Standards of Practice for Primary Eyecare John G. Classé. Columbus, OH: Anadem Publishing. 1998. Pages: 134. Price: $44.00. ISBN 1-890018-22-8.
If you have ever taken a continuing education course from Dr. John Classé, who is both an optometrist and an attorney, you may have scribbled some lecture notes that resemble parts his newest publication. In 134 spiral-bound pages, this soft-cover book includes 45 tables of clinical risk management issues for optometrists, ranging from suggested standards for impact resistance of ophthalmic lenses (which he assesses as a “significant” risk) to endophthalmitis (which he assesses as a “minimal” risk). In each table, he includes his own assessment of the risk, his recommended standard of practice, and several pearls of wisdom based upon his considerable experience as an optometric clinician, educator, and scholar of optometric legal issues. Although he states in his introduction that “Readers are cautioned to use their own judgment in making decisions on the issues covered in this book… (and) the material is not intended to substitute for the advice of a qualified attorney or other professional… ,” he has obviously provided his learned opinion on a standard of practice in optometry that he recommends for his patients, students, and colleagues. Although, logically, he directs this book to the optometric profession, I feel most of it is equally applicable to the practice of ophthalmology [i.e., “Optometrists or ophthalmologists (my emphasis) who do not wish to diagnose or manage binocular vision anomalies should refer patients to practitioners who will provide the appropriate care”]. In fact, in sections 5 (Posterior Segment Disease), 6 (Anterior Segment Disease), and 7 (Ophthalmic Drugs), he emphasizes that “a medical standard of care applies… . ”FIGURE
In addition to the tables, Dr. Classé has included 12 useful appendices in his book, some of which are the American Optometric Association’s Clinical Practice Guidelines for the frequency of Adult and Pediatric Eye and Vision Examinations, a general algorithm for the treatment of primary open-angle glaucoma from a 1996 paper authored by Dr. Jimmy D. Bartlett, a sample patient fitting agreement for extended wear (overnight) contact lenses, a triage checklist for patients with eye emergencies, and a protocol for postoperative care of cataract patients. Also included for Ohio-licensed optometrists are 2 hours of continuing education credit if they elect to complete the multiple choice test and return it for grading to The Ohio State University College of Optometry.
The shortcomings of this easy-to-read book are minor. In my view, the title is not well matched to its content. Standards of Practice for Primary Eyecare implies more to me than simply knowing how to avoid optometric malpractice suits. There are no discussions of social, economic, ethical, or moral codes of conduct that are also critically important standards of practice for a healthcare provider in any discipline and this book does not even attempt to address standards of practice in traditional optometric specialty areas of binocular refraction, low vision, or vision therapy. Although the author has chosen a sub-title of “Risk Management Guide” for his book, most of its pages contain selected ocular disease diagnosis and management topics, along with some helpful practice management issues, such as record keeping and professional liability insurance, without any mention of many other important quality assurance and risk management topics, such as unrestricted state licensure, credentialing, privileging, certification, continuing education, infection control procedures, and emergency preparedness. However, the author readily admits to these limitations: “Emphasis in this manual is on the reasons that liability claims were brought [against optometrists] so that clinicians will better understand current liability risks and thereby take appropriate steps to reduce these risks in clinical practice.” To stress this point, the first table lists “100 Malpractice Claims, 1977–1997”; however, he provides no explanation for how this information was researched or how it might apply now that U.S. optometrists in all 50 states and the District of Columbia can use therapeutic pharmaceutical agents.
Another minor criticism of this book is that it is written in an outline format, which appears to be a quick “checklist” of things to do or think about, rather than as a narrative, in which more information could be provided to establish a rationale for each of his proposed standards. In fact, even though hundreds of standards for primary eyecare are proposed, most have no justification(s) or reference(s) for them other than the author’s considerable erudition and clinical experiences. There is no reference or suggested reading list provided for readers who wish to learn more about this subject, and there is no index for readers to easily locate specific items of interest.
In summary, despite the aforementioned minor shortcomings of limited scope and lack of reference material, I liked this book very much. For $44.00, it is a concise, clinically relevant, and “user-friendly” manual that should help every optometrist in his or her primary eyecare practice.