Insight

Professional Judgement in the COVID World

Some of you have continued to practice in some form since the beginning of the COVID-19 pandemic. Many of you are just now returning to practice. Certainly, as the province of Ontario begins loosening restrictions on businesses, opticians are dealing with the ever-changing requirements of practising safely and responsibly in the midst of a pandemic.

During the past few months, you may have implemented and/or increased your use of remote dispensing practices. You may have offered curbside pick-up for the first time ever. You will have made decisions about how to practice social distancing while providing services and what sanitation protocols you will implement. Some of these measures and actions would have been unthinkable a few short months ago. 

Now that all of the province has opened under Stage Three, things have started to “return to normal”. Well, at least a new kind of “normal”. This “new normal” makes it more important than ever that opticians exercise professional judgment in order to minimize risks to patients, staff, and self.

What is Professional Judgment?

As you no doubt aware, last year the College amended the Standards of Practice which, where appropriate, reference the use of professional judgment. This is a recognition by the College that opticians can use their professional judgment when providing their services.
What is “professional judgment”? At it’s simplest, it means that when several courses of action are available, you should apply your training and expertise and choose the one that is most appropriate based on an assessment of the patient, their visual needs and the patient’s best interests. This takes on a new dimension during the pandemic as you consider not only the patient’s health and safety with respect to disease transmission, but also your own and that of your staff and any other visitors to your dispensary.
The patient, or their agent, are partners in the decision-making process and must be provided with enough information to understand the options, risks and choices that are available to them. It is the role of the optician to clearly provide this information to patients in an understandable way. 

Using Professional Judgment

The prescribed laws, protocols and policies of the profession can never, nor do they attempt, to provide detailed solutions for every possible situation that an optician might encounter. Rather, they provide a comprehensive set of requirements, standards, and guidance for opticianry practice. Similarly, the guidelines and directives provided by the Ontario government can never address every situation during a pandemic. Rather, they are intended to minimize the spread of COVID-19 based on the latest available scientific information.

It would be expected that since March, and as your area of the province has moved through the different stages of re-opening, your practice will have changed. As health experts and others learn more about the virus and the best way to prevent its spread, you are expected to adjust your professional practice accordingly. 

Throughout the pandemic, the College of Opticians has provided information on its website intended to assist opticians in making decisions about operating safely. Opticians are expected to stay up to date on provincial requirements and professional expectations, making the health and safety of their patients, their staff and themselves paramount.
Part of using professional judgment is knowing when to refuse service or insist on specific service requirements. Working in a retail environment often means that opticians have a heightened sense of customer service and are accustomed to accommodating their patient’s wishes when it is safe and legal to do so. In the past, this has meant that opticians have learned to diplomatically refuse certain patient requests (for example, opticians routinely refuse to submit inaccurate insurance claims even when patients request them to do so). 

Operating during the pandemic may create circumstances where opticians are confronted with patients who do not wish to comply with the safety protocols that have been put in place. Patients may refuse to wear a mask in the dispensary, practice social distancing while selecting frames, or provide necessary health screening information. If this is the case, opticians should make every effort to offer alternate delivery or services. This may take the form of offering remote services, accommodating religious or health requirements by offering services by appointment only to minimize contact with other patients, or providing services through an agent of the patient.

However, opticians have both the right and the responsibility to refuse service if a patient’s non-compliance puts themselves or other employees at risk. Opticians are expected to be knowledgeable on required protocols and use their professional judgment to determine an appropriate course of action for each patient. At a minimum, opticians must take reasonable and appropriate measures to ensure the safety of others and themselves. Opticians who are employers will have additional responsibilities under employment, occupational health and safety, privacy and human rights legislation with which they must comply. 

In all cases, opticians should document accommodations in individual patient records. Opticians should also keep records of protocols that they have put in place during the pandemic as a record of the measures they have taken to protect their patients, staff, and themselves.

Things to Remember When Exercising Your Professional Judgment 

Use the resources available! The Ontario Government and the College continue to provide guidelines, legal requirements, and practical tips on how best to minimize the risks of the COVID-19. Experts are constantly learning new things about the virus and guidelines will change. The College updates its resources as information changes – check the College website frequently to keep yourself and your colleagues up to date.

Remember to consult the College’s Return to Practice Guidelines, its FAQs and the Ministry of Health’s Health Sector Restart Requirements when making decisions about opening and providing services.

Keep good records. Anytime you are exercising your professional judgment, document your actions and the reasons for your decisions in the patient record. Your patient records should be able to be read by another optician (or yourself months later) and tell the reader why certain decisions or actions were taken. For example, if you opted to mail replacement contact lenses to a client, even though they were due for an in-person re-check, because your store was closed due to the pandemic, this should be noted in the patient record. That way, now that the store is open again, anyone reading the patient file can explain to the patient why an exception was made last time, but this time they must come in instead of just having replacement contact lenses mailed to them.

Health and Safety is your responsibility. As the regulated professional, you are responsible to ensure that you are using the resources available to make decisions about safe practice. Create and implement protocols based on evidence and recommendations available from the Ontario Government and the College. Comply consistently with the protocols in place allowing for accommodations where necessary and appropriate in your judgment. Don’t be afraid to refuse service when health and safety is at risk.

by Cathi Mietkiewicz, JD