Consults- Memorable/Dismal/Ridiculous/Unique

[eyeeye_captain]

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Was the doc another ophtho, or an FM type?

Sadly another ophtho with the kind of reputation you’d expect.

Worst injection complication I’ve heard of, ironically with the same med here, was something my friend claims he saw in residency. FM doc injects a chalazion for his resident (of all people) with subsequent vision loss. Somehow he’d apparently gone through the lid, halfway into the eye, and injected into the lens.

Google doesn’t show a case report unfortunately, would love to see the pictures. I’ll have to shoot him a text.

There are also a good number of reports of central retinal artery occlusions from periocular filler injections. Guess that’s one way not to notice your wrinkles.

 

[VA Hopeful Dr]

Sadly another ophtho with the kind of reputation you’d expect.

Worst injection complication I’ve heard of, ironically with the same med here, was something my friend claims he saw in residency. FM doc injects a chalazion for his resident (of all people) with subsequent vision loss. Somehow he’d apparently gone through the lid, halfway into the eye, and injected into the lens.

Google doesn’t show a case report unfortunately, would love to see the pictures. I’ll have to shoot him a text.

There are also a good number of reports of central retinal artery occlusions from periocular filler injections. Guess that’s one way not to notice your wrinkles.

I was an ophthalmic tech for 2 years before med school, FP now. Why the hell would any FP put a needle anywhere near the eye outside of maybe, MAYBE, FB removal?

 

[eyeeye_captain]

I was an ophthalmic tech for 2 years before med school, FP now. Why the hell would any FP put a needle anywhere near the eye outside of maybe, MAYBE, FB removal?

Maybe? Most people run away from anything near the eyes. I’m just lucky to have been nowhere near him to have to see any more misadventures.

That’s not to say folks won’t try it if there’s some money and/or scope involved. I do zero cosmetics, but those medspas staffed by an army of 2 day weekend certificate needle jockeys have you covered. At least the ODs have to take a full FOUR day course to be an “optometric surgeon”. (I legitimately have no clue what’s going on in that photo, but I’m qualified to say it isn’t surgery. Guess it’s not their fault when they’ve never actually been in an OR, but they’ve seen it on TV or were playing dress up with their kids.)

 

[VA Hopeful Dr]

Maybe? Most people run away from anything near the eyes. I’m just lucky to have been nowhere near him to have to see any more misadventures.

That’s not to say folks won’t try it if there’s some money and/or scope involved. I do zero cosmetics, but those medspas staffed by an army of 2 day weekend certificate needle jockeys have you covered. At least the ODs have to take a full FOUR day course to be an “optometric surgeon”. (I legitimately have no clue what’s going on in that photo, but I’m qualified to say it isn’t surgery. Guess it’s not their fault when they’ve never actually been in an OR, but they’ve seen it on TV or were playing dress up with their kids.)

My dad was an optometrist. Apparently the ones that want expanded scope for procedures mainly want/wanted anterior chamber lasers.

Now admittedly he's been dead for 21 years so things might be different now.

 

[eyeeye_captain]

My dad was an optometrist. Apparently the ones that want expanded scope for procedures mainly want/wanted anterior chamber lasers.

Now admittedly he's been dead for 21 years so things might be different now.

It’s changed a lot, and no shade against the profession then or now. More of a shift toward medical eye care as opposed to mostly glasses/contacts. Very good at what they do, but procedural work is, as I noted, not exactly taught to a rigorous degree.

Most of the education comes from ODs who taught themselves after getting scope expansion through state legislatures then “teaching” others from there. It’s at worst scary mid-level stuff, but I’d say they’re generally very good at saying “nah, that ain’t my speed.”

 

[WinslowPringle]

1. Pt shows up to clinic 3pm insistent he see us. Irate. We do extensive chart search to figure out…..supposed to be at the competing practice across town. He didn’t apologize. Ooops.

2. Pt consult for an asymptomatic CT finding. Doesn’t meet any criteria for surgery but transplant team is insistent he get it because he “needs it for his transplant”. (No data support this.) Pt also has multiple other functional deficits……and is moving out of state next week. I did not book him.


3. Patient has been in the hospital for over a week, had relevant studies the week prior. I am consulted on supposed day of discharge for discharge “clearance”. Of course consulting team doesn’t call me personally…..I hear about it from the floor nurse in the evening as in “why haven’t you seen this patient, they can’t go home until you do.”


4. Patient is near end of life, bed bound, has a drain in, been in the hospital over a month. Drain has minimal (normal physiological) output and has like three studies demonstrating no residual fluid. I am consulted for a surgery to deal with this fluid that doesn’t exist. I recommend the inserting team pull the drain…..and after I discuss goals of care with the patient (who wants to go home and have no more interventions), I also recommend the medical teams do the same and if they won’t have the decency to have that conversation, consult someone who will. They consult palliative and she gets out a week later.