When I first started this job, one piece of advice I was often given was to keep conversation with patients to a minimum. It's a piece of advice I've grown to ignore. Screeners generally have a very limited amount of time with each patient, and it's true that no clinic would ever run to time if we asked everyone where they're going for their holidays, but the fact remains that the conversations I have with my patients are frequently the highlight of my day.
So whilst a lot of screeners believe that to ask anything more than the most essential questions is to open the nightmarish door to an eternally late-running clinic and a lot of unpaid overtime, I've learnt to chatter away to my patients as I get on with the job, ensuring that they get a friendly service, I get an entertaining few minutes, and we both get away on time.
The stories I hear as a result are what keeps the job interesting for me. Take today, for example. I was stuck for eight hours in a remote clinic in the middle of nowhere, with no internet access and a failing mobile signal. But rather than feeling isolated and lonely, I've actually had a very entertaining day. This morning I chatted to a man with chronically poor diabetic control, which has previously resulted in referable retinopathy, whose life has been turned around by a quad bike accident last summer. Having broken his collarbone, fractured his ribs, and generally ended up like the six million dollar man on a budget, he's spent so long being cared for in hospital that his sugar levels are back to normal for the first time in years.
But when it came to the award for Anecdote of the Day, that chap was blown out of the water by my very next patient: a lady in her seventies who was blind in one eye. Her notes said she'd been that way since childhood, so I decided to ask her about it. And I'm glad I did. The details made a quad bike accident sound tame in comparison.
Picture the scene. It's the 1930s. My patient's mother is heavily pregnant, and her father arranges for a local doctor to deliver the baby at home. The mother duly goes into labour one evening, and the doctor is called. He arrives soon afterwards, but is, as my patient put it, "as pickled as a newt" (at least I think she said pickled). With no alternative help on offer, the parents-to-be allow the man to take charge, but it soon becomes apparent that there's a problem, and the baby will have to be delivered using forceps.
The doctor seems to struggle with his equipment (and his sobriety), but the baby eventually emerges... with a prong of the forceps buried deep into one eye. In the 21st century, that would have resulted in a multi-million pound medical negligence case and a lot of media attention. In the 1930s, people just got on with their lives. Every week for the next ten years, my patient saw various eye specialists, but all to no avail. No sight was ever restored to that eye. Until, that is, she was ten years old...
As a small child, she'd seen a brilliant young eye surgeon who'd subsequently gone to America to carry out research and develop new techniques. On his return, he contacted my patient's father and said that he may be able to help her, but that he would have to charge for the treatment. The money was duly raised, an operation was carried out, and when the bandages were removed, a minor miracle had taken place. My patient could see with both eyes for the first time in her life. She described it to me as a miraculous experience, and spoke in gushing terms of how wonderful it was to see the world with two eyes.
Six weeks later, on the day of her eleven-plus exam, she awoke to darkness. The surgery had failed, nothing could be done, and sixty years on, her vision in that eye has never returned. It was an incredible, heartbreaking story. And one I'd never have heard if I'd just asked for her GP, address and date of birth.
Q. How many Retinal Screeners does it take to change a lightbulb?
A. Two. One to change the lightbulb, and one to move it to the side for the nasal view.
But that aside, here's a little anecdote I was lucky enough to hear today...
A small boy walks into his parents' bedroom late one night and finds them making love. He sees what they're doing, but decides to keep quiet, and creeps back out of the room without saying a word. The next morning at breakfast, his father calls him over and says "Son, I saw you come into the bedroom last night, and I was proud of your tact and discretion. As a reward, I'm giving you a pocket watch that my father gave to me". He hands his son a beautiful gold watch.
The next day at school, the boy shows the watch to his best friend, and recounts the story of how he got it. The friend is naturally impressed, and says "I'm going to try that myself!"
So the next night, the friend gets up and walks ino his parents' bedroom, where they too are making love. His father sees the boy at the foot of the bed and says "What do you want, son?". The boy replies "I want a watch". So his Dad says "Well, pull up a chair, but shut the door - there's a draught going straight up my backside".
I've cleaned that up considerably. The original was so fruity it would count as one of your five a day. But here's the real punchline:
That joke was told to me today by one of my patients, shortly after I'd administered the eye drops. I think he was trying to put me through as much pain as I'd put him through. I wouldn't mind, but he made the story last a good five minutes, and performed it as though he was doing an open mic slot at the Comedy Store. He even did the whole routine on his feet. I've never seen anyone take stand-up comedy so literally. I kept looking around for a red buzzer like they have on Britain's Got Talent.
