1. Ethical Issues and Standards in Optometry Aleksandr Kozlov

2. Objectives for the Semester  Pick and research an existing case study  Establish some of the more common ethical issues optometrists face Decide the ethical way to deal with each one of the issues  Create multiple case studies dealing with the common ethical issues

3. Objectives for the Semester  Finalize the paper from last semester Add the case study components to the paper Produce a finished product with several fully developed case studies

4. Sources for the semester  Professors at the School of Optometry  Personal research  Optometry students Optometry ethics class 3 rd year students case studies  Optometrist contacts Job Shadowing

5. Common Ethical Issues  The disconnect between the legal and the ethical in medical mistakes Some states make doctors admissions of guilt and apologies inadmissible in court  Attending v.s. Student debates  DMV driving standards  The medically indigent

6. Case Study #1 Truth Telling in a Clinical Setting  Jim is a third year optometry student in his first term in clinic.  During a routine exam Jim caused a large tonometer footprint on the eye of the patient  He had forgotten to rinse off the hydrogen peroxide from the tonometer tip before using it in the exam, causing the footprint

7.  What would you tell your supervisor, Dr. Melvin?  Practicing under the attendings license  How important is it to take your attendings advice? Case questions:

8.  4 Possible courses of action Don’t tell the patient Tell the patient, offering condolences Tell the patient, offering condolences and admission of guilt Tell the patient, offering condolences, admitting guilt, and offering compensation

9.  What would you tell Ms. Jones after discovering the footprint? Do you have an ethical obligation to disclose the true cause of the patient’s pain? If you deem the likelihood of any serious damage to be extremely low would that have an impact on your decision-making?

10.  Ethical and legal obligations of a heath care professional Legal benefits of telling the truth The truth is not always the best option  Doctor-Patient relationship  Expected patient reactions Positive results are never guaranteed Loss of faith Feeling of vulnerability Anger

11.  Do you bill the insurance and mark corneal damage on your route slip? If you do not have enough samples in your office, do you bill the patient for the drugs required to reduce pain and prevent infection of the eye now that it is compromised?

12.  Law states the party responsible for the damage to the patient must handle the costs Out of pocket expense Free sample drugs Malpractice insurance

13.  Jim tells Dr. Melvin what he has done. Dr. Melvin tells Jim to say nothing to Ms. Jones because of liability concerns. How would this addition to the story complicate the ethical life of Jim? What would you do if you were Jim in this situation?

14.  Very common in the case studies of the 3 rd year optometry student interns Attending vs Intern situations  Legal ramifications versus ethical obligations  The disconnect between what is ethical and legally beneficial to the practice

15. The difficulty of facing mistakes  Perfection is taught to be the only acceptable outcome Not a reasonable expectation  Numerous factors can keep doctors from telling the truth  The self-confidence of a doctor Proper ways to deal with mistakes Fear ○ Unfavorable Reactions ○ Consequences ○ Professional embarrassment

16. My case studies  Truth telling in optometry: Wrong prescription  Issues of payment: The medically indigent  Issues of payment: The less expensive option  Serving the community: DMV driving standards

17. My case Study: The cost of treatment  Patient: 49-year-old Hispanic female, Rochelle, with a chief complaint of blurred vision.  No Insurance, can barely afford cash payment Ignorance toward medical advice because lacking money  Type 2 diabetic, no previous eye exams  Need for corrective vision, strong indication of glaucoma  Patient is driving, but vision is well below acceptable DMV guidelines

18.  You have sample contact lenses in stock that match the prescription of the patient. Not FDA approved for overnight wear, and are only good for up to two weeks. The practice does not have any contact lens samples that match the patients prescription, are unexpired, and in stock.  The contact lenses are also a few weeks past their expiration date.

19. Case study Questions: Question 1  Is it your responsibility to convince the patient to come in for the glaucoma workup? If she cannot afford this, should her financial situation limit the amount of care she gets from your clinic? Do you offer a free follow up visit to do the glaucoma workup?

20.  Does the answer to this change if you suspect the a free follow up will lead to her informing others without insurance and money that you do free work and cause a flood of people with similar situations to your practice?

21. Question 2:  Do you call the DMV and inform them of the issue with Rochelle’s vision possibly resulting in her getting the drivers license revoked?

22. Question 3:  Do you give Rochelle the expired trial lenses to prevent her from posing a danger to other drivers on the road during the drive back home?

23.  Does the answer to this question change if you suspect she will wear them continuously, and for as long as she can because she cannot afford any other vision correction device?

24. Question 4:  Does her lack of money sway you to treat her differently then a patient with money or insurance? Are you obligated to treat her ethically and/or legally even if she cannot pay ?

25. Future plans:  Applying to the school of optometry during the 2010-2011 year  The role of this internship: in my application process and grad school work In my future practice of the profession

26. Any questions?