In his shortlisted essay for the 2021 John Henahan Prize, Dr Khayam Naderi says that in responding to the COVID-19 pandemic we may have to combine the ‘old-school’ with the ‘new kids on the block’

Colin Kerr

Posted: Sunday, May 9, 2021

I smile at my patient as I explain that her next follow-up appointment in our clinic will be in six months’ time.
“Can you make sure it does not clash with my other eye clinic appointment dear?”
“Let’s see what I can do,” I reply as I accompany her to the front desk. With the help of my administrator colleague, we somehow manage to arrange her next two clinic appointments at staggered times on the same morning. A small effort for which she is very grateful for.
I trot back to my desk with an extra bounce in my step as I reflect on how I have managed to save my patient an extra hospital visit. However, it soon dawns on me that there are many such patients requiring multi-specialty input and I will not be able to synchronise future clinic visits for all of them!
Avoiding unnecessary hospital visits for our patients has always been something to strive for during the best of times. But as I ponder (yet again) on how a simple journey to hospital can now expose my patients to a deadly virus, minimising extra visits where possible is more important than ever before.Could it be that rather than merely changing practice, COVID-19 has simply reminded us to re-evaluate how we deliver patient-centred care?
There are growing calls for the return of the general ophthalmologist, amplified by the hurdles that we continue to face one year into a pandemic. Rather than addressing a single ailment during a visit, managing a second condition where possible would go a long way to reducing additional clinic appointments and meeting patient expectations. This may sometimes mean nipping down the corridor to consult with a colleague. But those extra few minutes spent will lead to happier patients. I sometimes have to remind myself that most patients do not identify with the ‘retina clinic’ or the ‘cornea clinic’. They simply attend the ‘eye clinic’ and hope that their needs are addressed in a single sitting. We must structure our clinic lists accordingly and set aside extra time for those patients requiring multiple clinical tests. A big shout out for the ‘double slot’.
Some of our patients will indeed require expert specialist care for which there can be no substitute. A few will even need referral to tertiary centres for complex treatments. But on the whole, it is not farfetched to claim that a notable proportion of our patients can be managed safely in a general ophthalmology clinic. A step back into the past when an ophthalmology consultant was expected to be the ultimate multi-specialist!
In recent years, sub-specialisation has been the ultimate long-term goal of many ophthalmology residents. Having crossed the halfway stage of my residency training, I have narrowed down my choice of future subspecialties following much contemplation. But I have recently started asking myself: do I have to settle on just the one specialty for the rest of my career?
Becoming dual-trained will equip me with a larger skillset and allow me to expertly manage a larger cohort of patients. Plus, it will keep things more interesting in the long run. This will likely mean prolonging of my training time. But isn’t medicine all about lifelong learning anyway? The pandemic has pushed us to not only re-evaluate our clinical practice, but our training pathways as well.
But do we always need to see each patient in person? As a progressive specialty, we have been quick to take advantage of new technology in ophthalmology.
Use of virtual clinics continue to expand in glaucoma and medical retina. Mobile apps can detect wet AMD. Breakthroughs in deep-learning algorithms in the management of medical retina conditions appear promising. The utilisation of telemedicine continues to gather pace in many subspecialties, including oculoplastics.
The time and money saved by adopting innovative strategies alongside the traditional face-to-face clinic approach is a no-brainer. We were already making use of such approaches before the emergence of COVID-19. The pandemic has simply shed even more light on their respective potentials.
At the time of writing where global vaccination programs appear to have given healthcare services the upper hand in the battle against COVID-19, we must pause before we declare our intentions to get back to ‘normality’. Things will never be quite the same again. We must reflect on the lessons of the pandemic and prepare even better for future challenges which may be around the corner. Sometimes, this can mean looking at past practices which have worked. Sometimes, we may have to combine the ‘old-school’ with the ‘new kids on the block’. The results may pleasantly surprise us all.
Dr Khayam Naderi is a UK ophthalmology trainee, currently undertaking an MD (Res) at St.Thomas’ Hospital and King’s College London, UK

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