But here's the second punchline:
The chap was 87, and my oldest patient of the day.
I don't know what they're putting in the water around here, but they need to stop before the man gets an agent. Whatever happened to pensioners who just sit quietly in a corner, dribbling?
It's interesting the things people choose to complain about. I had a patient today who was outraged that hospital transport had refused, for the third year running, to bring him to his retinopathy screening appointment. And why? Because he's perfectly able-bodied.
The man was only in his sixties, lived less than two miles from the hospital, and had the use of both legs. But that wasn't the issue. The issue, so he told me, was that he couldn't get a direct bus from his house to the hospital, and for us to expect him to change buses en route was completely unacceptable. So he'd been forced to get a taxi. The cost of which was an outrage. So every year, he'd tried to request hospital transport, they'd asked him about his mobility, he'd said he's fine thank you very much, and they'd put the phone down.
This was a man who wanted answers. As he said to me, "Why shouldn't I get hospital transport, just because I can walk?". It's a good question. I felt like offering to push him back to the waiting room in a wheelchair, just to save him the effort. But being a helpful sort of person, I chose instead to politely explain our policy on transport and travel expenses (which was essentially that you're not getting either), before offering some alternatives. I suggested that maybe next year he could ask a friend to drive him to the appointment. He looked at me stony-faced and said "I don't have any friends".
I didn't know quite what to say to that. The obvious reply was "I'm not surprised, the way you keep moaning", but I felt that wouldn't be professional. So instead I asked him to start reading from the top of the eye chart. The complaining continued right through the VA, the drops and the photos. If the man was being sponsored to moan, he'd have raised enough money to hire a chauffeur driven limo. Personally I was tempted to phone Travis Bickle.
To be honest, I don't think the chap would have been happy unless I'd offered him a lift home or given him a tenner for the taxi. And frankly I was tempted, just to shut him up. I think I'll arrange to pick him up myself next year.
Sometimes I think my patients are being referred to me by Roger Hargreaves. In the past I've had Mr Happy, Mr Noisy, Mr Bump (complete with bandages) and Little Miss Awkward. In fact the only one I haven't met is Mr Tickle. Which is something of a relief. Today, however, I screened Mr Angry.
At the time, I was unaware of the drama which was unfolding in the waiting room. The first I knew was when I waved goodbye to a patient, and emerged from the consulting room to call my next victim. One of the receptionists promptly came running (literally) up to me, and took me straight back inside, where she told me what was going on. Apparently one of my patients, a man in his sixties, had arrived ten minutes late for his appointment, and immediately been abusive to one of the ladies on reception.
There were three different clinics taking place there this morning, so having established the patient's name, the receptionist asked him what he was there for. He'd taken offence at this request for personal information, refused to say, and ended up shouting and throwing the appointment letter at her. He'd then proceeded to the waiting room where he'd apparently upset a couple of other patients with his complaining.
The question is how to deal with someone like that. I've talked to other screeners who take the line that if a patient treats others (whether they be healthcare profesionals or fellow patients) in an unacceptable manner, then they don't deserve friendliness and helpfulness from the screener. As a result they receive a cool and curt service, possibly with an admonishment for their behaviour.
I take a slightly different line. I agree that they don't deserve to get service with a smile, but I give it to them anyway. In bucketloads. When I called this gentleman into the room, he was exuding silent rage from every pore, his body language screamed anger, and he was clearly spoiling for a verbal fight. So I greeted him like a friend, turned on the charm, and took niceness to new heights. By the time he left, I'd killed him with kindness and turned him into Mr Happy.
Morally, this is a bit of a dilemma. The receptionist in question is a lovely lady, and she was genuinely upset by this man's conduct. As was one of her colleagues. I would have been within my rights to refuse to see him, and have him removed from the building for unacceptable behaviour. So to choose instead to reward that behaviour by being extra nice to him seems somehow morally wrong. But the thing is, it works.
I began the appointment with a man so angry that both a receptionist and another patient had felt the need to warn me about him, and express concerns for my safety. Twenty-five minutes later, he and I were such good friends that I couldn't get rid of the man. He was so enjoying telling me anecdotes about his life, swapping tips about superfoods, and even making me laugh with his jokes, that he didn't want to leave. He told me he's such a coward about eye drops that if he was fighting in Afghanistan, the Taliban would only need to arm themselves with Tropicamide and he'd surrender immediately.
