Independent Prescribing

Fragile

Today we’ve been fitted out for PPE and have been trained in robust safety procedures including staff temperature logs. I’ve ordered scrubs because most of my suits are dry-clean only and I’ll feel better if I can wash everything daily. Quite how and when ‘routine’ eye examinations will be allowed I don’t know. At the moment the one clinical member of staff in the practice is restricted to ’emergency and essential’ work only, though what ‘essential’ is has no clear definition either. There isn’t much in the way of guidance from the British College or the AOP, but I’m guessing that they are waiting for guidance from the government. We are all signed up to CUES though, the Covid Urgent Eye-care Scheme.

Everything feels so fragile right now, like the world is balancing on a knife edge. My ten-year-old has gone from asking ‘When will things go back to normal?’ to ‘Will normal ever happen again?’ Currently I have no satisfactory answer.

Black Lives Matter

I had thought we were starting to move in the direction of that now hackneyed phrase ‘the new normal’, albeit with the smallest of baby steps, then the terrible events of Monday in the US unfolded.

George Floyd was murdered in broad daylight in the most callous way imaginable, suffocated by a police officer while begging for his life. Whatever his background, whatever he’d allegedly done, no civilised society should countenance such behaviour from its officials. There is so much justifiable rage spilling over right now and really it’s not about George Floyd, or even Breonna Taylor, the emergency medical technician on the front line of fighting the pandemic, fatally shot eight times back in March while sleeping, by officers who forced their way into her apartment. Their deaths were the catalyst that ignited the anger for sure, but it’s about so much more… generations of oppression; 400 years of unfairness and discrimination, and it ties in directly with the pandemic as black and ethnic minorities have been both disproportionately infected and killed by the virus. There are so many reasons for this, and this blog is not the right place to offer discussion or opinion but I felt I could not let it pass without comment. I do not have the same life experiences as my black colleagues and friends, but I am educating myself, and will stand with them. I will stand with you. Black lives matter.

Baby Steps

It’s been a rollercoaster few weeks. I became obsessed with watching the daily news briefings for a while, but started to limit my exposure because it really was not good for my mental health. Currently I’m still furloughed but after optometrists and dentists being left out of the much touted ’60 page document’, we are making preparations for a return to practice as soon as we’re allowed.

One nice piece of news for me is that my lovely Ophthalmologist mentor has been in touch to say that he’s keen to get me in at the earliest opportunity. The British College have finally told me I have two years to complete my placement. At least the extra wait means a bit more revision time for the Clinical Management Guidelines I guess. I think it’s going to be a very long road back to anything approaching normality but we are finally starting to move in that direction.

Furlough

A couple of short weeks ago I had never heard of the word, and now here I am…furloughed, along with all the team, apart from one clinican and a receptionist for emergency cover. But the word ’emergency’ has changed definition it seems. Conditions which would have been straight to Eye Casualty (do not pass go, do not collect £200) are now ‘wait and see’ or ‘monitor’. Hospitals are no longer deemed safe spaces it seems.

One good thing is that groups of like-minded practitioners are forming on FB and we’re working together to get through this, with mental health and businesses in tact. Sadly not all all practitioners are taking this collaborative approach but I’ve met some fabulous fellow optoms and ophthalmologists all keen to use the time to share and expand our knowledge.

Keep Calm and Hoard Loo Roll

Everyone at the practice is anxious. We’re hot on hygiene anyway but we’re disinfecting more, wiping doorhandles, computer keyboards and anything patients touch with alcohol wipes. People are becoming more frightened by the day. When I tried to buy hand gel at the pharmacist. she advised me to buy Polish Vodka and mix it with aloe gel! Only there’s no Polish Vodka, in fact there’s a national shortage of alcohol gel, hand soap, pasta, loo roll…and now Polish vodka!

I guess panic-buying makes people feel more in control.

I’m worried about my doctor and nurse friends and whaat will happen if hospitals are overwhelmed like they are in Italy.

There seems to be no other news in the entire world. I never thought I’d say this but…I really miss Brexit!

Worrying Times

The virus which appears to have migrated from China to Italy is truly alarming. The TV footage from Wuhan, Milan and Lombardy is horrific and terrifying. Could this happen here? For years we’ve been expecting a pandemic yet no government seems at all prepared. Everyone has been caught off guard.

