Professional Conduct Competency 2.5

Competency 2.5 : The ability to demonstrate an understanding of the legal, professional and ethical obligations of a registered optometrist

This competency looks at the trainee’s overall understanding of their professional obligations to their patients and to the public.  There are three essential documents that you must read and in some part learn in order to achieve this competency:

  • The College of Optometrists Code of Ethics & Guidelines for Professional Conduct
  • The Opticians Act
  • The Association of Optometrists (AOP) Handbook

The first document tells you what you should do and how you ought to behave. The Optician’s Act tells you the minimum that you must do to fulfil your legal obligations in undertaking the eye examination of a patient.  The final document is a hefty volume that is an invaluable source of standards, regulations and advice that you can refer to in practice.

You will be able to demonstrate this competency during the discussion of Patient Records with your Assessor.  Discussion of Case Scenarios may also be necessary if insufficient breadth of this topic is covered in your own patient records and additional questions asked to clarify your understanding.

Legal Obligations

There are three aspects of law which apply:

  • Common law duty to practise to the same standard as a reasonably competent optometrist (the College guidelines indicate what a competent optometrist should do)
  • Statutory duty as imposed by the Opticians Act which states who may carry out an eye examination and what duties must be fulfilled when examining a patient’s eyes
  • Contractual duty to the patient when agreeing to undertake an eye examination and to the NHS when providing GOS services

Ethical Obligations

The principles of the College of Optometrists Code of Ethics state that the optometrist should always act within the law and not conduct themselves in any manner that would compromise their own professional integrity, that of other colleagues or of the profession as a whole.  The optometrist also has a responsibility to ensure that they are adequately trained in any procedure that they intend to undertake in clinical practice and that they keep up to date with continuing education and training (CET).  The overriding emphasis is that an optometrist put the interests of the patient and the public before all other considerations.

Trainees are advised to read the section on Ethics which cover:

  • Professional integrity
  • The patient practitioner relationship
  • Patient practitioner communication
  • Inter and intra professional relationships
  • Delegation
  • Research
  • Supervision

Professional Obligations

The College of Optometrists Guidance for Professional Conduct indicates what must or should be done in the course of optometric practice.  Make sure that you know these guidelines inside out as they cover everything from when to issue a contact lens specification, to the supply of ophthalmic drugs as well as covering the examination of given patient types.  However it should be emphasized that they do not constitute checklists and the optometrist should use their own professional judgement in interpreting these guidelines.

Example Patient record and case scenarios

Examples of situations which highlight legal, professional and ethical obligations of an optometrist include the following:

  • Where a patient no longer meets the legal requirement for driving, your advice to the patient and what you would do if the patient intends to ignore your advice
  • Where a patient exhibits ocular manifestations of a systemic disease but does not wish to see their GP
  • Where a patient presents with symptoms of a life or sight threatening condition but cannot be examined either because there is no appointment available or the patient refuses to pay for an examination
  • Where a patient has had an examination or spectacle dispense elsewhere and complains to you about the quality of care
  • Where the patient complains of symptoms for which there is no apparent clinical explanation
  • Where a young child presents with clinical signs of physical abuse
  • Where a contact lens patient requests a copy of their contact lens specification with the intention of ordering lenses over the internet
  • Where a diabetic patient continues to have annual eye examinations even though they are routinely monitored by their consultant ophthalmologist
  • Where the patient has incurable vision loss

This list is not exhaustive and this competency could be demonstrated when discussing apparently “normal” patient records.  Think about what you would do if these situations presented themselves and make sure that your plan of action falls within the legal requirements and professional guidelines.

It is worth remembering that your professional responsibility to a patient does not end if you cannot resolve any problems that they may present with, and that you can usually refer them onto another professional who can help them.

Areas of Further study (not an exhaustive list).

  • The General Optical Council: Code of Conduct
  • Duty of care: Public Liability, Health and Safety, Medicines Act, including use and supply of medicines by optometrists
  • Professional Bodes: inter professional working groups and associations (GOC, AOP, ABDO, FBDO, SMC, FODO, OCCS etc
  • CET, Registration, Revalidation and Clinical Governance
  • Record Keeping Data Protection & Freedom of information
  • Sale and supply – Spectacles and Contact Lenses
  • Complaints and procedures, professional indemnity
  • The Disability Discrimination Act, Race Relations: Equality & Diversity, Community Care Act
  • Working with children and vulnerable people – Criminal Records Bureau (CRB)

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