Ontario Opticians refracting?

[Stonegoat]

Once again a sight-tester puts the blame on the patient for not seeking the appropriate level of care. Pathetic.
Just so you know, Tmores, most GPs don't even know how to use an ophthalmoscope. And most patients don't complainto their GP and complain of blurry vision. They come and see me...or, regrettably, some sight-testing @ss like yourself.

[HarryChiling]

Try again Harry, the appeal is based on section 52 of the Health professions act which gives powers to seek injunction:


And again, all I'm saying here is that your argument that sight testing is safe b/c of this case is disingenuous. The judge in this case did not render an opinion on whether or not sight testing is safe. That is not the role of the court in this case.

Serve and volley:

[14] As can be seen from the above the case for the appellant is that the nature of the Act, being one in part to protect the public, coupled with the investigatory powers of the inspectors under the Act, necessarily leads to the inference that the Board has the power to enforce the Act through injunction proceedings as is sought here.
[15] With respect, I cannot agree.
[16] Nothing could have been easier than for the Legislature to include such a power in the Optometrists Act but that was not done. It has been done in the Health Professions Act, R.S.B.C. 1996, c. 183, s. 52.

It may not be explicitly stateing that harm to the health can occur, but it was obvioulsy not sufficent evidence to allow optometrists to one stop him from provideing sight testing, and two when that failed from allowing optometrists from seizing his equipment. (that was just uncalled for to even try and seize his equipment, you guys behave like barabrians).

Hey Ted got anymore fo those rolex's, I could see it now FREE ROLEX WITH EVERY SIGHT TEST.:D

[Oedema]

He 's got a GP, doesn't he? And if more damage is likely to occur, then... my answer is "C'est la vie!" , Tough luck, Charlie, S*it happens... take your choice. Last year I developed an acoustic neuroma and I didn't blame anybody.

If all the protocols were followed, and the sight-tester achieved 20/20, all is well. I would suggest that he should have told his GP that his vision is "off" before attending at your office. How long did he sit on his hands?

I hope your GP puts on the rubber glove next time you present with the sniffles.:D:D

C'est la vie, Mrs. Jones, that really is too bad you've had a macular detachment. Why did you trust me anyways? Oh well, it really is your fault for not talking to a doctor when they could have saved most of your vision isn't it.:hammer:

Pathetic

[tmorse]

Once again a sight-tester puts the blame on the patient for not seeking the appropriate level of care. Pathetic.
Just so you know, Tmores, most GPs don't even know how to use an ophthalmoscope. And most patients don't complainto their GP and complain of blurry vision. They come and see me...or, regrettably, some sight-testing @ss like yourself.

I don't do sight-testing nor teach sight-testing, Stonehead.:hammer:

[HarryChiling]

C'est la vie, Mrs. Jones, that really is too bad you've had a macular detachment. Why did you trust me anyways? Oh well, it really is your fault for not talking to a doctor when they could have saved most of your vision isn't it.:hammer:

Pathetic

Since sight testing has been in place for some time now, name one incident where a patient has been harmed? And it is unprofessional of you to use a patients name outside of the office to the public shame on you. (oh wait a minute that's a made up patient, that's Ok then carry on)

I will give you time to contact your associations and colleges to compile the lists and lists of data. Untill then why don't you try and get yourself some fo those half priced rolex's Teds got. :D

[tmorse]

Once again a sight-tester puts the blame on the patient for not seeking the appropriate level of care. Pathetic.

Yes I do believe a person must take responsibility for his actions (or in this case, his inactions). OD's also will blame the patient when it suits their purpose.
Many tears ago I had customer come in one day, who appeared a little drunk, but I fit him using an across-town OD Rx. When glasses arrived he said they didn't work. I double-checked again and they were spot-on, so I said," These glasses have been properly dispensed. You will have to return to your Doctor". Comes in later again still looking hung-over with new (and different) Rx from this same Doctor, so I reorder at no charge. Again they arrive, he tries them on, and again says "they don't work". After these two (2) redo's, I called this Doctor for an explanation and he says' "I can only go with answers he gives me during the refraction." Reasonable, but this time I send him to my own OD, who gives me a third (and again different Rx).

