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Should I insist on compliance?

U2.7.15 Should I insist on compliance? (2019)

It was after a CET event that this query came up. The member asked that if she had serious doubts that a patient would be compliant with their contact lens care, should she refuse to continue with the fitting. Certainly it was a point that needed careful thought.

By non-compliant I would interpret that as a patient who neither cares for their lenses correctly or discards them on time or attends for check-ups. It does not include patients who simply wish to buy lenses elsewhere with the properly issued specifications.

Patients have the legal right to buy their contact lens supplies wherever they choose, within the stipulations of the law. You may not refuse to supply specifications or fit patients who may wish to avail themselves of the deals available in the High Street or online.

Our legal and professional obligation to all our patients is to put their welfare first. But would refusing to fit a patient do that? Surely they would simply try other opticians until they found one who was less concerned than you; there are plenty of opticians to choose from. Conversely, isn’t that a bit of a cop out?; “I might as well do it otherwise they will simply go elsewhere.” We all like to think our patients will do as we tell them, but how can that be guaranteed?

It would be fair to say that you should treat every patient as an individual with particular needs and attitudes. Perhaps it might be a young man who, with false bravado, tries to be macho and claim that he wouldn’t bother with throwing lenses away after a month, but rather wait until they fell to bits. In reality, he would probably be the first one to come back to see you if he encountered a problem.

Then there is the patient, who doesn’t seem to engage with you, asks no questions, appears rather uninterested in the whole process. You wonder if they are really listening at all. Perhaps they are using indifference to conceal real anxiety or they really don’t care if they have lenses or not.

As a practitioner, you have very little control over your patients’ actions. You are not there in the bathroom when they wear their lenses in the shower, or late at night when they fall asleep wearing their lenses after a heavy night.

All anyone can ask of you is that you give clear and concise instructions, verbally and in writing. In the case of a child or young adult, it would be necessary to ensure that a responsible adult, a parent perhaps, is present when such instructions are given. There is an exception to this case, it is called Gillick Competency – but that subject is for another occasion.

If patients wish to be irresponsible that is their concern, but you must give them the time and attention to reinforce your message. As with photographs of cancer afflicted lungs on packets of cigarettes, maybe photographs of eyes infected with Acanthamoeba might be used.

If the patient has an eye condition that would lead to serious, sight-threatening results if lenses were misused, the patient with an amblyopic eye for example, and you felt your concerns were not being taken seriously by the patient, you may refuse to continue fitting and supplying their contact lenses. Such a decision must be documented and politely explained to the patient.