The primary eye care examination: opening the case history and the patient's uninterrupted initial talking time

The uninterrupted initial talking time (UITT) of optometric patients was measured in response to the clinician's opening question: "Do you have any problems with your eyes or your sight?"

UITT was measured surreptitiously by the optometrist. Also noted was whether an eye/sight problem was claimed by the patient and whether or not this was subsequently confirmed by the examination.

Data were collected from 822 adults, mean age 59.1yrs (SD 17.6), range 16.0-92.0yrs. UITT data were positively skewed; median value 28.87s (IQR 19.81-43.03s) and no statistically significant difference between genders (p=0.9). 53% of patients had completed their opening statement by 30s, and 90% after 1min. 75% of these individuals (age range 26-75yrs) had a median UITT 27.82s; younger patients (16-25yrs) spoke for a significantly shorter time (18.39s: p=0.002) and elderly patients (≥76yrs) a significantly longer time (37.27s: p=0.003) than the majority value. Previously unexamined patients, habitual spectacle wearers, and individuals presenting with an eye/sight problem all recorded a significantly longer UITT (p≤0.006) than their peers. The practitioner's opening question had a sensitivity of 0.54/specificity of 0.95, and a positive predictive value (PV) of 0.78/negative PV of 0.87: with a calculated value of κ=0.53, the strength of agreement between subjective claim and objective outcome could be regarded as 'moderate'.

These data suggest that an optometric patient's UITT of <30s is unlikely to prove disruptive to the clinical routine.