Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientspatients the knowledge and skills to care for themselves.For example, good blood-glucose and blood-pressurecontrol reduce the risk of progression of diabeticretinopathy and help to preserve vision. Liaison withGPs, physicians and specialist nurses is important toreinforce these messages and to provide additionalsupport. Skilful counselling is required to inform andeducate while recognising the individual’s expertise intheir own condition.Patient support groups, which include those for patientswith visual loss and those with specific medicalconditions, enable patients to gain from the lifeexperience and understanding of others. An ophthalmicphysician will have links with one or more localsocieties for the visually impaired and many alsosupport charities at a national level.Visual impairmentOphthalmic physicians need to take account of thespecial needs of the patient with visual impairment,whether temporary or long term. The Royal NationalInstitute of Blind People (RNIB) ‘Losing PatientsCampaign’ has highlighted the difficulties faced byblind and partially sighted people who are given healthinformation that they cannot read. 3 Patient informationshould be available in a format that is accessible topatients with visual impairment and currently the NHSfalls behind on this ideal. Staff should be trained toassist those with visual impairment and to be alert tothe difficulties of communicating for patients with dualsensory impairment.In the UK, only one in three blind or partially sightedpeople is working. 4 Diabetic retinopathy and uveitis arethe leading causes of visual impairment in the workingyears of life 5 and these groups in particular need accessto specialist employment advice, which is usuallyprovided through charities. Advancing technology andcomputer software mean that many patients with sightloss can often retain their jobs if they are given adequatesupport.Timely registration using the certificate of visualimpairment (form BP1 in Scotland) enables patientswith poor vision to gain access to practical and financialsupport (although access to services for the visuallyimpaired should always be on the basis of need ratherthan registration).Ethical and religious considerationsOphthalmic physicians should be sensitive to culturaland religious beliefs and how these impact on a patient’sacceptance and understanding of their condition andtreatment.Patient-centred eye servicesA patient seeing an ophthalmic physician may need tohave a number of assessments and investigations, eg anorthoptic assessment and a visual field test for aneuro-ophthalmic appointment or retinal photographyand optical coherence tomography imaging at a diabeteseye clinic. Treatments such as intravitreal injections andretinal laser therapy are provided through outpatientdepartments.Services should be organised to enable patients to havetheir investigations and clinical review at the sameappointment wherever possible to minimise hospitalattendances. The Royal College of Ophthalmologistsissued guidelines on the commissioning of services forAMD in 2007 and recommends a ‘one-stop’ clinic,where investigations and treatments are performed atthe same visit. 64 Interspecialty and interdisciplinary liaisonWithin the ophthalmology department, ophthalmicphysicians work closely with ophthalmic surgeons,optometrists, orthoptists, ophthalmic photographers,electrophysiologists and ophthalmic nurses.Increasingly, ophthalmic nurses and optometrists arebeing trained to see and manage patients according toprotocols for conditions such as AMD and acuteanterior uveitis.Working with ophthalmologistsOphthalmology is divided into a number of subspecialtyareas and while the vast majority of patients aremanaged by one specialist, some patients may bemanaged by an ophthalmic physician in associationwith an ophthalmic surgeon. Patients may need to bereferred on for ophthalmic surgery, and others withcomplex disease benefit from seeing an ophthalmologistwith a special interest in their condition, eg a patientwith glaucoma secondary to uveitis may see anophthalmic physician, for control of their ocularinflammation, as well as a glaucoma specialist.An ophthalmic physician may be called to assist withthe management of ophthalmic patients with medicalneeds, for example a patient under the care of a cornealsurgeon requiring immunosuppression for a complexcorneal transplant.162 C○ Royal College of Physicians 2013