Absolutely Ridiculous Argument for an MD to Make Against Pharmacists

qwopty99

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Hi folks

This article was in yesterday's Toronto Star - the most highly-distributed newspaper in Canada.

It discusses the MD viewpoint on why pharmacists should not get "prescribing rights" (which at the moment mean extending prescriptions, changing medications, etc.). I don't really have an opinion in the matter (not my turf) but what I found shocking was that the MD being interviewed (Pres of the Ontario Assoc of Meds) used an eye condition to cite why pharamacists shouldn't "prescribe".


"We spend hours and years learning those skills," Arnold said of the training that goes into proper diagnostic technique. "And I'm not sure that it's just so easy for a pharmacist to pick that up," he said.

Arnold also questioned the term "minor" in reference to illnesses, saying things that look insignificant can escalate to dangerous diseases.

An optic ailment that may look like simple pink eye – something a pharmacist might presumably diagnose – could really be the first blossoming of something much worse, he said.

The early stages of glaucoma, for instance, resemble pink eye, he said. "And acute glaucoma could involve blindness in two days."


Why is this ridiculous? Because we've all (OMDs included) encountered COUNTLESS examples of family docs prescribing gentamycin for a pink eye for a week that doesn't heal, only to have the patient sent in to ophthalmology to discover the patient has iritis (or HZ, or what have you, but NOT pink eye). I know. I took these cases in the ophthalmology practice where I worked. I'm further certain that unless this Dr. Arnold himself is an ophthalmologist, he has never diagnosed glaucoma before (and doesn't know how to).

It's just ridiculous that in the fight with pharmacist-precribing, they use an ailment against pharmacists that they (the "average" MD) don't themselves know how to treat.

Ridiculous right?

http://www.healthzone.ca/health/article/540922
 

qwopty99

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Fair enough, but how many cases of acute glaucoma have you seen that your local internist diagnosed as pink eye?

I don't recall, but it may be the case that your internist has (mis)diagnosed EVERY "acute glaucoma" they have ever encountered as pink eye.
 
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panzer

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Cool the pharmacists get dragged in....

Let the :love: begin!


:smuggrin:
 

evilolive

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Here's my token two cents:

I wish I could be a doctor. OH WAIT! I already will be!
 

362.04

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Missing acute Glaucoma.

The most course of acute angle closure or pupillary block glaucoma is the sudden but grdual onset over 3-5 5 days of rapid IOP increase. If you see a patient at day 1, they have hyperemia Grade 1/5. Their corneas are clear. There is no pain, but discomfort. There is no affect on vision. There is no photophobia, no nausea, etc.

What you will see is an IOP of 18-20 in one eye and about 25-30 in the other. During the next 24 hours, that IOP will go to 30-40 and by the third day you will have 45-55. By the fourth day, you will have significant hyperemia 4/5, a slightly steamy cornea and pain. The patient may have vision of 3-4 lines worse than before. At 60 or higher, you will start to get a uveitis and corneal edema will approach 20% increase in corneal thickness thus obscuring the fine architecture of the iris.

Another acute glaucoma is uveitic glaucoma . In this, a uveitis is often mistaken for conjunctivitis or angle closure is either left mistreated. By the end of the 1st week, the IOP has gone up to 45-50. At the end of the second week, you will get 60. The pupils are immobile and you definitely cannot see much in the way of iris architecutre.

Lastly, a misdiagnosed condition is indolent uveitis that is mistaken for allergic conjunctivitis and is not painful, acutely red or not. But left untreated for 1-2 months or more (as I have seen), you will soon face the prospect of severe posterior synechiae with entrapped pupil. At 3-4 months, the IOP will be 30 or so coming up from 18 or so. Although not really a glaucoma diagnosis, the risk is there that it will become a pupillary block or uveitic glaucoma.

In fact, a primary care physician once called me a red eye which I found to be a Jarisch-Herxheimer reaction. The patient lost the sight of that eye.
 

qwopty99

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stop!!!!!!!!!!!

Stop what?

This thread is completely unrelated to the OD/OMD turf war that I think you are referring to.

This is a thread discussing a very current newsworthy article.

What is it about my post you don't like?
 

qwopty99

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Fair enough, but how many cases of acute glaucoma have you seen that your local internist diagnosed as pink eye?

I just want to point out that this has nothing to do with "bashing" internists or family docs or whatever. I'm sure when they give gentamycin for a "pink eye", they're completely aware that they might in fact not be looking at pink eye, but they also couldn't possibly refer EVERY pink eye they see to ophthalmology on first presentation, cause many of them will in fact BE pink eye. As such, they treat genta q.i.d. for one week and if there's no improvement, they send it off.

I don't expect non-OMD MDs to know eye stuff. They simply don't have the training and its no fault of their own.

My point is - why did that MD use an eye condition (of all things) to make his argument - I'm sure there could've been an equivalent "internal-med" analogy that would've been much more appropriate and resilient to criticism.
 
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