To be honest, I think that joke speaks volumes. A lot of anger comes from fear, and I think this was a man driven to rage by his fear of the appointment. That doesn't excuse his behaviour, of course, but it did enable me to solve the problem. By responding to his stress with compassion, treating him with respect, and showing him that he had nothing to fear, the man's anger was dissipated within minutes. He left with a smile on his face, and even said a cheerful "Bye bye!" to the receptionist he'd abused.
The receptionist didn't deserve the treatment she'd received from Mr Angry, and Mr Angry didn't deserve the treatment he received from me. But two wrongs don't make a right. I could have treated this patient the same way he'd treated our staff - it would have been no more than he deserved - but I'd have got exactly the same treatment back, probably tenfold. By ignoring what he'd done and letting it go unpunished, I got the best out of a potentially difficult patient, and he left relaxed and happy, with a positive experience of retinal screening. It might seem morally wrong, and I feel bad for the receptionist who suffered, but it's the only way I can work.
According to my moles working undercover in the higher echelons of the British Association of Retinal Screeners, the 2010 BARS Conference will be held in... [drum roll please]... Manchester.
Rumours that the keynote speakers will include Wayne Rooney and Liam Gallagher are, as yet, unconfirmed, but at the very least I'm hoping for a tour around the Cadbury's factory with a group of type 2 diabetics.
Personally I'm still wrestling with my 2009 Conference Evaluation Form, and working out how I can give a minus score to the 'Modernising Scientific Careers' lecture. It's a difficult thing to rate though. On the one hand, it bored me to tears, had very little relevance to my job, and couldn't have been more dry if we'd heard it in Death Valley, but on the other, it was delivered by a man called Mr Mody. And you've got to admire anyone named after a type of diabetes. I might give him a 10 for commitment alone.
Just occasionally in this job, I manage to reach the parts of a patient that other healthcare professionals just can't reach. And sure enough, this week a gentleman dropped his trousers in front of me.
I knew there was something up when he suddenly began to waddle as he entered the consulting room, and said "I think I'm going to embarrass myself here...". The chap was in his eighties, and for a moment I thought he was about to wet himself, but as I closed the door behind him, he clarified the situation by adding "I think my underpants are falling down", before asking "Do you mind if I adjust them?"
For some reason, despite his use of the word 'underpants', I assumed he was talking about his trousers, which looked a bit baggy and ill-fitting, so I cheerfully replied "That's fine" and stepped back, expecting him to hoik them up over his hips, and sit down.
Instead, he undid his belt and dropped them to the floor. Which might have been ok, were it not for the fact that he was right about the underpants. They were fast approaching his knees.
It was at that precise moment that I decided I had something extremely important to examine on my clipboard. Something which needed my full and undivided attention for... well, for about the same amount of time that he was standing semi-naked in front of me. I must admit, as I stared intently downwards, it did cross my mind that he was some kind of serial flasher, and that his whole intention was to get me to look at him. Something I had no intention of doing. I had visions of the two of us stuck forever in a permanent impasse of nudity: me refusing to look up, and him refusing to get dressed.
But as it turned out, he was just an innocent old man with dodgy pant elastic. Having fiddled with his ill-fitting underwear for thirty seconds, he successfully redressed himself, tightened his belt, and took a seat. I've never been so relieved to start a VA.
They do say that you don't realise what you've got until it's gone. And for all its faults, I'll never moan about our computer system again. Well, not for the rest of this week, anyway. We had a major server crash at work overnight, resulting in the temporary loss of three of the hospital's computer systems. Two were restored within the hour, but the third was out of action for the rest of the day. And that system was ours. Every bit of software used by the Diabetic Retinopathy Screening Programme was unavailable until late afternoon.
No appointments could be booked or rearranged, no grading could be done, and out in the field, I had to get through a clinic using Photoshop and a few sheets of paper. Capturing the images was frustratingly time-consuming, but what I missed most were the little things: the ability to check past results, to see a patient's eye history, and even just the computer's ability to tell me how long a patient had been waiting since I administered the eye drops. I had to take addresses, GP details and medical records by hand, and ended up with pages of scrawled notes that only a doctor with a graphology degree could read.
