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Feb
05

From the Front Line: Mark on volunteering at the Royal London Hospital’s Covid ITU

Mark in full PPE

As you may have read, several of the large NHS London hospitals and Covid centres put out a call for staff volunteers to help out on their Intensive Therapy Units (ITUs) by doing shifts. As a result, many ophthalmologists, myself included, have volunteered. However, we consultants are so specialised in our field of ophthalmology that we are of limited use for acute care of the patient!  On ITU, we were usually asked to act as “gofers“ – fetching things, stock-checking, proning patients, doing video calls with patient relatives, or writing down readings from the multitude of monitors. Having said that, nothing quite prepares you for the shock of seeing so many critically ill  patients on ventilators.

As the pressure on the ITU at the Royal London has eased just a little bit recently, thankfully, the ITU have asked us to use our expertise in managing eye problems in these very sick patients – after all, that is what we do best. You may think that worrying about eye problems, is, for some of these patients, the least of their problems. However, caring properly for the eyes is quite a challenge for unconscious patients. These patients can develop serious drying out of the cornea, which can result in corneal ulcers, because the normal eyelid closure and blink reflex mechanism doesn’t work. In severe cases you can loose vision. Thankfully, most cases can be prevented by applying intensive lubricating ointments to the eyes and the ITU teams are very good at recognising those patients most at risk. We take over the management of the more severe cases.

Although we have seen quite a few cases, I am pleased to say that collectively we have not had any cases of severe sight loss at the Royal London, which is quite gratifying given the frightening numbers in ITU.  At the very least, the work of my ophthalmic colleagues and I relieves the ITU nurses and doctors so that they can concentrate on the critical care – and we can help by playing a small part.

Above is a picture of me taken in the donning room where we gown up before entering the ITU. Communication is challenging because of the masks so we write our name, and the specialty on our gowns . At least we don’t have to write “Ophthalmology”.

Jan
22

Lockdown 3 and Medical Appointments

Dear patients and professional colleagues,

We trust that you are all keeping well.

As we find ourselves in yet another lockdown, we wanted to remind everyone that medical appointments are exempt from the restrictions.   We will continue to care for our patients as normal in our safe clinic environment with strict hygiene and social distancing protocols in place (see below).  We’re also contactable directly by phone and email Mon-Fri (and email is monitored intermittently at weekends too).

For the moment all non-urgent surgery has been put on hold, but we would expect this to change in the next few weeks, as the hospitals Mark operates at are not currently needed for Covid patients.  Mark will make the final decision when he feels that it is safe to start again – this may well be after the hospitals have re-opened to elective surgery.  We are keeping a careful waiting list and will be in touch as soon as he feels that the risks are low.

All our patient-facing team in the clinic have now been fortunate enough to have a vaccine.  Obviously we will continue taking all the precautions necessary to keep our patients safe.

Procedures in place for your visit to the Clinic:

  • Patients arriving at the Clinic will be given a sterile face mask, asked questions about current health, have their temperature taken and will be asked to sanitise their hands.
  • Only the patient will be allowed to enter the London Clinic Eye Centre. We have to maintain social distancing where at all possible. Whilst we have ample space, this is jeopardised if patients are accompanied by relatives, partners or friends. This rule currently applies to the vast majority of private and NHS hospitals. Relatives who come by car will be asked to wait in the car. The only exception to this rule is designated carers. If there are concerns or problems with this then please let us know in advance of any visit.
  • Rest assured that strict social distancing rules are applied in our waiting rooms.  We’re fortunate in that even on our floor we have 4 separate areas for patients – although with appointments more spaced out, it’s unlikely they would ever all be used.
  • Mark and Avni wear disposable gloves and aprons which are changed for each patient. Rooms are disinfected between patients.  All practice staff wear masks.

We have redesigned and streamlined the patient journey in order to reduce the waiting time by:

  • Minimising essential tests – for example we will not usually dilate patients’ pupils. Where possible, we will avoid performing visual fields when another test will do.  For example, with the OCT scan, we can broadly maintain the 2-meter separation rule, so we rely more on these tests. We have a new eye pressure machine which is quicker, more comfortable and minimises close-up examination time (Icare tonometer).  Where possible, Mark and Avni will avoid the slit-lamp test as this involves closer doctor/patient contact (although patients are protected by a plastic screen for when it’s necessary). We will also minimise the use of drops.
  • Either Sandrine or Anabela will be in the office to book your follow-up appointments and any further tests or treatments. Payments can safely be made on the day or afterwards via bank transfer/secure online payment.
  • We are of course always contactable on non-clinic days during the week via telephone or email.  The practice is (thankfully) totally electronic and we have secure access to everyone’s notes and accounts.

