer to the area you would like to find out more about. For example: “You mentioned that
you’ve been getting tired eyes recently, can you tell me about when that tends to happen?”

1) Selection of question type

what is a clarifying question?

Clarifying questions are a type of closed question that clarify a particular issue. They are useful to
help the patient understand a particular point, or why you are making a particular
recommendation. For example: “You say that you don’t like driving at night any more, is this
because of your vision?”

(2) Question wording

how do you begin the consultation?

How to begin the consultation? Patients often display difficulty being asked about ‘problems’ with their eyes at the start of the consultation – ‘Are you having any problems at the moment?’ as they feel it is the task of the examination to deduce whether any problems exist.
Instead, patients appear more comfortable being asked about ‘concerns’ or ‘changes’ with their eyes.

How do you identify if a patient will be comfortable with the use of jargon?

The use of jargon: word questions to suit individual patients. The answers that patients provide to the first few questions in the consultation indicate their level of comfort with vocabulary.
Word questions that relate to categories of patient understanding rather than optometric ones.
E.g. Ask ‘How is your vision looking at signs in the distance?’ rather than ‘How is your distance
vision?’
Patients frequently find subjective refraction challenging and experience difficulty answering the
optometrist’s test questions, perhaps also stating concern over the quality of their answers. E.g. cross cyl check

(3) How do you maintain appropriate eye contact?

Eye contact is central to all forms of face-to-face communication. It shows that both parties are listening to each other and helps facilitate the exchange of conversation.
When practitioners maintain eye contact, their patients feel listened to and involved in the consultation. By contrast, patients whose practitioners spend much of the time looking at notes
are more likely to report feeling that their concerns are treated as unimportant.
Practitioners should also consider their seating position in relation to the patient to allow the
opportunity to engage eye contact.

Communication tips when dealing with a visually-impaired patient?

•Identify yourself - don't assume the person will recognise you by your voice.
•Speak naturally and clearly. Loss of eyesight does not mean loss of hearing.
•Continue to use body language. This will affect the tone of your voice and give a lot of extra
information to the person who is vision impaired.
•Use everyday language.
•Name the person when introducing yourself or when directing conversation to them in a group
situation.
•Never channel conversation through a third person.
•In a group situation, introduce the other people present.
•Never leave a conversation with a person without saying so.
•Use accurate and specific language when giving directions. For example, "the door is on your
left", rather than "the door is over there".
•Avoid situations where there is competing noise.
•Always ask first to check if help is needed.
•Relax and be yourself.

How do you help a patient to adhere to their eyecare recommendations?

• Giving clear instructions
• Speak clearly at a relaxed pace
• Use plain English; use short sentences
• Don’t use complex grammar
• Don’t use double negatives
• Written instructions should use a clear font size, and
have a good contrast between the colour of the ink and
the colour of the paper
• Don’t use technical terms or jargon

A64: Communication guidelines

-          communicate in a way that is appropriate to the child’s age, maturity and ability to understand

-          talk directly to the child and answer their questions honestly,

-          ensure the accompanying adult is present in the consulting room throughout the examination

What are risk assessments used for?

to identify, assess and control potential risks in
the workplace. They are part of the overall process to manage risk and keep people safe and healthy at work.

Practice owners must undertake risk assessments to identify potential hazards, the likelihood and seriousness of these, and take steps to address them as part of their formal health and safety policy.

Is the law different for small and large businesses?

It is a legal requirement for both small and large businesses to carry out a risk assessment. The only difference is that if you employ five or more people, you must record the significant findings from the assessment. This includes what may cause harm, who might be harmed and how, and what you are doing to control the risks

Why should you involve staff in the risk assessment?

As they understand the risks involved in their work and can let you know about any potential shortcuts or problems.
•The Health and Safety Executive (HSE) states that involving staff in health and safety in the workplace reduces accidents and ill health. It also creates a positive health and safety culture where risks are managed well.
•Risk assessments are used to develop health and safety procedures. If staff are involved in developing these procedures, they are more likely to follow them.
•To involve staff in risk assessments, employers need to consult with them. This means listening to all their views and not making decisions for them. Employers also need to work with and train health and safety representatives, so they understand what is involved and can fulfil their role.

What are the 5 steps to manage risk?

1.Identify hazards – think about what could cause harm in your workplace.
2.Assess the risks – decide how likely it is that someone could be harmed by each hazard and how serious it could be.
3.Control the risks – look at what you’re doing to control the risk and decide if you need to do more.
4.Record your findings – you must record your main findings if you employ five or more people.
5. Review the controls – check the controls you have in place are working

What are the specific risks in optometry?

Vulnerable people such as pregnant women, children and those with disabilities.
One of the important risks to staff and patients is the spread of infection because of potential close contact within a healthcare setting and the nature of the care being provided.
•The College’s Guidance for Professional Practice sets out how to prevent or control transmission from person to person and through contaminated objects or surfaces. It provides specific guidance for situations where certain patients or staff groups may be identified as being at greater risk of developing an infection and how to mitigate this risk.

How should individuals undertake risk assessments for
wearing PPE?

•Optometrists should use their professional judgement to risk assess whether to wear PPE. College guidance recommends that when providing direct care to patients, PPE should be worn if an individual anticipates being exposed to transmissible infections, blood, body fluids or non-intact skin, and while
handling or decontaminating equipment.