Communication is a core competency that practising optometrists constantly use to deliver the best possible care to patients. Despite this, speaking to patients can be challenging for students and practitioners at the start of an optometry career.
Although personal experience can be a great teacher, so is learning from the experiences of those further ahead than you. So, what knowledge and advice do today’s newly qualified optometrists have to share with those of tomorrow?
‘When I began to explore optometry as a potential career, I had to mentally prepare myself for the communication side of the role,’
explains Rejoice Bangure, a recently qualified optometrist working at Optical Express.
‘Public speaking had never been my strong suit, so the idea of working in a one-to-one setting felt quite intimidating; there’s nowhere to hide.’ Bangure’s experience echoes that of many about to embark upon a career in optics. Apprehension regarding patient communication is understandable, but like any skill, it can be learned and developed.
‘It took practise to reach a point where the confidence came easily, but as my knowledge grew, it became easier. This journey has taught me that communication isn’t just about speaking, but about preparation, confidence and finding the balance between listening and leading the conversation. It’s a skill I continue to work on, but it’s been rewarding to see how far I’ve come,’ Bangure says.
Although the specific act of interacting with patients as a practitioner may initially be foreign, students and newly-qualified optometrists likely already have past experiences through which they’ve begun to develop their interpersonal skills. These can serve both as a confidence booster and a foundation to build upon for future progression.
Zahraa Khan, a pre-reg optometrist at Specsavers Romford, recalls: ‘Looking back, my previous job working as a health advisor with the London Ambulance Service helped build my communication skills to ensure patients get the right care. Active listening, finding commonalities, and leading with empathy and respect are important skills I learned then and continue to use now.’
A key initial step of communication is establishing an effective connection with patients. ‘Building rapport with patients and understanding their lifestyle and needs are important for providing the most effective and personalised care and end-product,’ explains Isha Saghir, who
qualified in 2023 and works at several Hakim Group practices in Merseyside and Cheshire.
‘Getting to know your patients on a more personal level by asking about their hobbies and interests is one way to build rapport. Picking up on something they may have mentioned at their previous sight test is also a great way to build trust and embed that personal relationship, and patients are often more open about their concerns as a result of this,’ Saghir adds.
One strategy that Bangure employs is using her surroundings as an ice-breaker. ‘Our clinic is in the city centre, so we often hear buskers playing outside,’ she explains. ‘Talking about the music can spark conversations, especially if the patient loves music or plays an instrument themselves. Moments like these naturally segue into discussions about their hobbies, which help me understand how their vision needs to fit into their lifestyle.
‘These informal chats also help patients relax in what they often perceive to be a formal environment. A light-hearted comment can make them smile and once they’re at ease, they’re more likely to share details, providing deeper insight into their needs. That trust is invaluable for tailoring solutions to their vision requirements,’ she adds.
No two patients are the same, which is something that applies not just to their visual needs. ‘Being on a patient’s level is key to gaining their trust and involving them in the conversation,’ explains Khan. ‘I make sure to use language and phrases that patients understand, taking into account factors like their age.
‘I recently had a young patient who was uncomfortable wearing an eye patch, but I related my experience of wearing one when I was young to explain its importance. That made a difference. It felt like he understood, and his dad was grateful, saying that I’d talked to his son in a way that he would understand, which was rewarding.’
There are, however, general approaches that can make effective communication easier. ‘As a visual learner, I tend to use diagrams, where possible, to explain things,’ says Bryce Tidmarsh, a recently qualified optometrist at Specsavers Stroud. ‘Some concepts we need to convey may be more easily appreciated with a quick internet image search to supplement a verbal explanation and a leaflet.’
Saghir notes that it’s important to stick to everyday language when explaining clinical findings because medical terminology and concepts may be overwhelming. She points to analogies as a useful tool for cutting through complexity.
‘Having a clear structure when explaining findings to patients is crucial for their understanding, but also to ensure you’ve covered everything,’ she adds. ‘Additionally, instead of assuming the patient understands everything at the end of the examination, I always encourage questions. The College of Optometrists’ patient leaflets are also a useful tool for patients, because they’re a written summary that patients can take away and review in the comfort of their own home to fully process the information.’
Communication challenges
However, sometimes challenges arise that make effective communication a little more difficult. ‘A big challenge can be dealing with language barriers,’ Bangure says. ‘I’ve had cases where patients spoke no English, making explaining conditions or gathering histories difficult. In one instance, I used Google Translate to communicate basic medical concepts and guided the refraction process by asking the patient to indicate preferences with hand gestures.
‘For vision testing, the Landolt C chart proved incredibly helpful, as the patient easily understood the directions. You have to adapt your routine and approach depending upon the circumstance.’
