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Give optometrists larger role: Report - Council suggests allowing them to prescribe Also calls for tighter rules for psychotherapy

May 24, 2006. 01:00 AM

Patients with eye problems should be able to get prescription medications from optometrists ? a move that would ease the doctor shortage, says an advisory council to Health Minister George Smitherman.

The recommendation, strongly opposed by medical doctors who specialize in eye care, is one of several in a wide-ranging review that also asks Ontario to streamline the complaints process for patients across the health-care system.

The system could do a better job of protecting patients by regulating a number of health providers, including people who call themselves psychotherapists and deal with the "emotionally vulnerable," adds the 340-page report.

"Anyone may represent him or herself as a psychotherapist regardless of credentials, training, education, experience or lack thereof," notes the review by the Health Professions Regulatory Advisory Council.

"Many people are surprised to learn that psychotherapy is not regulated."

While doctors and psychologists, for example, who practice psychotherapy are already regulated by their own professions, there are "few, if any, consistent professional standards" in a field that has others working under no supervisory authority at all, the report states.

"There is significant risk of harm inherent in the practice of psychotherapy," it warns.

Smitherman said the government will consider regulating the field along with naturopaths, homeopaths, pharmacy technicians, kinesiologists and hearing-instrument practitioners through the Regulated Health Professions Act that already governs doctors and chiropractors.

"We'll be introducing changes ... this fall," he said in a statement.

Naturopaths, now regulated under what they call the "toothless" 1925 Drugless Practitioners Act that has no provisions for investigating misconduct or incompetence, applauded the recommendation.

Implementing it would "provide real protection to both the public and our profession," said Ruth Ann Baron, president of the Ontario Association of Naturopathic Doctors.

"It can't happen fast enough," Baron said.

The recommendation to allow optometrists ? perhaps best known for examining patients needing eyeglasses ? to prescribe medications for eye problems other than glaucoma is already facing stiff resistance despite the fact that optometrists in seven provinces and the United States already have the power.

"They're experts in their area but they shouldn't be prescribing," said Dr. Andrew Budning, head of the ophthalmology section of the Ontario Medical Association. "They didn't go to medical school."

But the report points out that ophthalmologists ? medical doctors specializing in eye care and surgery ? are retiring faster than new graduates can replace them and warns Ontario risks losing optometrists to other jurisdictions.

"These developments support an expanded vision-care role for optometrists to offset pressures occurring elsewhere in the health-care system," the authors wrote, saying the new power would reduce wait times for appointments with ophthalmologists.

The Ontario Association of Optometrists is thrilled at the recommendation and says it makes good sense, freeing ophthalmologists and family doctors to treat other patients.

"Right now ophthalmology is so short staffed they can barely keep up with the demand to do cataract surgery," said Dr. Derek McDonald, a Waterloo optometrist who heads the group that was infuriated two years ago when Smitherman scrapped coverage of routine eye exams for most adults under the Ontario Health Insurance Plan (OHIP).

Typical conditions optometrists might begin treating with medications include infections, eyelid diseases like sties, and allergy-related problems that are often treated with prescription drops like Patanol at this time of year, McDonald said.


I agree, to a certain point. Regarding optometrist - if the eye problems are less serious (doesn't require specialist), then yes, but if the problem is serious, then they will refer the patient to a specialist (ie opthamalogist) anyway, and consistent appointments will be made to see the specialist regularly.

As for psychotherapy, I also agree that there should be more stringent regulation.

When it comes to prescribing meds, it should be careful that the patient shouldn't be able to get same script from all relevant drs.
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