EyeTools Optometry Skills

189: I have just received a letter from a patient. He has asked me why I didn’t refer him at his last eye examination with me a year ago. He went to another eye specialist and has been diagnosed with primary open-angle glaucoma. He has been told that he has had glaucoma for around two years. I’ve looked in his clinical records and there is a copy of a referral letter but I can’t remember if I told him I was referring him as a glaucoma suspect. What should I do?

Two of my current medico-legal cases involve claims by patients that they weren’t told by their eye specialist that they were being referred for suspect eye problems. One involves glaucoma in a young man and the other a corneal problem associated with rigid gas permeable contact lenses. Each patient claims they were not informed about a possible eye problem and that they were being referred. There is a copy of a referral letter in each case but no evidence that this was sent to the patient’s general practitioner and no evidence that the patient was informed about a possible eye problem and that they were being referred.

Each patient claims that if they had known that they were being referred they would have contacted their general practitioner to confirm an appointment with an appropriate eye doctor. Specialist eye care was delayed for each patient by six to 12 months and they are claiming that this delay caused unnecessary eye problems. The patient with glaucoma now has some irreversible visual field loss in each eye and the patient with a corneal problem had to have a corneal transplant in one eye.

In order to avoid receiving these type of complaints and suffering the stress and anxiety that comes with them I suggest the following:

  • Tell your patient verbally that you suspect that they have an eye problem and the name of that problem.
  • Note the suspect eye problem and that you have told the patient, in the clinical records.
  • Tell the patient you are referring them, to whom you are referring and that you will be sending a letter to another specialist and tell them who that specialist is
  • Give the patient a copy of the referral letter.
  • Send the referral letter to the other specialist using a postal system that requires a signature on receipt of the letter if you can. Or, if the other specialist is nearby hand-deliver the letter, get a receipt and the name of the person who accepts the letter.
  • Provide the patient with a contact telephone number and an address of the other specialist and advise the patient if they haven’t received an appointment in around 10 working days to contact the other specialist.

This may seem like a lot of time and effort but it’s in the patient’s best interests as well as yours. Better to take this time than receive a complaint letter.


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