I had patients asking me if their retinopathy was any worse than last year, or if their vision had changed, and I simply couldn't tell them. I didn't have access to their previous results, let alone past images or treatment records. Conversely, I had a lady who could barely see the top line of the eye chart, yet claimed her vision had not deteriorated in any way. I had no way of checking if this was true, and was unable to challenge anything she said. A lot of my working life is spent in low-level lighting, but today I was completely in the dark. And I didn't like it.
Our computer system may not be perfect, but when you're suddenly forced to work without it, you realise just how much we take the thing for granted. We have a wealth of information at our fingertips - in fact we know more about the patients than most of them do - and when that information's not accessible, you realise what diabetic blindness is all about. It's obvious that we couldn't do retinal screening without state of the art camera equipment, but in many ways our computer system is just as priceless. The thought of having all that information printed on cards and sitting in filing cabinets sends a shiver down my spine. We might moan about IT issues and technical breakdowns, but we should be damn grateful that we live in an age of computers and digital photography. The alternative doesn't bear thinking about.
It's the last day of October today, and I always like to see how many patients will wish me a Happy Christmas before Halloween. This year it was two. I think one of them was being slightly ironic in the face of postal strikes, but the other was entirely serious. It makes me feel like doing my clinics in a Santa hat.
Not everyone was in a festive mood this week, however. The camera in one of our remote clinics broke down on Wednesday, and I spent Thursday afternoon in the office, phoning patients to tell them that their appointments would have to be rescheduled for early December. It's interesting the different reactions you get to this news. Some people are entirely reasonable, and take the view that 'it can't be helped', but others seem to see it as a personal slight against them, and will argue relentlessly, as though pointing out how inconvenient it is will miraculously fix our equipment.
I spoke to one such lady on the phone. Having explained our reasons for the cancellation, and apologised profusely, she immediately got uppity with me, and started ranting about how long it had taken her to arrange for someone to give her a lift to her original appointment. Now, the thing is, I understand that completely, and I actually feel a lot of sympathy for her. I had a hospital appointment a few months ago, for which I rearranged my working week, only for it to be changed with less than two weeks notice. It's the most annoyingly frustrating thing. But the difference here is that I was fully explaining our reasons. I'd informed her that our equipment had broken down, when it was going to be fixed, and the earliest available dates for another appointment. It was clear that these were circumstances beyond our control.
But the lady went on and on. I suppose it was just her chance to vent her (understandable) frustration, but I do wonder what she expected me to do about it. I offered her an earlier appointment at a location further from her home, but that wasn't good enough. She kept repeating how downright inconvenient it was, then pausing, as if she expected me to say "Oh ok then, you can keep your original appointment". Maybe she expected me to offer to come round in person with an Instamatic and take a few snaps of her eyes.
To be fair though, some of the other patients were lovely. When I apologised to one lady, she told me there was no need to say sorry, it was nobody's fault, and she thinks she gets a wonderful service from us. Then there was the elderly lady who told me that it didn't matter because she wasn't planning to come anyway. That threw me slightly.
In other news, I saw a patient yesterday who told me the amusing story of how she was first diagnosed with diabetes. Apparently her husband has been diabetic for years, and was given a blood glucose monitor for home use. The lady told me that she used to watch him test his blood every day, and then one day, whilst feeling a little bored, her curiosity got the better of her, and she decided to try it on herself. She got a reading of 18. The next day it was 19. And the day after that, she was officially diabetic. As she said to me with a shake of the head and a roll of the eyes, "I only did it because I was bored".
Dorothy Parker once said "The cure for boredom is curiosity. There is no cure for curiosity". Although in this lady's case, it turned out to be Metformin.
There are times in my working life when I have absolutely no idea what to do. Fortunately they don't occur too often or I'd probably be sacked, but I had one such moment yesterday. And I still can't work out what I should have done.
I saw a patient on Friday morning who was a lovely lady with learning difficulties. People with such challenges in their life are not uncommon in our screening programme, and I'm generally able to screen them without too much trouble. In fact, one of the most enjoyable appointments I ever had was with a patient who had the mental age of a child, and insisted on me photographing her carer too. Never has a consulting room been filled with so much laughter and carefree chatter.