Please rest assured that coming in to see us is as safe as it possibly can be.  Obviously if your journey is difficult, or you would prefer to postpone, please let us know and Mark will review your file and let you know how long it’s safe to postpone for.

All the very best and keep safe.

Mark, Sandrine, Avni and Anabela

 

Dec
21

Tier 4 restrictions and medical appointments

Dear patients and professional colleagues,

We trust that you are all keeping well.

As London and much of the South East heads into Tier 4 restrictions, we thought we should re-emphasise that medical appointments are exempt from the restrictions.   We will continue to care for our patients as normal in our safe clinic environment with strict hygiene and social distancing protocols in place (see below).

We have also been carrying out surgery very successfully for some months now, ensuring that national procedures regarding self-isolation and Covid testing are adhered to prior to surgery.

Procedures in place for your visit to the Clinic:

  • Patients arriving at the Clinic will be given a sterile face mask, asked questions about current health, have their temperature taken and will be asked to sanitise their hands.
  • Only the patient will be allowed to enter the London Clinic Eye Centre. We have to maintain social distancing where at all possible. Whilst we have ample space, this is jeopardised if patients are accompanied by relatives, partners or friends. This rule currently applies to the vast majority of private and NHS hospitals. Relatives who come by car will be asked to wait in the car. The only exception to this rule is designated carers. If there are concerns or problems with this then please let us know in advance of any visit.
  • Rest assured that strict social distancing rules are applied in our waiting rooms.  We’re fortunate in that even on our floor we have 4 separate areas for patients – although with appointments more spaced out, it’s unlikely they would ever all be used.
  • Mark and Avni wear disposable gloves and aprons which are changed for each patient. Rooms are disinfected between patients.  All practice staff wear masks.

We have redesigned and streamlined the patient journey in order to reduce the waiting time by:

  • Minimising essential tests – for example we will not usually dilate patients’ pupils. Where possible, we will avoid performing visual fields when another test will do.  For example, with the OCT scan, we can broadly maintain the 2-meter separation rule, so we rely more on these tests. We have a new eye pressure machine which is quicker, more comfortable and minimises close-up examination time (Icare tonometer).  Where possible, Mark and Avni will avoid the slit-lamp test as this involves closer doctor/patient contact (although patients are protected by a plastic screen for when it’s necessary). We will also minimise the use of drops.
  • Either Sandrine or Anabela will be in the office to book your follow-up appointments and any further tests or treatments. Payments can safely be made on the day or afterwards via bank transfer/secure online payment.
  • We are of course always contactable on non-clinic days during the week via telephone or email.  The practice is (thankfully) totally electronic and we have secure access to everyone’s notes and accounts.

Please rest assured that coming in to see us is as safe as it possibly can be.  Obviously if your journey is difficult, or you would prefer to postpone, please let us know and Mark will review your file and let you know how long it’s safe to postpone for.

Meanwhile we would like to wish all our patients and colleagues a merry Christmas, even if it’s not quite the one you anticipated, and a healthy and happy New Year.

All the very best and keep safe.

Mark, Sandrine, Avni and Anabela

Nov
02

Medical appointments exempt from restrictions: Keeping patients safe

Dear patients and professional colleagues,

We hope that you are all keeping well.

Sadly another lockdown is needed, but the Government has been very clear that medical appointments are exempt from the restrictions.  Some of the conditions we see are very treatable conditions if identified and managed, but can be sight-threatening if not.  We will continue to care for our patients as normal in our safe clinic environment with strict hygiene and social distancing protocols in place (see below).

We have also been carrying out surgery very successfully for some months now, ensuring that national procedures regarding self-isolation and Covid testing are adhered to prior to surgery.

