Exam Pass Notes

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Key takeaways

• GOC Standard 13 requires optical registrants to show respect, act fairly and avoid discrimination in all interactions - greetings, consent, clinical advice and commercial conversations.
• Respect and fairness are patient safety behaviours: visible dignity, clear explanations and consistent treatment reduce complaints and incidents.
• Small, standardised actions (introductions, accessibility checks, neutral option presentation, clear records) hard‑wire respectful practice and guard against bias during pressure.
• Recordkeeping is a key accountability tool: who was present, what options/costs were offered, adjustments made, and why a particular path was chosen.
• Use brief scripts, checklists and team huddles to prevent drift and ensure parity across groups.

Overview - What Standard 13 expects

• Treat patients and carers with dignity and fairness, irrespective of age, disability, gender reassignment, marriage/civil partnership, pregnancy and maternity, race, religion/belief, sex or sexual orientation.
• Prioritise clinical need and evidence, not perceived wealth, assertiveness or persuasion.
• Make reasonable adjustments and provide interpreters or alternative formats for consent/complex decisions.
• Separate clinical advice from sales language and be transparent about costs.

High‑yield behaviours (easy to demonstrate in practice and exams)

• Offer a clear introduction and check the patient's name and preferred pronouns.
• Ask about accessibility needs at the start (hearing, sight, learning disability, language).
• Explain options, risks and costs equally for all patients; document what was offered.
• Use teach‑back for key instructions (e.g., contact lens hygiene).
• Face the patient, not the screen; sit at eye level when possible.
• Pause to confirm consent before procedures (dilation, contact lens fitting).
• Invite questions and record the patient's priorities and chosen option.
• Note any reasonable adjustments, who authorised them and review dates.

Consultation structure to keep visible (recommended standard order)

1. Welcome and accessibility/preferences check.
2. Patient agenda and clinical assessment.
3. Options explained (pros, cons, costs) and shared decision recorded.
4. Safety‑netting, follow‑up plan and documentation of who was present/what was offered.

Records and documentation - essentials for accountability

Always include:

• Who was present (patient, carer, interpreter, staff).
• What options were presented (clinical and commercial) with risks and costs.
• Patient's priorities and chosen option, and the reason where relevant.
• Any reasonable adjustments or accessibility needs and when to review.
• Rationale for triage, deferral or escalation (objective justification).
• Factual account of any disrespectful behaviour, exact words if relevant, actions taken and escalation.

Keep language neutral, avoid value judgements and quote the patient's words when important.

Recognising discrimination and subtle drift

Indicators that bias may be occurring:

• Different tone or less detailed explanations by accent, age or appearance.
• Fewer options offered to certain groups or assumptions such as "it's just age".
• Repeated interruptions of particular patients or addressing carers instead of the patient.

Practical mitigations:

• Standardised introductions and option checklists.
• Pre‑consultation prompt for accessibility/preferences.
• Use professional interpreters for consent and complex decisions.
• Fairness "buddy check" in dispensing for complex or high‑value choices.
• Regular peer review of records for parity of detail across groups.

Handling commercial interactions fairly

• Present clinically suitable options across price points with equal clarity.
• Explain differences in durability, warranty and fit without implying moral value.
• Clearly separate clinical recommendations from sales/details about style.
• Make pricing visible and document options offered so choices are transparent.

Managing disrespectful behaviour (from patients, carers or colleagues)

First responses:

• Name the behaviour, not the person: "Let's allow [patient name] to finish."
• Set a calm boundary: "We do not use that language here; I can continue once we keep it respectful."
• Offer to pause and involve a senior if the behaviour persists.

Escalation:

• Involve a senior or manager, arrange chaperone or change staff member if needed.
• If necessary, end the interaction with safety (offer to rebook with conditions).
• Record time, exact words (where relevant), actions taken and who was informed.

Support for staff:

• Brief debriefs, check‑ins and access to support.
• Log incidents factually and share learning in team briefings.

Scenarios - distilled ideal responses (quick reference)

• Older patient with mobility issues: offer stable seating, explain steps, adjust room/set‑up, prioritise essential tests and book prompt follow‑up; document safety rationale.
• Carer giving medication history: thank carer, check patient's consent for input, accept brief safety‑focused details, and return to patient; document contributors and discrepancies.
• Clinic overrun by complex case: agree minimum safe next steps, book prompt follow‑up, inform waiting patients with apology and realistic times; record rationale.
• Steering toward high‑priced frames: present equivalent lower and higher price options with same clarity; record options and patient reasoning.
• Reception addressing carer only: greet and address patient first, ask how they prefer support, offer easy‑read or extra time, and record preferences.
• Religious dress concerns: explain what needs to be uncovered and why; offer private space and, when possible, same‑gender clinician; document discussion and consent.
• Family member dominating: set ground rule that questions go to patient first, offer short private time if needed, and record who contributed.
• Patient using discriminatory language: set boundary calmly, reference practice policy, pause or end appointment if necessary, escalate and support staff.

Quick scripts and phrasing (high‑utility under pressure)

• Reset / respect: "Let me check I've understood your priority before we choose lenses."
• Protect patient voice: "I'll address your question and then come back to [patient name] so we keep their voice central."
• Boundary setting: "We do not use that language here; I can continue once we keep it respectful."
• Family management: "Thank you. To make sure we hear from [patient name] first, I'll ask them this question and then ask for your input."
• Time pressure: "We can complete these essential checks today and book a prompt follow‑up for the remaining items. Is that acceptable?"

Keep scripts visible at points of care and practise in huddles.

Checklists and lightweight artefacts to implement

• Fairness checklist for dispensing conversations (introductions, options, costs, adjustments).
• One‑page orientation for locums/students (introductions, accessibility prompts, interpreter routes, escalation).
• Short decision log template: date/time, who present, options discussed, cost transparency, adjustments, reason for recommendation.
• Pre‑consultation accessibility/preferences prompt on booking or reception.

Measuring, audit and continuous improvement

Measures that matter:

• Parity of options recorded across demographics.
• Themes in complaints about tone, pressure or respect.
• Audit of interpreter use when indicated.
• Uptake of easy‑read / large print materials.

Practical approach:

• Sample a few records monthly for clarity and neutrality.
• Review complaints/compliments for respect themes and feed into scripts/training.
• Share quick wins (better introductions, clearer cost explanations) in team briefings.
• Rotate who leads fairness spot checks and include a review date for adjustments.

Exam tips - how to answer Standard 13 questions succinctly

• Start with the principle: Standard 13 = respect, fairness, no discrimination; link to patient safety.
• Describe concrete actions (introductions, accessibility check, options + costs, consent check, record details).
• Use a short structure: What (behaviour), Why (safety/accountability), How (scripts/checklist/records).
• If a scenario includes time pressure/commercial tension, highlight triage by clinical risk, prompt follow‑up, and transparent options.
• Always mention documentation: who/what/when/why and neutral language.
• For discrimination questions, name protected characteristics, give examples of micro‑behaviours and mitigation (interpreters, standardised scripts, audits).

Final practical checklist to carry into practice or the exam

• Introduce yourself; check name and pronouns.
• Ask about accessibility and communication preferences.
• Explain options, pros/cons and costs equally.
• Invite questions and use teach‑back where safety critical.
• Record: who was present, options offered, chosen option, adjustments and rationale.
• Use a script to reset or set boundaries if required.
• Log incidents factually and feed learning into huddles and training.

Keep these behaviours routine - respect and fairness are not optional extras but core safety practices under Standard 13.