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An Interesting Site on Malpractice Claims
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Originally posted by anothertony
Tom OD,
the one case about "Delayed Diagnosis and Treatment of Glaucoma", I thought Glaucoma is irreversable ....
I thought we can only minimize or delay its effects....
True.
In this particular case, I believe the complaint was unneccessary surgery with incidental bad results.
These cases just go to show how easy it is to get sued and how patients and attorneys will go after the doctor, even in the face of obvious patient non-compliance.
"Outcome
The litigation screening panel agreed that surgery was an option in 1988 when the insured first recommended it. However, in the absence of intervening problems, the ophthalmologist on the panel did not believe surgery was clearly warranted based on clinical findings alone when the patient returned two years later. In the end, it was the patient's demonstrated noncompliance in "disappearing" for two years which convinced the panelists that the insured's treatment plan was justified nonetheless. Documentation by the insured and subsequent treaters specifically indicated that the patient was noncompliant in keeping appointments and taking medications. This documentation laid a firm foundation for the defense's arguments that it was probably the patient's own negligence which caused her reduced visual acuity."
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Originally posted by anothertony
Tom OD,
the one case about "Delayed Diagnosis and Treatment of Glaucoma", I thought Glaucoma is irreversable ....
I thought we can only minimize or delay its effects....
Think of glaucoma like this.
Vision is like sand in an hour glass. Once it's gone... that's it.
As people age, there's already a natural loss of the sand b/c the ganglion cells die at a steady rate with age. It's the natural progression of life. Glaucoma (which can be the result of numerous diseases) will speed up the lost of the sand. Medical and surgical therapies influence how fast the sand flows. Thus, with proper medical and surgical treatment, we can slow the process so that patients don't have to die blind.
A good example is congenital glaucoma in children. If the diagnosis is missed at age 2 months, then the child will be count fingers vision at age 2 years. However, if surgery had been done at 2 months, then the child will grow into a normal, productive individual without a white cane.
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What's this "count fingers vision"?
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Dear aphistis,
When a visual acuity is less than the largest letter on a vision chart, the examiner will hold up fingers at 10, 6, or 3 feet. This gives the examiner an indication of the vision much like 20/something would. Of course Hand Motion (HM) is the level of vision that is more severe than "CF (counting fingers)" or "FC (finger counting)".
Richard_Hom
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Egad. So by the time someone reaches that point, I'm assuming the patient is pretty much blind from a functional viewpoint? This is one test I suppose I don't want to score off the chart on.
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Correct.
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Andrew Doan,
wow! comparing glaucoma to sand in an hour glass is a brilliant analogy, I have to admit.
I didnt think about it that way......
when I did my internship with my optmetrist last summer, I remember the older patients always asked why they are getting cateract and the Dr. always told them:
"because of all your birthdays!"
...I thought he was weird for mentioning "birthdays" but now it makes sense! the older you get ( and this will happen to all of us) the more likely you will become to developing some kind of eye disease.....some treatable, some not.....
but this aging problem begs another question: if the death of ganglionic cells are the CAUSE of the sand falling down the hourglass, shouldn't we be doing more research on how to PREVENT these valuable cells from dying? I mean, prevent ganglion cells from dying and you prevent blindness! am i on the right track here?
wow! comparing glaucoma to sand in an hour glass is a brilliant analogy, I have to admit.
I didnt think about it that way......
when I did my internship with my optmetrist last summer, I remember the older patients always asked why they are getting cateract and the Dr. always told them:
"because of all your birthdays!"
...I thought he was weird for mentioning "birthdays" but now it makes sense! the older you get ( and this will happen to all of us) the more likely you will become to developing some kind of eye disease.....some treatable, some not.....
but this aging problem begs another question: if the death of ganglionic cells are the CAUSE of the sand falling down the hourglass, shouldn't we be doing more research on how to PREVENT these valuable cells from dying? I mean, prevent ganglion cells from dying and you prevent blindness! am i on the right track here?
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Neuroprotection is a major focus in ophthalmology research right now.
Interestingly, high intraocular pressure is only one factor that influences the health of the ganglion cells. For instance, there are individuals who have severe glaucoma with low intraocular pressures. We have yet to understand the complete pathophysiology of glaucoma.
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thank you Dr. Doan,
I enjoy reading your comments---
listen, my friend starts Dental school this year and he found a book online called "Anatomy of the teeth".....he told me that its gonna really help him in dental school.
is there a book you can recommend for me to read (about the eyes) before i begin optometry school this year?
(p.s this Q'n is directed to anyone really....) it would be nice to get a head start you know...
I enjoy reading your comments---
listen, my friend starts Dental school this year and he found a book online called "Anatomy of the teeth".....he told me that its gonna really help him in dental school.
is there a book you can recommend for me to read (about the eyes) before i begin optometry school this year?
(p.s this Q'n is directed to anyone really....) it would be nice to get a head start you know...
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Tony,
I recommend the book written for beginning ophthalmology residents cited in my FAQ. You will find the reference there by clicking on the link in my signature.
Best regards,
Andrew
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Originally posted by anothertony
many thanx Dr. Doan
No problem. I also recommend the Wills Manual to provide a general introduction to eye diseases.