This particular patient was also a cheerful soul, and insisted on shaking my hand and smiling in a friendly manner. But in addition to her learning difficulties, she was also profoundly deaf, and could only communicate through sign language. Naturally she had a carer with her who translated for me, and I carried out the VA with no problems at all. She was quite happy to have the eye drops too. In fact, the first half of the appointment went without a hitch. The problem was the photos.
Unfortunately the lady lacked the mental capacity to understand that she needed to look directly at the light. So I had to direct her. Picture the scene: I have a lady positioned with her head on the chin rest, able to see nothing but the lens of a camera in front of her, and I want to give her an instruction. She can't 'hear' that instruction unless she moves her head to look at her carer, but if she moves her head, that instruction no longer applies.
For example, I need her to look a little more to the right. So the carer taps her on the shoulder and signs the instruction to her. By which time she's looking in an entirely different direction and the instruction is no longer relevant.
We tried this for more than twenty minutes. The carer attempted to explain that she needed to look at the light, but she struggled to understand, and once in position at the camera, she couldn't 'hear' a thing without moving her head. On a few occasions, she would look in the right direction by chance, but her eyes would be half shut. I wanted to tell her to keep looking in that direction and to open her eyes a little wider, but in order to do so, she would need to look elsewhere, and I'd lose my shot.
We tried it with the light, with my finger, and with the carer trying to point, but all to no avail. I managed to capture a few semi-acceptable images, mostly due to luck and persistence, but after twenty-five minutes, the previously smiley and relaxed patient was becoming stressed and irritable, and I felt we'd pushed her to her limits of co-operation. I decided to let her go.
So here's the question: how do you say "Stay where you are" to someone who can only hear you by moving?
I've been doing my monthly Online EQA System grading over the past couple of days. Sadly I can't reveal my results for legal reasons (and the fact that it would send my patients running for the hills in terror), but the main issue I have with the system is quite simply the amount of time it takes to complete an image set.
We were told that it should take us approximately ninety minutes a month, which sounds perfectly reasonable. In reality, however, even the fastest grader in the west couldn't get through an image set in that time. The EQA website is as slow as a ninety-year-old diabetic with bad feet, and makes you feel like you've gone back to the bad old days of dial-up. I had to shut it down and log back in more than half a dozen times yesterday after the whole thing ground to complete halt and wouldn't move.
I don't know if the answer is better servers, more bandwidth, or just a few extra hamsters on the generator wheel, but something needs to be done. It's taken me the best part of two days to get through thirty questions, and it's time I can ill afford to spare. I'm all in favour of monthly EQA tests to ensure that we're all grading to a reasonable standard, and to give us a few pointers if we're not, but at the moment the system isn't really fit for purpose.
One of my patients today was an Indian lady in her 60s who spoke very little English. Her daughter had come along to translate, but to be honest she was very little help, and the patient and I spent most of the time communicating with each other in pidgin English.
When I tried to administer the drops, the lady had great difficulty keeping her eyes open, so having placed a couple of drops on her eyelashes, I told her to keep her head tilted back and blink a few times to let them run in. She managed to follow the first bit of that instruction, but failed to comprehend the second part. From the way she suddenly started going "owww", however, I guessed the drops had successfully entered her eyes.
So I asked her to take a seat back in the waiting room. At which point she stood up, eyes still closed, and called to her daughter in another language. The girl responded by taking her mother's hand and leading her out of the room like a guide dog for the blind. I assumed it was a melodramatic reaction to the pain of the eye drops (some patients do tend to act like they've been shot in the face), and thought nothing of it.
When I went outside to collect the next patient, the Indian lady was sitting slumped in a chair, head right back, with her eyes closed. I assumed she was having a nap, and ignored it. It wasn't until I called her back in that I realised something had apparently had been lost in translation.
On hearing her name, the lady stood up, eyes still closed, and held out her arms like a sleepwalker. Her hands found the shoulders of her daughter, and they proceeded down the corridor like the world's shortest conga line. I wondered if I should say something, but to be honest, my first thought was that the longer she keeps her eyes closed, the better dilated her pupils will be, so I decided to stay silent.
Upon entering the consulting room, the lady's first words to me were "Can I open my eyes now?". I said yes. And chose not to tell her that she could have done so twenty minutes ago. I didn't want to risk her misunderstanding, and keeping them closed for another twenty minutes.
When I went to lunch, one of the ladies on the reception desk called me to one side and told me that when I'd sent my Indian patient back to the waiting room, she'd walked all the way there with her eyes closed and her body bent so far back, they'd all thought she was entering some kind of limbo dancing contest for the blind. Next time I tell a patient to tilt her head back, I'll remember to add "And now sit up straight again".