Procedures in place for your visit to the Clinic:

  • Patients arriving at the Clinic will be given a sterile face mask, asked questions about current health, have their temperature taken and will be asked to sanitise their hands.
  • Only the patient will be allowed to enter the London Clinic Eye Centre. We have to maintain social distancing where at all possible. Whilst we have ample space, this is jeopardised if patients are accompanied by relatives, partners or friends. This rule currently applies to the vast majority of private and NHS hospitals. Relatives who come by car will be asked to wait in the car. The only exception to this rule is designated carers. If there are concerns or problems with this then please let us know in advance of any visit.
  • Rest assured that strict social distancing rules are applied in our waiting rooms.  We’re fortunate in that even on our floor we have 4 separate areas for patients – although with appointments more spaced out, it’s unlikely they would ever all be used.
  • Mark and Avni wear disposable gloves and aprons which are changed for each patient. Rooms are disinfected between patients.  All practice staff wear masks.

We have redesigned and streamlined the patient journey in order to reduce the waiting time by:

  • Minimising essential tests – for example we will not usually dilate patients’ pupils. Where possible, we will avoid performing visual fields when another test will do.  For example, with the OCT scan, we can broadly maintain the 2-meter separation rule, so we rely more on these tests. We have a new eye pressure machine which is quicker, more comfortable and minimises close-up examination time (Icare tonometer).  Where possible, Mark and Avni will avoid the slit-lamp test as this involves closer doctor/patient contact (although patients are protected by a plastic screen for when it’s necessary). We will also minimise the use of drops.
  • Either Sandrine or Anabela will be in the office to book your follow-up appointments and any further tests or treatments. Payments can safely be made on the day or afterwards via bank transfer/secured online payment.
  • We are of course always contactable on non-clinic days during the week via telephone or email.  The practice is (thankfully) totally electronic and we all have secure access to everyone’s notes and accounts.

Please rest assured that coming in to see us is as safe as it possibly can be.  Obviously if your journey is difficult, or you would prefer to postpone for another reason, please let us know and Mark will review your file and let you know how long it’s safe to postpone for.

Our priority over the last few months has been to manage our patients’ care as safely as possible, and we’re very confident that we’re set up to do that.

All the very best and keep safe.

Mark, Sandrine, Avni and Anabela

Jun
19

For our professional colleagues: Angle closure glaucoma

Dear all,

We hope you and yours are all well. Things seem to be gradually going back to some sort of normal [fingers massively crossed]…

We have been running small clinics for the last 4 weeks and they’ve been going well. We started off with 1 patient an hour, but found that such a large separation wasn’t really necessary with the social distancing and hygiene measures already in place (although Mark was FINALLY getting on top of his email inbox in the gaps…). So we will increase the number of patients slightly over the coming weeks. It has also forced us to do things slightly differently – we have an afternoon devoted to video consultations, with patients coming into the London Clinic for quick pressure checks/scans with the nurses beforehand.

We hope that most of you are back in your practices or planning to do so – we understand that the guidance has been somewhat mixed, which must be frustrating. But as one of you said to me: ‘If Primark are open then I think we should open’ – I suspect people need you more than Primark…..

As you may have quiet periods over the next few weeks and hopefully your inbox is in slightly better shape than Mark’s, here’s another lecture to take a look at, on angle closure glaucoma:

https://www.dropbox.com/s/6wv3yliv9c5fnc4/ACG_2020.pdf?dl=0

Some of you heard through the grapevine that Mark caught the coronavirus – he had it during the lockdown (almost certainly caught from a patient) and was pretty unwell although thankfully not hospitalised. He is now fully recovered and is the proud owner of a positive antibody test! Despite joking that he can lick door handles with impunity, he says it’s a nasty disease and is covering himself with the requisite PPE as immunity is likely but not guaranteed – and he’d really rather not go through it again.

All the best to you all as we slowly find our way back to some sort of normality. Keep safe.

With kind regards,

Mark, Sandrine, Avni and Anabela

May
29

Practice re-opening and our safety measures

Dear patients and professional colleagues,

I hope that you are all keeping well.

