Catherine Tay, Kah Guan Au Eong. Medico-legal and ethical issues in eye care: case scenarios for optometrists, opticians, ophthalmologists and family physicians. Singapore: McGraw-Hill Education (Asia); 2009. Pp 248.ISBN:978-007-126994-0. US $43.

The complexity and tension in the relationships between the patient, the ophthalmologist, the optometrist, the optician and the family physician, against the backdrop of ever-progressing ophthalmic technology within the confines of the law, are palpable. This book authored by a lecturer in law, Catherine Tay, and a practising ophthalmologist, Kah Guan Au Eong, is likely to guide eye care professionals in dealing with patients efficiently within the stern boundaries of legislation.

The number of malpractice suits against eye care professionals is on the rise in the wake of increasing awareness among the public. To understand the implications of a ‘wrongful act’, it is necessary to be fully informed about the working of the legal system, acts that are likely to be considered unlawful, specific unlawful acts in medical practice and methods to safeguard against these. There is a need to understand the legal aspects of entering into a contract in business and the sale of goods by opticians.

However, it is not always ‘law’ that guides us in our acts, but also moral principles and ethical codes. Ethical principles, when duly followed, enable a medical practitioner to overcome the paternalistic approach to a patient and safeguard him/her against a ‘wrongful act’. The legal and ethical dimensions to be understood, followed, and integrated into medical practice have been clearly portrayed in the first part of the book by the authors.

The best way to learn about the right applications of legal and ethical issues in day to day medical practice, while dealing with patients, is through case scenarios. In the second part of the book, the authors describe probable ethical dilemmas and legalities through common situations in ophthalmic practice. Issues pertaining to competence of the patient and the importance of valid consent are elaborated in the first few case scenarios. The duties and responsibilities of optometrist, optician and ophthalmologist, negligence and delayed or missed diagnosis, are depicted in the form of cases

Research in ophthalmology is at the frontline. Several regulations need to be followed by the researcher when conducting a study, including a clinical trial, in order to ensure respect for the autonomy of the participants. The roles of the researcher-doctor, as a researcher and as a doctor, need to be understood. The needs and the role of a research participant-patient are equally important to appreciate. These concerns have been highlighted clearly through case scenarios in this book.

Informal consultations and over-the-counter prescriptions are issues often encountered by professionals without their realising the possible consequences. These issues are covered by the authors through examples in the form of case vignettes.

No surgeon can boast of never having had a surgical complication. When complications occur, issues erupt pertaining to the disclosure of complications to patients, referral to other doctors, managing another surgeon’s complications, and second opinions. These issues are presented here in apt case scenarios.

The professional etiquette to be pursued by optometrists, opticians and ophthalmologists while dealing with each other is extremely important in today’s world of competition. Problematic situations may arise due to referrals, differing opinions, overlapping responsibilities and defamation, and have been depicted with suitable case scenarios.

Ethical issues like honouring the privacy of the patient, maintaining confidentiality, disclosure of information and shared confidentiality have been discussed with ‘when, how, whom and why’ questions in a range of case situations. Finally the role of an eye care professional as a legal witness has been presented with examples.

The book therefore presents itself as a practice guide for eye care professionals in dealing with eye care practice, while safeguarding the interests of eye patients, and of themselves. It may also be referred to by students to understand the basics of ethical and legal issues in ophthalmology.