One of my patients today was an 87-year-old lady who'd been diagnosed with diabetes in August and been referred straight to us for screening. Now, I know everyone's entitled to the best care available, and I have no objection to her receiving it, but on a human level, I have to wonder whether it was really worth making that diagnosis.
The lady was in good health, not overweight, required no tablets and had no sign of retinopathy in her eyes. That's the good news. The bad news is that in her 88th year, this sudden diagnosis of diabetes has caused her all kinds of stress. She told me that she'd had a routine blood test for something else, which had led to her being told that she's diabetic. Before she knew it, she was being referred for retinopathy screening, and worrying about everything from her eyes to her feet.
She was even panicking about what she should be eating, and was desperate for information on the kind of diet she should be following. When I gave her a few basic details, the relief was visible in her face. Her response was "That's what I tend to eat anyway".
Maybe she has slightly high blood sugar levels, and maybe she'd benefit from bringing them down, but at the age of 87, is it really worth giving the lady two months of stress just to achieve it? I think that in this case, maybe no news would have been good news.
As a general rule, I like screening teenagers. They usually don't need eye drops, their vision is good, and they can follow every word you say without a hearing aid. In my experience, they tend to be well brought up too, because the ones with bad parents don't bother turning up to retinal screening appointments.
Of course there are bound to be exceptions, and I met one today. I don't know if St Trinians have opened a branch nearby, but the 15-year-old girl I screened this morning was straight out of the films. Bizarrely, her mother was lovely, and just how a parent should be: polite, respectful, interested in her daughter's health and concerned about the results. I can only assume the girl takes after her father.
Things started badly when I attempted to do the VA, and the girl immediately started taking the mickey out of me to my face. To my astonishment, she informed me that I have a "stupid posh voice", and that I sound funny. I was tempted to say "see how funny you find these eye drops", but sadly she didn't need any. So I went straight for the photos, with her throwing a strop between each one, and refusing to remain seated at the camera.
Her mother did her best, but the girl was in no mood to take any notice. So when it came to pointing out the problems with the girl's retinas, I addressed the information to the mother. Like a toddler trying to get her parents' attention, she then tried to break the external light off the camera. When that failed, she wiped her fingers on the lens. Naturally I moved the whole thing away from her. So she grabbed my mouse and started clicking randomly on the screen.
Now, learning difficulties and behavioural problems I can understand, but this girl was fully aware what she was doing, and simply didn't care. Her helpless mother even told me that she'll be going off to college next year, and university two years later, and that she's terrified she'll stop taking her insulin. She has good reason to be worried: apparently her daughter was hospitalised last year after refusing to take it while away from home.
We have a section on our patients' notes where we can add a warning for next year's screener, in case of a difficult patient. The moment she'd left the room, I opened it up and started typing. And then I stopped and deleted it. I wouldn't want anyone judging me on the person I was when I was fifteen, so I decided to give her the benefit of the doubt. There's a world of difference between fifteen and sixteen, and with a bit of luck she'll be a changed person in twelve month's time. Here's hoping, anyway.
One of the things I love most about my job is the people you get to meet. A complaint I hear quite often from other screeners is that the job can get repetitive, and whilst it's true that you're essentially doing the same things over and over again, what keeps it fresh for me is the fact that every patient is different. And at least once a day you can guarantee that you'll meet one like no other.
My favourite from this week was a 70-year-old chap who walked in carrying a briefcase, and immediately told me that he used to be an optician. This news put me on the back foot slightly, as I assumed his ocular knowledge would be far in advance of mine, and I'd have to end up admitting that compared to him, I know nothing. It was a similar story when I screened a retired GP a couple of months ago. I felt very self-conscious giving diabetes advice to a qualified doctor.
Fortunately I needn't have worried. To be honest, my suspicions should have been aroused by the man's demeanour alone. He was a lovely chap, but he spent the whole time grinning like a Cheshire cat, and had the manic, wild-eyed look of... well, not of a retired optician, that's for sure. But I took him at his word, especially when he started talking about Atropine, and asking if we ever use it.
Things took a turn for the weird during the VA. He told me his vision was a little worse in his left eye, and he assumed he'd probably got "a bit of a bleed" in that one. I didn't quite know what to say to that. But I decided to reserve my judgement on his ophthalmic credentials until I took the photos.