The purpose of this message is to highlight some changes to the clinic visit that we have made in the light of the coronavirus pandemic.  This is primarily for the safety of our patients and  staff.  Just as your visit to a supermarket is different now, compared to before lock down, your visit to us will likewise be different, and please be reassured by this.  This is in everyone’s interest. Things to note:

  • Patients arriving at the Clinic will be given a sterile face mask, asked questions about current health and asked to sanitise their hands.
  • Only the patient will be allowed to enter the London Clinic Eye Centre. We have to maintain social distancing where at all possible. Whilst we have ample space, this is jeopardised if patients are accompanied by relatives, partners or friends. This rule currently applies to the vast majority of private and NHS hospitals. Relatives who come by car will be asked to wait in the car. The only exception to this rule is designated carers. If there are concerns or problems with this then please let us know in advance of any visit.
  • Rest assured that strict social distancing rules are applied in our waiting rooms.  We’re fortunate in that even on our floor we have 4 separate areas for patients – although with appointments more spaced out, it’s highly unlikely they would ever all be used.

My team and I have redesigned and streamlined the patient journey in order to reduce the waiting time by:

  • Minimising essential tests – for example we will not usually dilate patients’ pupils. Where possible, we will avoid performing visual fields when another test will do.  For example, with the OCT scan, we can broadly maintain the 2-meter separation rule, so I will be relying more on these tests. We have a new eye pressure machine which is quicker, more comfortable and minimises close-up examination time (Icare tonometer).  Where possible, I and my optometrist, Avni, will avoid the slit-lamp test as this involves closer doctor/patient contact (although patients are protected by a plastic screen for when it’s necessary). We will also minimise the use of drops.
  • Booking your follow-up appointments, any further tests or treatments, and invoicing will not be done “face to face” and we would kindly ask patients to contact our administration staff via telephone or email. My practice manager, Sandrine, and Anabela are all working at home but will be pleased to help you.  The practice is (thankfully) totally electronic and we all have secure access to everyone’s notes and accounts.
  • For some routine follow up appointments, we are asking patients to come into the London Clinic for pressure readings and scans, and I will follow this up with a video consultation on another day.

Please rest assured that coming in to see us is as safe as it possibly can be.  We started small clinics this week and they went very well.  We are hoping to re-start surgery towards the end of June (depending on the release of operating theatres from the NHS, who leased them during the pandemic).

Things will be different for a while, and I look forward to the day when our waiting rooms are full of chatter again, and we have the whole team working together in the Clinic.  But for now our priority is to manage our patients’ care as safely as possible, and I’m confident that we’re set up to do that.

All the very best and keep safe.

Mark

May
15

For our professional colleagues: Retinal Disease

We hope you, your families and all in your practices are well.

As we head towards some slight loosening of the lockdown rules (picnics! garden centres!), we are beginning to make plans for resuming our clinics in this new environment, as we hope you are too. Things will be rather different: social distancing means separate or spread-out waiting areas, and no accompanying relatives; investment in and use of diagnostic equipment that minimises risk and can be thoroughly disinfected, or with disposable parts; seamless patient flow to ensure they spend as little time as possible in the building; follow up admin taking place by phone or email. It will be less personal and distanced, but very safe – certainly more so than many supermarkets, for example. But we’ll look ahead to a time when the waiting rooms are buzzing and our regular patients are greeted by the team like the old friends they are….

Anyway, please find below the link to the latest in the series of Mark’s slides to give you something to mull over. This one looks at retinal disease, and the importance of understanding a patient’s history to help you make sense of the clinical signs:

https://www.dropbox.com/s/8jq3e88d7y4umxd/macular%20tips_2020%20.pdf?dl=0

(Note: Some browsers seem to only show the first slide. If so, try another browser or download the pdf file using the arrow button next to the ‘Sign in’ button at the top.)

We are open, as always by phone and email. We are planning to start running our small, socially distanced clinics at the end of May and into June. Mark has been going into the clinic mainly to carry out AMD injections, which generally can’t be postponed (for those of you who know him primarily for glaucoma, he is also Medical Retina trained, and does a lot of this with his uveitis clinics at Moorfields). We hope that you are also in a position to plan a return to work – please let us know if there’s anything we can do.

Meanwhile, enjoy the picnics and gardening this weekend!

Apr
17

For our professional colleagues: Examining the optic disc

Dear all,

We hope that you and yours are all safe and well.

As promised, we have posted another of Mark’s lectures on an educational topic. This lecture is a refresher on how to examine the optic disc in order to detect glaucoma and other conditions.

We hope you find it of interest, and we welcome any feedback.

https://www.dropbox.com/s/ey6jkxx5os7gghu/Optic%20disc%202020.pdf?dl=0

(Note: Some browsers seem to only show the first slide. If so, try another browser or download the pdf file using the arrow button next to the ‘Sign in’ button at the top.)