Customer doesn't return to pick up despite many weeks of phone calls. Finally, I remembered that his son was also on file, so I called him... was told his Father had died three (3) weeks ago... apparently he was an undiagnosed diabetic and despite appearing drunk/hung over, both OD's refracted him without catching it.
Sorry, but I do blame the patient for not seeking appropriate care. His GP would probably caught it. True Story.

[Excalibur]

"If all the protocols were followed, and the sight-tester achieved 20/20, all is well."

-----------

All is well? Really.

Shows how little you know about asymptomatic eye disease.:finger:

[tmorse]

C'est la vie, Mrs. Jones, that really is too bad you've had a macular detachment. Why did you trust me anyways? Oh well, it really is your fault for not talking to a doctor when they could have saved most of your vision isn't it.:hammer:

Pathetic

Listen OD... Opticians are trained NEVER to give a diagnosis... so stick your ridiculous story, you know where.

[Excalibur]

If you are going to use history at least use it correctly it was opticians and they were esentially selling ready made glasses from outside of jewelry shops. OD's as a profession stemmed from those brighter opticians in the back of jewelry shops who felt they could provide more accurate, so they educated themselves in refraction and called themselves OD's. Due to refractions not causeing any harm to the public over the years optometry has gained an incredible increase in scope of practice. Optometry of today is nothing at all like the optometry of your forefathers, and Ophthalmology was fighting it then like they fight now for therapeutics and other privledges.

If optometry was left to refractions alone that would be regression, but opticianry refracting is progress and as such should be embraced. Bakc then 2 years was adequate for refractions, and due to the success optometry as a profession has acheived I would tend to agree, that's is why opticians are now stepping up to the plate for that additional 2 years of education to learn refraction.

Good for you.

But first get your own house in order until you start trying to dictate how the rest of the ophthalmic world must practice. Get your licensure procedures straightened out (a significant number of jurisdictions are unregulated). Take your programs out of community colleges and night schools where they teach janitorial sciences and put them in more credible institutions. Start attracting higher caliber students with something more than a C grade level in high school. Act like professionals and less like merchants. Don't try to dumb down the evolution of eye care by justifying independent refractions as being acceptable.

Don't get me wrong. I like opticians, and I think everyone should own one.... or at least employ one. :D

[LandLord]

To my fellow opticians. Don't answer the trick questions about eye disease. Only doctors know the answers. The OD's want you to give a wrong answer so that you can look stupid.

To the optometrists. You'll appear more intelligent and professional if you admit that opticians are better at dispensing than your receptionist is. If you are really honest, you'll admit that opticians are better at dispensing than you are.

There's been some constructive dialogue in this thread. Let's boil it down to the real issue here:

Optometrists want to make more money, so they hire a receptionist to dispense (because they can.)

Opticians sit alone in their stores waiting for a customer that will never come because he's at your office being fitted for glasses by your receptionist.

The above scenario causes opticians a great deal of anguish. This feeling is amplified when the optician observes an OD driving by in a Porsch Boxter.

Solution:
For optometrists: hope for TPA's or even Lasik so you can trade in the Boxter for a Ferrari.

For opticians: a) hope for refraction so you can better fit the guy who saw the receptionist last year. Let's face it, you don't really want to spin dials. You just want what's yours.

b) hope optometrists will quit dispensing. Then there would really be justice in the world.

c) become an optometrist.

[HarryChiling]

Good for you.

But first get your own house in order until you start trying to dictate how the rest of the ophthalmic world must practice. Get your licensure procedures straightened out (a significant number of jurisdictions are unregulated). Take your programs out of community colleges and night schools where they teach janitorial sciences and put them in more credible institutions. Start attracting higher caliber students with something more than a C grade level in high school. Act like professionals and less like merchants. Don't try to dumb down the evolution of eye care by justifying independent refractions as being acceptable.

