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Age related macular disease
  1. Kirkcudbrightshire, Scotland

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    Editor,—I am a retired doctor who suffers from the wet form of age related macular disease (ARMD) in both eyes. In the triangle of doctor, patient, and ARMD what are the implications for one of the key role holders, the ophthalmologists? Is there any longer a place for the phrase oft used by them “I am sorry I can do nothing further for you”.

    There is in fact a lot doctors can do both in practical terms and in more subtle shifts of attitudes and behaviour. For example, general practitioners often admit they know little of the disease and may refer a case which requires an early opinion through the usual channels, which may take weeks. Opticians may not refer at all when necessary. Who better to educate and remedy these deficiencies but the experts, the ophthalmologists. Likewise, much needed low vision clinics are more likely to be achieved if promoted by a consultant rather than by a pressure group of patients. Or a rethink on how to make the loss of eyesight more easily interpreted to patients for whom the word “Snellen” has little meaning—present criteria are primarily geared to use by professionals. Or an explanation that being registered blind has a different connotation from being totally blind and so on.

    No general surgeon or physician nowadays would use such chilling words to a patient with a terminal or degenerative condition.

    It has been said that everyone in the health service including patients is a manager. Do all doctors realise the word manager also applies to them? Is there still a feeling among ophthalmologists that they continue to live in the halcyon days when being a doctor meant solely practising clinical medicine, while leaving the mundane business of getting the service to the patients to others. Doctors see themselves rightly as leaders of the clinical team which in turn exists for the purpose of serving the patient. Delay in the processing of forms for registration may mean little to the professionals but a great deal to the patient. Whose responsibility is this? Do doctors communicate sufficiently with social services which should play such an important part in the follow up service. Do doctors resent the fact that social services hold the statutory powers? Do they know what statutory power is?

    Of all those using the National Health Service the patients are the most disempowered. Regrettably, as experience has shown, major changes in doctors' attitudes and practices are all too often brought about by events overtaking them.

    Firstly, the ageing explosion, then the cataract explosion and soon, if patients' hopes are realised, the macular disease explosion. Ever increasing workloads for doctors and ever lengthening waiting times for patients solve nothing. Setting priorities, identifying problems, and making decisions for the future—in short, management, may be an unwelcome alternative for clinicians but it is likely to be more productive.

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