Case study: Avoid blurring line between clinical practice and research in optometry

The stage is set immediately by the authors of the latest case study by the AOA’s Ethics & Values Committee.

Both clinical practice and clinical research are essential to the delivery of care, each contributing to the advancement of science and patient care, say Timothy Wingert, O.D., and Satya Verma, O.D., case study authors and members of the committee. Dr. Wingert is the committee chair.

But they are fundamentally different, they add in the paper titled, “Case Study: Difference Between Clinical Practice and Research in Optometry.” And without clear lines, patients may become confused. Read the full case on EyeLearn, the AOA’s professional development hub.

“It is important in the doctor-patient relationship to be clear as to the role the doctor is playing at that time,” Dr. Wingert says. “As they can have conflicting roles and interests, it is important to keep the roles separate.”

Adds: Dr. Verma: “The ethical dilemma comes into play when the clinician is also the researcher, and the research is being conducted in the same facility.”

Clinical care vs. clinical research

What’s the difference?

According to the authors, clinical practice or care “revolves around diagnosing, treating and managing the well-being of the patient by applying the results of accumulated clinical research. In clinical care, the clinicians rely on already established health care guidelines, best practices and the most current available treatment modalities in diagnosis and management.

The case study notes that patients often visit their eye doctor because they are experiencing specific signs and symptoms. Their doctor, based on their education, training and experience, will treat the patient using approved treatment options, considered “the standard of care.”

Standard of care reflects the degree of care a prudent practitioner would exercise—being informed by clinical guidelines, regulatory requirements, scientific journals and other sources, the doctors of optometry say.

By comparison, the authors say, clinical research “serves to enhance and move forward health care knowledge. The focus here is in generating novel insights, testing new approaches, and evaluating the safety and efficacy of health care interventions and treatment options.”

Its methodologies are rigorous and regulated.

The dilemma

For some, the difference between care and research may be evident. But, for others, particularly patients, the lines may appear to blur.

Both care and research can occur in the same clinical settings. A doctor might provide clinical care and perform research. For a patient, it might be confusing. For a doctor, it might create an ethical dilemma.

Write the authors: “It is important to distinguish one (role) from the other.”

The case study discusses the role of institutional review boards and informed consent documents in providing clarity for all.

“The clinician providing care and doing research should keep in mind the patient’s primary reason for the visit and let that guide their actions,” the study concludes.

Learn more about the professional ethics and values that guide the delivery of optometric care.

Have an ethical dilemma?

The AOA Ethics and Values Committee routinely produces hypothetical case studies concerning ethical challenges and how best to approach such situations based on the AOA Standards of Professional Conduct, AOA Code of Ethics and the Optometric Oath. Access these case studies through AOA’s member-exclusive, centralized education portal, the AOA’s EyeLearn Professional Development Hub.

Have an ethical challenge or question you wish to share? Submit your idea or a case description to legal@aoa.org. The case description may be reviewed by the AOA Ethics & Values Committee.