Originally posted by Ophtho_MudPhud
Tom,
This is such a naive statement. Consider these cases.
There was a case where the OD failed to diagnose pellucid marginal degeneration and sent the patient for LASIK through a co-management deal. The patient had a horrible outcome. Both the MD and OD are being sued. They go back to the OD's office and find multple cornea topography scans clearly showing the pellucid degeneration.
Another case where an OD was co-managing post-cataract surgery. The IOP was very high, and the OD kept "burping" the cataract wound, even though there was vitreous to the wound. By the time the retina service saw the pt, there was a complete RD. Interesting "co-management" issue to have non-surgeons manage post-operative patients.
And another recent case where the patient was too nice to place blame on anyone. My patient had a sharp piece of metal hit his eye (pinpoint injury). Went to see the local OD with the complaints of slimey discharge from the eye, floaters, but 20/20 vision. OD prescribed Gatifloxacin. Pt then developed endophthalmitis. Presented 5 days later with LP vision. I look at the patient and find a vitreous strand protuding from a superior-nasal, pin-hole scleral defect. Had the defect been recognized, then one stitch in the OR with exploration would have sufficed. Instead, the patient presents with florid endophthalmitis with necrotic retina.
So be aware that when patients sue, they usually sue the surgeon. Furthermore, most patients doen't sue, and cases of negligence remain forever lost, except for the patients who live with their problems.
Okay, I'll go:
I will be willing to bet that in your academic center you see misdiagnosed referrals from both OD's and Ophthalmologists.
I have a few for you right in my office.
A temporal lobe lesion misdiagnosed as glaucoma for 3-4 years on a patient that NEVER had a visual field from 2 seperate Ophthalmologists. She's under the care of an neurosurgeon now.
A recurrent corneal erosion misdiagnosed for years and treated with erythromycin ung for 8 months by an OMD. (Despite the 'textbook' complaint of sore, irritated eyes first thing in the morning).
A lady with 0.90/0.90 cupping treated with Restasis for dry eyes with recent, 2 month old copies of the OMD's record showing 0.30 cupping.
A foolish OMD that doesn't get my cataract referrals because he refuses to use post-operative Pred-Forte for fear of pressure spikes! He sends patient back consistanly with inflammed, red eyes and worse post-op vision.
I have case after case of patients misdiagnosed with macular degeneration with 20/15 acuity and perfect maculas (insurance fraud??)
I've had a lady with an orbital floor fracture undiagnosed by an OMD the morning before I saw her.
I've had a child with Retinopathy of Prematurity and angle-closure a week after seeing an OMD who refused to see the child that day.
I had a guy today with a lid infection that had LASIK sx 2 months ago. I've seen him 5 times over 2 years for corneal abrasions, FB's and ulcers/infiltrates. There is no way in HELL that OMD should have taken his money and did refractive surgery. He is now +2.00-1.00 x 176 20/30 and -0.75 - 1.00 x 097 20/40 in the other with scarring and corneal haze. He was -1.50 OU before. This was not a comanaged case. He just happened to be in town for a lid infection. Disgraceful.
I got cases of OBVIOUS Keratoconus undiagnosed by previous OMD's.
I've had a guy go to 3-4 different doctors (OD's and OMD's) to figure out why he couldn't see. He had very small PSC that the other doctors were either too lazy to see or still using the anitiquated slit lamps. He had cataract surgery and is doing great.
I refered a lady for M.G. that had complained to her OMD for a year about drooping eyelids and fatigue. Neuro confirmed the diagnosis.
I could go on. And these are just off the top of my head within the last 3 years.
No doubt that doctors make mistakes. But if you here telling me only OD's goof up some times and every Ophthalmologist is perfect, I have some charts I'd like to show you...some simply scribbled notes on 3 x 5 index cards with little more than "VA's and IOP's".
But if we are really talking about scope of practice and harm, most opticians in the know and most consultants can tell you that Ophthalmologists should not touch a phoropter. Their remake rate is rediculous. It's very poor optical training and skills. (How's that for a blanket statement). How many OMD's do von-Grafe phoria testing, NRA/PRA's, accommodative convergence, bi-chrome testing. Hell for that matter, how many Ophthalmologists even own near point rods?
How many have tech's put in the autorefration and write the spectacle rx from that.
But I give up. All of you guys (and gals?) are right. I'm going to tell all my patients I'm a clown and a fraud. I'm going to make them give me that bottle of Timpotic back because it's doing them no good. I'm going to call the guy with the lid infection tomorrow morning and tell him to stop taking the dicloxicillin because I had no business giving it to him. And I'm going to tell the lady who had tears in her eyes when I told her she didn't have macula degeneration that she, in fact, does have it because the careless, sloppy OMD told her she did and he is much smarter than I am with my 90D and HRT. I'm going to sell my Lexus and my house and give the insurance companies their money back.
I'm going to close down my office Monday and quit work and go back to medical school and learn about orthopedics and ob/gyn. That'll help me treat glaucoma better. Don't worry, I'll send all of my patient's to a real doctor in the meantime.
Really, I'm getting bored with it and my 3 year old needs some attention. We aren't going to change anyone's mind here. Remember, it's better to try to elevate yourself and your profession than to try to bring others down. You can't go forward yourself when your holding someone down to the ground.
It's time to play. I'll move aside and let anyone else who would like to respond do so.
Happy Thanksgiving everyone.