Ethics in Optometry

[eyedream82]

Your partner is on extended vacation. One of his patients comes in and you discover the patient has and probably has had for some time now, chronic open angle glaucoma. Neither you partner nor the patient is aware of this. What do you do?

anyone want to take a stab at this situation and how you would handle it?

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[od2b77]

Your partner is on extended vacation. One of his patients comes in and you discover the patient has and probably has had for some time now, chronic open angle glaucoma. Neither you partner nor the patient is aware of this. What do you do?

anyone want to take a stab at this situation and how you would handle it?

Easy in my book! As a doctor, you are obligated to provide the best care you can. Thus, I would tell the patient whats going on and start that patient on a treatment plan. Then I would try to understand why didn't my partner see that before. I'd check how often the patient comes in for a check up, if he/she refused dilation... If I cannot come up with any reasonable explanations, I would rethink my partnership, as that partner is obviously a bad OD.

 

[file014]

I think there's too many questions that need to be answered first. Was the doc not doing tonometry, DFE, or visual fields at all in the past? Are the records just way off on the actual C/D ratio's? What are the current indications that the patient has glaucoma?

Or iss this just a hypothetical situation for the sake of conversation?

 

[Tom_Stickel]

OD2b77,

I think in this case it would be a little early to jump the gun and label your partner a bad OD. Much as we would all like to think differently, doctors occassionally make errors. Long before you rethink your partnership or form an opinion of your partner, you need to actually DISCUSS the issue with your partner. Glaucoma's a tricky disease. You need to find out why s/he did what s/he did. If you can't discuss something like this openly with a partner, your partnership is already in big trouble. If your gut instinct to this situation is to think about dissolving the partnership instead of communicating, I'd strongly advise you against ever entering into a partnership.

As for the patient, just tell them that glaucoma develops over time, they didn't have it before, they have it now, and they need treatment.

I have a dentist friend who tells me about a patient he saw with fillings and work that just looked awful. His first instinct was to wonder what kind of quack had worked on him. He of course thought that he could do a much better job. When the patient asked him about the work, he bit his tongue, sai d it looked OK, but that he was going to touch it up. Turns out that the patient was horribly uncooperative, moved all over the place, and was very skittish. Because of the patient, by the end, my friend's work didn't look any better than what he thought he would fix. Goes to show that if you weren't there at those exams, you never know exactly what occurred.

Now this is different than seeing a pattern. If one of your patients come back from the cataract surgeon with a torn up iris, then maybe that patient coughed during surgery. If every third patient comes back like that, you have an ethical obligation to find another surgeon. Or if you start to review your partner's charts and see a pattern of problems, then you could think about dissolving your partnership.

Tom Stickel
Indiana U. 2001

 

[od2b77]

Tom, good point. But would like to point out that I said that I would rethink the partnership if I cannot find a reasonable explanation for the error. Thus, I would look into everything that could possibly occur and yes, I would discuss this with the partner as soon as possible. And yes, I would consider my partners history. If thats the only or one of the few mistakes, thats not a problem as we're all only human ( I guess thats what the insurance is for)

 

[JennyW]

Easy in my book! As a doctor, you are obligated to provide the best care you can. Thus, I would tell the patient whats going on and start that patient on a treatment plan. Then I would try to understand why didn't my partner see that before. I'd check how often the patient comes in for a check up, if he/she refused dilation... If I cannot come up with any reasonable explanations, I would rethink my partnership, as that partner is obviously a bad OD.

I would be very cautious about saying that someone is "obviously a bad OD" for having missed a diagnosis. There are always two sides to every story.

Also, you should never have to reconsider a partnership based on clinical competencies because if you feel that your partner is not clinically competent, then you should never have formed a partnership with them in the first place. You should have known this long before you formed the partnership.

Jenny

 

[cpw]

Never be too quick to judge another doctor... things have a way of presenting to you,even a few days later, which look ENTIRELY different from the way the patient presented initially. (especially with herpes)

 

[rpie]

Never be too quick to judge another doctor... things have a way of presenting to you,even a few days later, which look ENTIRELY different from the way the patient presented initially. (especially with herpes)

I agree with Jenny, that before you go into any partnership or group practice you must feel absolutely comfortable and confident in your associate/partners abilities. Tom’s suggestion about telling the patient “he now need TX “ is exactly what I would do. Keep in mind that in many cases if your partner/associate looks bad so do you.

An interesting glaucoma case I will share with you all. One of my associates patients last week had IOPs of 12,13, C/Ds, .45. Doing an FDT and threshold VF’s actuate scotomas in both eyes were found and confirmed. My associate placed him on Travatan that lowered his IOP to 9 and had our fellowship trained Glaucoma sub-specialist take over the care since she did not feel comfortable managing or co-managing an LTG patient. (Especially since he is 39 Y.O.)

This patient had been going to a group practice of 2 OMDs for the past 7 years, and also notorious for bad mouthing many practices including ours. I guess they were more concerned about judging what we do instead of taking care of patients.

 

[xmattODx]

An interesting glaucoma case I will share with you all. One of my associates patients last week had IOPs of 12,13, C/Ds, .45. Doing an FDT and threshold VF’s actuate scotomas in both eyes were found and confirmed.
This patient had been going to a group practice of 2 OMDs for the past 7 years, and also notorious for bad mouthing many practices including ours. I guess they were more concerned about judging what we do instead of taking care of patients.

I heard some good advice once:

Never be too quick to judge another doctor...

 

[sco1styear]

Hello fellow classmate,
I was originally looking for the same answer you were...and stumbled upon this. So, let me now rephrase your original question....does anyone know any sources we can use to answer this question?