In one particularly memorable experience, Bangure was able to explain to a non-English speaking patient her high prescription and undiagnosed cataracts and navigate her through the process of arranging and preparing for cataract surgery, using diagrams and animations.
‘At her post-op appointment, I saw this patient, whose conditions had previously seriously impacted her vision, smiling for the first time,’ she recalls. ‘She saw my face clearly and said, “Today is the first time I’m seeing your face and I’m happy.” It’s a moment that’s stuck with me because it reminded me of the profound impact we can have on patients’ lives. Optometry isn’t just about eye health, it’s about improving quality of life. Experiences like that reinforce the value of what we do every day,’ Bangure says.
Other medical conditions or issues a patient might have may also present communication challenges. ‘I once had a patient with dementia come in for her annual eye examination with a particularly bloodshot eye,’ explains Saghir. ‘This patient often worries and, on this particular occasion, as soon as she sat down in the consultation room, she burst into tears. She already had it in her mind that something was seriously wrong with her eye, which made communication more difficult.
‘I had to be careful and tailor my approach, being sensitive towards her situation. It was important that I let her know that it is okay to feel nervous or anxious, and that she did the right thing by coming in to see us. By letting her express her feelings, reassuring her, calmly explaining what had happened and the next steps, her nerves settled and she left much happier.’
Khan agrees with the need to adapt one’s approach to a patient’s requirements. ‘It’s vital to care for the range of patients we see,’ she says. ‘For my patients with hearing loss, I sound my words more carefully and often write what I’m saying on a computer or paper. I also make sure to ask if they have any questions along the way which they could write down.’
Sometimes, however, communication may be made more difficult simply because of the breadth of potential conversation topics, or the constraints of time. ‘Some patients are naturally inquisitive,’ Tidmarsh explains. ‘They can ask wide-ranging questions from anatomy to how equipment works. Providing the crucial information first is a good yardstick when conversing with patients, who may have limited time themselves. After that, it’s great to know and share places where they can find additional information themselves, should they want to research further.’
Excellence in sight
Ultimately, the end-goal of patient communication is facilitating the delivery of excellent care, something that patients typically communicate back to practitioners. ‘You can normally tell when a patient is happy with the level of care provided through either verbal validation or positive body language,’ Saghir says. ‘It is also lovely when the patient requests to see me again.’
One particular experience that has stuck with her is that of an elderly patient, whose last test was over a decade prior and for whom she identified and made a referral for bilateral cataracts. ‘A few months after his operation, he came to see me and became quite emotional, expressing his gratitude,’ she recounts.
‘He said that he felt like he’d regained his independence, mentioning that he didn’t think he’d ever be able to recover his sight, and was extremely worried at his initial appointment. This was one of the first interactions I had which made me realise the impact our everyday job can have on an individual.’
It’s also important to remember that although some conditions may appear routine to an optometrist, for the patient it’s potentially a serious, sight-threatening and life-changing problem possibly being experienced for the first time.
‘I’ve had patients write me a thank you letter for what we, as clinicians, might think of as something simple like a routine cataract referral but is hugely important to them,’ says Tidmarsh.
Khan has experienced similar. ‘I saw a young adult who had previously suffered a bilateral retinal detachment,’ she recalls. ‘He felt neglected during previous tests and hospital checks as he felt no one took the time to try to improve his prescription. I took my time to explain everything and made any changes I could to the spectacles – for which he was grateful. It reminded me of the importance of empathy.’
Advice to action
So, what advice should students and newly-qualified optometrists take hold of? For Tidmarsh, it’s to talk frequently with your fellow optometrists. ‘Keep in regular contact with as many colleagues as possible so you not only stay up-to-date with best practice, but also see different perspectives of things that you wouldn’t see yourself,’ he says.
Khan emphasises the need for students to exercise patience. ‘It may be one of the hardest study years of your life, but you are not in it alone and everyone felt the same,’ she says. ‘The reason it feels hard is because you spend your day working and then have to muster up some energy to start revision after work for your visits.’
Saghir’s advice is to master the basics. ‘Avoid rushing through the clinical tests and ensure your consultations are thorough,’ she cautions. ‘The habits you build initially are the foundations of your lifelong career. Absorb as much knowledge and experience as possible early on and take time to speak to and learn from your supervisor, other optometrists and colleagues.’
She also signposts to Kanski’s Synopsis of Clinical Ophthalmology, as a great resource which helped her familiarise herself with various forms of pathology.
Bangure tells students to get as much hands-on practice as they can, pre-reg students to focus on honing core skills, and reminds newly-qualified optometrists that confidence comes with experience. ‘Use resources like the College’s of Optometrists’ clinical management guidelines and local referral pathways to stay informed. Networking at Continuing Professional Development events can help combat the isolation of working solo, and staying updated on industry developments ensures you’re ready for patients’ questions. Trust in your training and always strive to learn and grow.’