When he came back in, he said that as an optician, he'd be very interested to see the images for himself. To be honest, I show them to most patients anyway, but I was happy to oblige for a fellow healthcare professional. The conversation went something like this:
Patient: What's that dark thing there?
Me: That's the macula.
Patient: Oh. And that thing?
Me: That's the optic disc.
Patient: Really?
Me: Yes.
Call me an old cynic, but I'm not sure he'd quite passed all the elements of the ABDO qualification.
Well I suppose the obvious place to start this blog is the British Association of Retinal Screeners 2009 conference, which took place in Newcastle at the beginning of this month. I have to say, I came away from this year's shindig with a slight sense of disappointment. Looking at the list of delegates who attended, it's clear that the overwhelming majority were screener/graders, and yet the conference programme seemed consistently geared towards managers. Maybe it's just me, but if I have the opportunity to spend two days with three hundred people who share my job, I want to be able to swap experiences, hear stories and learn from people in the same position as me. I don't want a dry lecture about modernising scientific careers, complete with flow charts and network diagrams.
I was hoping for talks that would relate to me and my job. Speakers who would share their techniques for administering eye drops, handling patients and grading images. Screeners who would tell me the problems they'd encountered and the methods they'd used to overcome them. Even just a few funny stories about nightmare patients or disastrous days. There was none of that. The speakers felt like they'd been booked by and for programme managers. It was all very worthy, but it wasn't for me.
Interestingly, an announcement was made at the beginning to say that this year there were no workshops taking place. Apparently people had complained that last year there were so many they'd wanted to go to, that they'd struggled to fit them all in, and had been upset to miss some. So the organisers decided to solve that problem but not holding any. It's a bit like saying that so many people want tickets to see Madonna, that we'd better cancel the concert to avoid disappointing those who can't make it.
So instead of interacting with other retinal screeners, we had two days of mostly uninspiring lectures. There were highlights, however. I particularly enjoyed the talk by Cathy Egan, a Consultant Ophthalmologist at Moorfields Eye Hospital, who outlined a few of the rarer eye conditions we might come across in our work. My only complaint is that she didn't speak for long enough. Having finally found a speaker with something to say, I wanted her to go into more detail and give me time to take notes. Next time she needs to be booked for an hour.
The segment entitled 'EQA - Where Are We Now?' was perhaps the most intriguing section of the conference. It felt like a religious revival for prodigal screeners, as a succession of individuals took to the stage to repent their retinal screening sins, give thanks for their forgiveness, and be baptised in the cleansing waters of the EQA. I've never seen anything like it. I kept expecting someone to shout "Hallelujah!" as they went back to their seat.
Dinner on the first night was our one and only chance to get to know other screeners from all over the country. And sure enough, my colleagues and I were joined on our table by a few members of another screening programme. Unfortunately I couldn't hear a single word they said. I don't know who booked the DJ for the evening, but next time, tell him not to start until we've all finished eating. The entire meal was accompanied by thumpingly loud music, and made meaningful conversation impossible. Any hopes I had of swapping experiences with a fellow screener were lost in a deafening chorus of Girls Aloud.
Day two featured an interesting lecture on screening in prisons, and an enthusiastic talk about OCT, but it was a very mixed bag. Never mind OCT, a couple of the speakers could have done with ECT just to liven them up a bit. But between Martin Harris, a Consultant Ophthalmologist, and Mr Diabetic Retinopathy himself, Professor Paul Dodson, the one consensus to come out of the conference appeared to be that we're all confused by the NSC's grading criteria. Apparently even thirty ophthalmologists locked in a room together couldn't agree on a definition of R2. So how have the rest of us got a chance? You might as well ask us to work out how many marbles were in the Medalytix jar.
Let me say from the very beginning that I love my job. This blog is not going to be a diatribe against the NSC, the NHS, the EQA or any other three letter acronyms (although the old JVC camera units are a bit rubbish). No job is perfect, but I enjoy mine and I'm lucky to have the career I do. So whilst I may have the occasional moan about my working day, it should be taken as part of a bigger picture of overall job satisfaction. This site is not here to laser the new vessels of an imperfect system. It's just a place for me to recount my experiences and thoughts. Think of it as my ongoing quest for the perfect photo of IRMA and a clear definition of R2. It could be a long road...
