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Review into optometry complaints highlights need for clear communication

Optometrists are being urged to carefully manage patient expectations when prescribing new spectacles and contact lenses, as well as improve their communication, following a formal assessment of complaints made to the national health regulator.

The recommendations are among the key findings from a recent review into 384 complaints lodged against 338 optometrists spanning from 1 July 2010 to 31 December 2017.

The report, conducted by the Australian Practitioner Health Regulation Agency on behalf of the Optometry Board of Australia (OBA), was a routine assessment to help inform OBA policy and the development of regulatory standards.

The review found just 5.6% of the 6,047 optometrists registered during the 7.5-year period examined had one or more complaints made against them. Overall, the profession drew fewer complaints than the average for all other regulated health professions.

OBA chair Mr Ian Bluntish said while the findings confirmed optometry was a low-risk profession that provided a high-quality service, dissatisfaction with treatment for refractive error was shown to be the most common single issue.

Communication issues were also identified as theme of many complaints.

“One thing the board learned from the review is that optometrists need to be very careful in setting realistic expectations about clinical care, particularly around prescribing spectacles or contact lenses,” Bluntish said.

“Although these are the simplest, safest and most cost-effective ways of correcting refractive error, there is a widespread belief that there is no period of adjustment to new corrective lenses, and many complainants felt that the dispensing optometrist could have been clearer in explaining that it may take a couple of weeks for their eyes to adjust to a new prescription.”

Due to subjective aspects of sight and vision correction explanations, Bluntish said it was important practitioners communicated in language patients easily understood.

“For example, optometrists need to better communicate the limitations of a prescription as many patients experience problems when changing to a new prescription for spectacles. Resolution of issues at an early stage are critical so that problems are not escalated unnecessarily.”

Bluntish said the review also found the onset of symptoms caused by retinal tears was another area where communication could be improved.

The report also highlighted the importance of ongoing professional development. The board’s newly revised continuing professional development (CPD) registration standard and accompanying CPD guidelines, announced in August, are designed to incorporate options and opportunities for optometrists to improve their practices, including communication.

The report’s general findings, as well as the low rate of notifications received, demonstrated that optometry compared well with other regulated health professions.

“It is therefore a relatively low-risk profession in the National Scheme, with lower risk procedures. Two-thirds of cases after investigation resulted in no further regulatory action, a finding which is also consistent with other professions within the National scheme,” Bluntish said.

Looking ahead, the OBA will now apply the report’s findings to the management of optometry-related notifications, and help to ensure the regulatory standards, codes and guidelines for optometrists remain relevant.

Understanding consumer law

In order to minimise the risk of complaints and claims, Optometry Australia (OA) chief clinical officer Mr Luke Arundel encouraged members to visit OA’s PII Insurance Risk Management webpage, which contains several resources, including a risk management checklist.

“We think it’s important that optometry service providers have an understanding of consumer law and both patient and provider rights when it comes to refunds,” he said. “We have a specific member resource on laws pertaining to refunds which can assist members avoid complaints being unnecessarily escalated to the regulator or being taken further, such as to a small claims tribunal.

“We encourage all our members to have a clearly communicated practice refund policy and to set realistic expectations for treatment of refractive error to avoid complaints and complaint escalation.”

OA also recommend investing an extra 30 seconds with patients to explain adaptation to a new pair of multifocals and to remind them to return to the practice if they are having problems adjusting to lenses.

“This small investment can often reassure a patient what to expect and gives them comfort that their optometrist is there to support them. Complaints over unsuccessful ortho-keratology have also been increasing and highlight the need for a refund policy to have been discussed before treatment is commenced,” Arundel said.

“OA members also have a strong professional body and whose Member Services team of optometrists, manages complaints from the public on a daily basis. In many cases, they are able to mediate a solution to a complaint for a member without the matter escalating to the regulatory body or to medico-legal action.

“We have also found poor communication is typically the main culprit for escalation and that with appropriate explanation to the patient, we are often able to successfully resolve a complaint on a member’s behalf.”

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