Don't get me wrong. I like opticians, and I think everyone should own one.... or at least employ one. :D

If you were a real man I would invite you outside, but I guess I will have to settle for a virtual braw strap snap **** THWAP. My house is in order I make sure to always voice my opinions and make sure to never believe that OD's have the patients best interest at heart and above all else, I won't work for schmucks liek you so it ensures that when opticians do get sight testing in all states and provinces (it's a reality honey) you won't have th advantage of haveing a highly skilled optician in your office. Might as well trade you prosche in for a hyundai or just keep cryin like a little *****.

OWN AN OPTICIAN, your views are sick and warped. Untill you trade that silly OD up to a rela deal MD you are just playing doctor. Why go see you for any pathology when all you can do is give drops and then pray it works. If you were concerned abotu providing REAL care to your patients you would call yourselves refractionists instead of doctors, and kick all the pathology up to the real docs the OMD's.

(hows that for a post with some hot sauce on it):D

PS - Who's your daddy, huh, huh, for real that stung a bit didn't it? Are you adjusting your g-string? Panties in a bunch?

I get such a rise out of an individual such as yourself with supposedly so much education stoopign to my level. t is obvious I can discuss a poitn intellectually with you, but after you have realized that you are no intelectual match, you resort to name callign and general nonsense. I love it, that's what I do. I can talk junk with the best of them so keep 'em coming, sweetheart.

[Oedema]

Since sight testing has been in place for some time now, name one incident where a patient has been harmed?

http://www.optometrists.bc.ca/webupl...studies_04.pdf

[HarryChiling]

http://www.optometrists.bc.ca/webupl...studies_04.pdf

Thanks, that was very infomative. How could things be changed to prevent these occurences from happening?

[Excalibur]

Thanks, that was very infomative. How could things be changed to prevent these occurences from happening?

Uh Duh... how can you minimize the risk to the public he asks? SIMPLE. Stop independent sight testing!:hammer:

[Excalibur]

If you were a real man I would invite you outside, but I guess I will have to settle for a virtual braw strap snap **** THWAP. My house is in order I make sure to always voice my opinions and make sure to never believe that OD's have the patients best interest at heart and above all else, I won't work for schmucks liek you so it ensures that when opticians do get sight testing in all states and provinces (it's a reality honey) you won't have th advantage of haveing a highly skilled optician in your office. Might as well trade you prosche in for a hyundai or just keep cryin like a little *****.

OWN AN OPTICIAN, your views are sick and warped. Untill you trade that silly OD up to a rela deal MD you are just playing doctor. Why go see you for any pathology when all you can do is give drops and then pray it works. If you were concerned abotu providing REAL care to your patients you would call yourselves refractionists instead of doctors, and kick all the pathology up to the real docs the OMD's.

(hows that for a post with some hot sauce on it):D

PS - Who's your daddy, huh, huh, for real that stung a bit didn't it? Are you adjusting your g-string? Panties in a bunch?

I get such a rise out of an individual such as yourself with supposedly so much education stoopign to my level. t is obvious I can discuss a poitn intellectually with you, but after you have realized that you are no intelectual match, you resort to name callign and general nonsense. I love it, that's what I do. I can talk junk with the best of them so keep 'em coming, sweetheart.

I have certified staff trained under the following program:
http://www.opto.ca/en/public/03_opto...assistants.asp

Our local opticians seem to be out to lunch. Maybe you can teach them about lenses like Sola Access, Free Forms or even materials like Trivex. They don't seem to know about them! How tough is that? My certified staff seems to know about these products better than our local lens grinders. And I bet my staff is also better looking in their g-strings than you!

Intellectual match with you? Please first learn how to spell! Your posts are quite comical and pedantic. Typical Grade C level education!

