Curious about diagnosis process

[Ploppit]

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One comment (a jab, really) that one of my colleagues said to me about ophtho made me think about this and prompted me to ask on the forum:

At this stage in my training, much of the diagnosis / etc in every field is a learning opportunity and serves to provide plenty of intellectual stimulation, so it is hard to assess what one would consider 'intellectually stimulating' in 20 years.

In ophthalmology, is the diagnosis if various dzs largely pattern recognition (as opposed to an 'intellectual' diagnosis)?

I definitely can see that any specialty can boil down to pattern recognition to an extent, but am curious as to what you all have to say about this in ophthalmology.

 

[Kizzel]

I do agree on one thing, it is about pattern recognition and understanding the physiology behind the disease process. The real tough part sometimes is the actual surgical treatment for some of the conditions which can be technically very demanding. Again, once you become proficient in these surgeries then it does make it a lot easier. The big draw for people that do ophtho is the fact that you can see the problem with your own eyes and fix it with your own hands and really change the lives of many of your patients.

 

[BuckleExtrusion]

I do agree on one thing, it is about pattern recognition and understanding the physiology behind the disease process. The real tough part sometimes is the actual surgical treatment for some of the conditions which can be technically very demanding. Again, once you become proficient in these surgeries then it does make it a lot easier. The big draw for people that do ophtho is the fact that you can see the problem with your own eyes and fix it with your own hands and really change the lives of many of your patients.

Quite a misconception. there are many disease that you don't 'see' in ophthalmology that can kill the patient. Besides a few things, everything in the eyeball has a systemic cause. Let's say you'see' scleritis from TB, what are you going to do with your hands that will make a difference? 😛

 

[MstaKing10]

What do you mean by intellectual diagnosis? I think every diagnosis in medicine requires some degree of intellect to make, even the easy ones. While in ophthalmology the majority of disease processes you can clearly see on exam, there are many diagnosis which cannot be easily seen or fall into a large gray area requiring careful consideration.

Boiling down ophthalmology to pattern recognition only is a gross oversimplification. There are so many complexities and nuances to recognizing and treating ophthalmic disease that it does indeed take an intellectual and inquisitive type to learn well. While a surgical sub-specialty, the medical component I feel is equally if not more challenging. Sure, recognizing an RD or tear, cataract or swollen nerve is "pattern recognition." But feeling comfortable with how to diagnose and when to treat these patients is a different story. Knowing the differential diagnosis of different signs, how to evaluate them thoroughly, and eventually instituting a treatment plan requires a large degree of intellect. Essentially, just because you recognize something on exam doesn't mean you can the blindly follow an algorithm to diagnosis and treatment.

The same could be said of all fields in medicine really. Is seeing ST elevation on an EKG and elevated troponins simple pattern recognition of an MI requiring little intellectual input? Does it make consideration of a treatment strategy mindless? I don't think our cardiology colleagues would agree! There are tons of such examples.

I'm not even getting into the complexities of ocular surgery because it seems your post is in regard to the medical aspects of ophthalmology, but this adds a whole other level of complexity that many other fields don't have.

 

[JMK2005]

One comment (a jab, really) that one of my colleagues said to me about ophtho made me think about this and prompted me to ask on the forum:

At this stage in my training, much of the diagnosis / etc in every field is a learning opportunity and serves to provide plenty of intellectual stimulation, so it is hard to assess what one would consider 'intellectually stimulating' in 20 years.

In ophthalmology, is the diagnosis if various dzs largely pattern recognition (as opposed to an 'intellectual' diagnosis)?

I definitely can see that any specialty can boil down to pattern recognition to an extent, but am curious as to what you all have to say about this in ophthalmology.

Are you a medical student?? What background in ophthalmology does this "colleague" have?

Every speciality has its bread and butter diagnosis which are easy and pretty much pattern recognition. There are plenty of diagnosis which are not as straight-forward. The reason why medicine in general can't be practiced in a cookbook fashion is because variability in patient complaints and the variety of ways diseases can present. A good doctor makes the diagnosis look easy because he asks the right questions (pertinent positives and negatives) and able to identify pertinent exam findings. To do this, you need a good differential diagnosis.

Watch a medical student get an ophthalmic history and you'll see how the patient can lead the novice doctor astray.

 

[BuckleExtrusion]

One comment (a jab, really) that one of my colleagues said to me about ophtho made me think about this and prompted me to ask on the forum:

At this stage in my training, much of the diagnosis / etc in every field is a learning opportunity and serves to provide plenty of intellectual stimulation, so it is hard to assess what one would consider 'intellectually stimulating' in 20 years.

In ophthalmology, is the diagnosis if various dzs largely pattern recognition (as opposed to an 'intellectual' diagnosis)?

I definitely can see that any specialty can boil down to pattern recognition to an extent, but am curious as to what you all have to say about this in ophthalmology.

If you want pattern, go into dermatology. Even then those clowns punch biopsy everything anyway. Please PLEASE don't go into ophthalmology as we are *****s and you won't be stimulated enough.

 

[BuckleExtrusion]

Are you a medical student?? What background in ophthalmology does this "colleague" have?

Every speciality has its bread and butter diagnosis which are easy and pretty much pattern recognition. There are plenty of diagnosis which are not as straight-forward. The reason why medicine in general can't be practiced in a cookbook fashion is because variability in patient complaints and the variety of ways diseases can present. A good doctor makes the diagnosis look easy because he asks the right questions (pertinent positives and negatives) and able to identify pertinent exam findings. To do this, you need a good differential diagnosis.

Watch a medical student get an ophthalmic history and you'll see how the patient can lead the novice doctor astray.

The colleague is most likely another @ss clown medical student.

 

[azzarah]

Ophthalmology as a specialty has a little bit of both. But you have to realize that there are 9 subspecialties in ophthalmology and each subspecialty will be a little different in terms of how you approach the problems related to that area (just like nephrology vs. neurology)

A given diagnosis (such as proliferative retinopathy) may have a long differential diagnosis--similar to medicine where renal failure will have a long ddx that requires further investigation.

Each exam finding individually will also have a differential diagnosis--such as conjunctival follicles, inverted ERG, bull's eye maculopathy, etc.--similar to a swollen lymph node--there are many things that will cause a swollen LN, just as there are many things that will cause a bull's eye maculopathy.

What is different about ophthalmology and some of the other fields in my opinion is the following:

You will have the ability to do surgery and other procedures as part of therapy for many diseases (cataract surgery, retinal detachment surgery, orbital fracture, intravitreal injection, lasers, etc).

You will also be able to work with both adults and children if you wanted or you could just not work with patients at all (ocular pathology) or you could be anywhere else along this spectrum.

You can decide how much you want to interact with other disciplines (ocular oncologists work with rad-onc & oncologists for example, and neuro-op specialists work with neuro, medicine, neurosurg all the time, uveitis specialists work with medicine, rheum, etc., oculoplastics specialists work with derm, ENT, neurosurg, plastics, etc.) You get the picture.

Most patients really value their vision (often more than their life) & appreciate what you do for them. When I was a first year resident, I went to see a drunk patient with multiple facial fractures who was screaming, cursing, and refusing a chest tube for his pneumothorax. When I got there, he is like, doc, thank G-d you are here, how is my eye?