Dr Li Wenliang, the ophthalmologist who tried to raise the alarm about the coronavirus in the early days of the outbreak, died of the infection last week. He was a member of the eyecare profession, which makes it all a bit harder and closer to home.

As ever when I’m anxious and things feel uncertain I look for facts. I’m pretty sure I use facts like the superstitious among us use rabbit feet, horseshoes and garlic. Facts are my way of protecting myself. If I know the facts I feel (completely unjustifiably) safer. So here is my fact file so far:

The mystery virus has a name now. Viruses are named by the International Committee on Taxonomy of Viruses (ICTV). The name is based on their genetic structure which is meant to help in the development of diagnostic tests, vaccines and medicines. Yesterday the ICTV announced the name of the virus as ‘severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)’. The name was chosen because the virus is genetically related to the coronavirus responsible for the 2003 SARS outbreak.

What many people don’t realise is that a virus and the disease often have different names and are actually named by different organisations. Diseases are officially named by WHO in the International Classification of Diseases (ICD). This is because WHO’s role is human disease preparedness and response so diseases are named in order that discussions can take place about disease prevention, spread, transmissibility, severity and treatment . This disease has been named COVID-19.

I have no idea whether this will affect my clinical placement though this seems an entirely petty and selfish concern under current cirumstances.

Good News and Bad

Well I passed the second module (properly passed…satisfyingly high mark!) so I’m very happy. I should be chomping at the bit to start the clinical placement section but this virus brewing in the background, the news footage and daily NHS updates which are becoming more alarming by the day are slightly taking the edge off the  celebrations. But it is what it is and we can only deal with things day by day as they unfold.

But…I PASSED!

The End is Nigh

I’ve totally negelcted my blog with studying, family stuff (concerts, conservatoire visits for the oldest son and Christmas recitals) and binocular vision courses, because obviously, studying for one qualification is not enough. My friends think I’m surely insane (my husband already knew this) but it will all be worth it. I hope.

Anyway, all MCQs complete. All assignments, case records and VIMOCS submitted a day early because tomorrow we’re off for a conservatoire visit with my oldest son. I’m particularly proud of the case records, esecially the contact lens one which turned out to be even more complex than I’d originally anticipated, but which had a satisfying resolution with plenty left to discuss for future management. Also the VIMOCs seemed too simple, and I’m not sure if that’s because I’d actually understood everything in the course and so could answer everything really quickly, or because I’ve misunderstood it all and am going to come a big fat cropper when its all marked!

Very low key submission procedure again; no fanfare, no ping to confirm that my precious hard work actually arrived at its destination. All I can do is wait. If the powers that be at Aston ever read this blog please note that all final assignment submissions need to be accompanied by bells, whistles and a big ‘CONGRATULATIONS FOR MAKING IT TO THE END’ message! It’s just polite!

Three is the Magic Number!

The Gods of Optometry must really be on my side because today I think I have a potential third case record! And joy of joys it’s my much-coveted contact lens case. Only problem is that it’s a new patient with a complex history and multi-factorial issues of long term overwear, poor fit, dry eye, meibomian gland disease and ocular rosacea, all topped off with early presbyopia. If I can unpick it all over the next few weeks and months and begin to make both sense of it and some progress it has potential to be a good (if awfully long) case history. I’m not going to worry about length though after all my stresses over keeping the essay in the last module short. I have decided these records will be as long as they need to be!

Room for two…

Still ploughing through all the course work and MCQs. I really don’t feel I’m making any headway, and as with the previous module all the MCQs together only make up 10% of the total marks for the module. It’s tempting to start writing up the case records but I really want to get to the end drawing out those areas which fit in with my chosen case records.

But in other news case record number two showed up today, unannounced. The Gods of Optometry smiled down on me. I referred her last year for suspected low tension glaucoma and she’s been under consultant care since. She showed up today because she’s stopped using her glaucoma meds due to side effects, but was too anxious to admit this to the consultant! I have detailed photos, OCT records, field plots and follow up letters from the consultant…and now side effects! Two down, one to go.