Most eye diseases can be treated very effectively with gtts and oral meds. Check this link: www.eyeupdate.com if you wish to learn more about how effective primary eye care can be with gtts. To think that surgical skill is required to cure most eye disease is stupid. Don't get into arguments on ocular pathology, or I'll tie my g-string around your long tongue.

I don't usually like to mud-wrestle with swine, but with you I'll make an exception.

[Laurie]

Landlord,

You hit the nail on the head.

Warren,

Looks like our dream of the 3 O's working together will take a little longer than we thought.

Excalibur,

I am embarassed for you. What if your patients got a glimpse of who you really are?

Laurie

[Excalibur]

Landlord,

You hit the nail on the head.

Warren,

Looks like our dream of the 3 O's working together will take a little longer than we thought.

Excalibur,

I am embarassed for you. What if your patients got a glimpse of who you really are?

Laurie

Embarrassed for me? Please.

I have one of the more frequent posting board members saying "whose your daddy" and claiming he will 'slap me around', and you expect me to stand pat and take that? Give me a break. And he can't spell either which makes his posts even more comical.

[Excalibur]

Landlord,

You hit the nail on the head.

Warren,

Looks like our dream of the 3 O's working together will take a little longer than we thought.

Excalibur,

I am embarassed for you. What if your patients got a glimpse of who you really are?

Laurie

So, what do you make of this?

http://www.optometrists.bc.ca/webupl...studies_04.pdf

You want to make light of this too?

Are you a graduate of the Sight Tester's School of Denial?

[Laurie]

Excalibur,

One thing for sure,

I am not in denial about appropriate behavior, especially in a professional forum.

The pathology piece has been discussed at great length...there will be pathology checks by a doctor. I would likely connect with an OMD, and the patient would get the best of both worlds. In fact, in the cases you posted, this model would have protected the patients, as the opticians would have been mandated to be sure of a pathology check, within one or two years, depending on the age of the patient.

I am not against ODs...I have had the pleasure of meeting and spending time with the greatest of all: Irving Borish, Theodore Grosvenor, Clifford Brooks, Frank Fontana, and others. Some of the greatest people I've met. And, with all of their amazing accomplishments, they remain humble.

Let's try to continue this dialogue in the same professional manner that our patients would expect.

: )


Laurie

[Excalibur]

Laurie-- I agree with the last line in your post.

How did these cases occur?

http://www.optometrists.bc.ca/webupl...studies_04.pdf

Evidently there is no 'safety mechanism' in place, and I surmise that if there was one it would be impossible to enforce.

[Laurie]

Excalibur,

Your link is a repeat from the last one, which I read and responded to.

This thread is about Opticians refracting in Ontario. Let's bring it back to that.

The College of Opticians of Ontario have a specific standard of practice in place which includes mandatory pathology checks. Enforcing any mandate in the health sciences requires assumed integrity. I believe that we are all in this for the good of the patients, as well as for the money, and thats OK. I also believe that we can accomplish this with integrity, and the patient will be well served.

: )

Laurie

[Stonegoat]

Laurie,

I agree with you...I think. I have said it before, and I will say it again. I think opticians should be trained to refract (including retinoscopy), but only be permitted to do so within the framework of a full eye exam. Yes, that will mean that closer relationships with ODs and OMDs will need to be established.

Stand-alone refractions by opticians (or optometrists for that matter) will result in missed pathology resulting in blindness, and in rare cases, death. It's as simple as that.

And Harry, I do not have my receptionist dispensing eye wear. I employ an optician, who is extremely competant. She knows more about dispensing and what technology is coming down the pipe than I do, which is expected as that's her job.

[AdmiralKnight]

Laurie,

I agree with you...I think. I have said it before, and I will say it again. I think opticians should be trained to refract (including retinoscopy), but only be permitted to do so within the framework of a full eye exam. Yes, that will mean that closer relationships with ODs and OMDs will need to be established.