We have quite a broad collection of lectures on many topics, and if there’s any subject area you’d particularly like a refresher on, we will do our best.

Our practice is currently partially open – we’re available by phone and email as usual, but for the moment we’re only seeing sight-threatening conditions at the London Clinic (fairly rare in Mark’s specialities of cataracts and glaucoma). All elective surgery has been cancelled as the London Clinic and Moorfields have offered their theatres for urgent NHS surgery, freeing up space in NHS hospitals for Covid-19 patients.

Mark is reviewing every patient we have booked in April/May to see just how far we can postpone their appointments. He also held his first video consultations this week with patients who needed to be seen more urgently – this worked surprisingly well, although if anyone can tell us how to measure pressures over the internet, we’d be grateful…..

We wish you all the very best – stay safe!

Mark, Sandrine, Anabela and Avni

Mar
31

For our professional colleagues: Online lesson on the interpretation of visual fields

Firstly, we hope that you and yours are all safe and well. These are quite extraordinary times we’re going through.

We would normally be contacting you now to invite you to one of our regular lectures + wine tasting at the Royal Society of Medicine. Sadly, we’re going to have to put that off for the time being.

We recognise that much regular work is not taking place at the moment and many of you are facing uncertainties over your businesses, staff, etc. However, this ‘down time’ can at least be useful for brushing up on your clinical knowledge – so we thought we would put one of Mark’s lectures online every 2 weeks or so. This week’s lecture is on visual fields and Mark hopes that it’s a useful refresher for you:

https://www.dropbox.com/s/f3wei9u0e5zjy6f/Automated%20visual%20field_Marks%202020.pdf?dl=0
(Note: Some browsers seem to only show the first slide. If so, try another browser or download the pdf file using the arrow button next to the ‘Sign in’ button at the top.)

Please let us know what you think, or if there’s a subject area you would find particularly interesting.

Our practice is currently partially open – we’re available by phone and email as usual, but for the moment we’re only seeing sight-threatening conditions at the London Clinic (fairly rare in Mark’s specialities of cataracts and glaucoma). All elective surgery has been cancelled as the London Clinic and Moorfields have offered their theatres for urgent NHS surgery, freeing up space in NHS hospitals for Covid-19 patients. Mark is reviewing every patient we have booked in April/May to see just how far we can postpone their appointments. We are also looking at telephone and video consultations.

We’ve heard of several optometrists forming local networks to manage emergency cases across their practices. If we can help facilitate this at all, please get in touch.

We wish you all the very best – stay safe!

Mark, Sandrine, Anabela and Avni

Mar
23

Coronavirus update 23rd March

As a result of the global Coronavirus pandemic, and in line with NHS and worldwide best practice in affected areas, we have decided to partially close the practice from today until after Easter.  All patients who were due to come in have been informed – Mark is reviewing their notes and we are contacting them individually in order to reschedule.  Fortunately the specialties of cataracts and glaucoma don’t tend to require urgent care, so most patients can safely postpone their appointments for 2 months or more.

The practice is only partially closed as we’re still available by phone Monday-Friday and via email on secretary@mark-westcott.com.  The practice is fully electronic so we have access to all our patients’ files.  Mark will be able to answer queries, usually on the same day.  We are also planning to manage patients by video consultation and telephone consultation after Easter.

If you have an appointment/procedure after Easter: We are monitoring the situation and will be in touch in the next week or two to confirm or reschedule.

If you have a concern or query: Please contact us on 020 7402 0724 or secretary@mark-westcott.com

If you need a prescription: Please contact your GP in the first instance – they will have your last clinic letter and can prescribe without requiring you to attend their practice.  If you need your last clinic letter, please let us know.  If it’s really not possible for you to get a prescription via this route, Mark will be sending out prescriptions twice a week, but obviously under the circumstances this is not his highest priority.

If you require urgent care: Please go to Moorfields Eye Hospital A&E.  As this is a specialist eye hospital, they are not currently treating patients with acute cases of Coronavirus.  If you are unable to get to Moorfields, we would recommend your nearest private or NHS A&E.

Please ensure you follow Government advice and stay safe!  We look forward to seeing you again soon.

Mark, Sandrine, Anabela and Avni

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