Stand-alone refractions by opticians (or optometrists for that matter) will result in missed pathology resulting in blindness, and in rare cases, death. It's as simple as that.

And Harry, I do not have my receptionist dispensing eye wear. I employ an optician, who is extremely competant. She knows more about dispensing and what technology is coming down the pipe than I do, which is expected as that's her job.

In an ideal world, that's how things would work. But we're talking about Ontario here, the province where it's Illegal for Opticians to work with ODs, unless they willingly give up their license. There's a lot of talk about taking steps back in care for the patient. What good does it do for them to lobby to make it WRONG for OD's and DO's to work together? Doesn't make sence to me, but this is what has happened in this province.

[HarryChiling]

post #8 Excaliber - I don't see any problems in patient care if an optician refracts as long as it is part of a complete assessment under the supervision of an OD or OMD.
post#15 Stonegoat - I work as an OD in BC and opticians conduct "sight-tests" without any direct or indirect supervision by an OD or MD. Essentially a refraction is performed without any ocular health assessment. Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received. They were NOT refered by the "sight-testing optician, but came of their own accord.
I completely aggree that opticians can and should be trained to refract. I think it's inevitable, and a reasonable scope expansion. I however, do not agree with the concept of fragemented eye care, and I think a refraction should always be in conjunction with an ocular health assessment by an OD or OMD.
post#16 Excaliber - Stonegoat-- great post. Thanks for the clarification.
post#17 Excaliber - which brings me to another observation....
refraction-only visits were the 'norm' decades ago. Going to this sort of scenario is regressive patient care.
If you haven't looked inside the patient's eye, how can it be called an assessment? This is certainly is not in the patient's best interest.
There are many, many patients I see monthly that would be far worse off if all I counted on was refractive data to judge their eyehealth/visual prognosis.

Excaliber,
It's hard to take your posts as serious, your original posts indicated that you were for opticiasn refractign with the right safe guards in place. Then when your peers say otherwise you immediately change positions which leads me to believe that you are more likely a follower than a leader. Your credibility on this issue is nil in my book, but what do you care I'm just an optician meant o be owned. :D

So, what do you make of this?

http://www.optometrists.bc.ca/webupl...studies_04.pdf

You want to make light of this too?

Are you a graduate of the Sight Tester's School of Denial?

I could have easily dismissed this as a document compiled strictly for amuniton against opticiasn and refracting so is therefore biased, but since I asked for the data and Oedema took the time to research and find this data I would rather take it for face value and discuss what this means. I am curious as to why it only covers incidents from 2002-2003, if it was that these are the only years that the optometrists were compiling data then it boils down to 5 cases per year average, if it is every case that has happened since the inception of opticians refracting then it boils down to even less.

Also, what the data does not provide is: How many cases is this out of, if these cases are 10 out of 20 then that is an alarmign trend, but if these cases are 10 out of thousands then they become statisticaaly less significant. Then it would also be nice to see a comparison of this data to OD's and OMD's comapreing the percentage of cases of pathology that get missed.

These are question that could be helpfull for both OD's and for opticians. I am sure if the time was taken to provide more objective data the name callign and the back and forth banter would be less likely to happen (which stinks, cause I'm the love to argue and call names type individual;)).

[HarryChiling]

And Harry, I do not have my receptionist dispensing eye wear. I employ an optician, who is extremely competant. She knows more about dispensing and what technology is coming down the pipe than I do, which is expected as that's her job.

Good for you and it only benefits your patients and gives you the right to argue the case of "what's good for the patient", but I would suggest you poll your collegues as to what their opinions on the matter are? If every OD's office staffed educated and trained personel then their would be no need for stand alone refractions, but sadly many see the labor costs as a place to save a buck and it comes at the patients expense, that has always lead to my doubts when OD's mention "it's not good for the patient for an optician to refract".

Obviously you do not fall into this boat, and liek I mentioned every Optician, OD or OMD is nt built the same.