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if you had a serious medical problem

Discussion in 'Optometry' started by HOLLYWOOD, Dec 4, 2005.

  1. HOLLYWOOD

    HOLLYWOOD Senior Member
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    if you had a serious medical problem would you go to a m.d. or an d.o.?(not starting a war with d.o.s some of my best friends are d.o.'s and my gp is a d.o.) i feel that most educated people will go to the m.d.. now let's say you, an educated person has glaucoma would you go to an optometrist or a glaucoma specialist ?( i manage glaucoma but some of my educated pts feel more comfortable with an md, my clinic pts dont care) my point is many ods feel that they are going to make a living txing dz. 1. most pts dont have dz.and 2. many patients feel more comfortable with an md. CHOOSE YOUR PATH CAREFULLY.
     
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  3. ariel winter

    ariel winter Senior Member
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    so you're suggesting all optometry applicants to apply to med school instead? hmmm, okay, this is interesting. while i admire your reservations to the optometry profession, i find it difficult to understand at times. from your previous posts, you seem to be doing quite well for yourself. i think most of us are "educated people" on this forum and thus understand the difference in responsibility and scope of and OD and MD. we have chosen this path for a reason. :)

     
  4. ProZackMI

    ProZackMI Psychiatrist/Attorney
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    Not to start a flame war, but you did ask. I'm an MD and my primary care doc is a DO. I have no problems with DOs since they have essentially the same training as MDs. Almost no difference in my mind.

    Now...asking if I had a serious ocular condition, would I see a physician or an optometrist? Uhhh, there is no question here: I would see the physician. If I needed glasses or CL, I would see an optometrist since it would be cheaper and faster; however, if I had a medical problem, why see an OD? No reason to see an OD unless you need a basic eye exam and new lenses. Sorry if the truth hurts. I don't care how many years you spend in school or if you've done a residency in CL, an optometrist is not a physician and only a licensed physician should treat any medical condition.
     
  5. ProZackMI

    ProZackMI Psychiatrist/Attorney
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    What's disturbing is that many optometrists, and to be fair, many other health care professionals, are trying very hard, through lobby groups and professional associations, to expand their scopes of practice to further encroach upon medicine (allo and osteo). An optometrist is an educated health care professional, but an optometrist is NOT a physician and should not be seeing patients for anything other than corrective lenses and basic eye exams. I can understand the desire to expand into the medical aspect of eye care, but I believe optometry is trying too hard to become more medicalized without justification or additional training.
     
  6. KHE

    KHE Senior Member
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    How much training does one need to prescribe patanol for an allergic conjunctivitis?
     
  7. ProZackMI

    ProZackMI Psychiatrist/Attorney
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    One could argue that if a master's level NP or bachelor's level PA can Rx antibiotics and/or antihistamines to treat simple conditions, why not an OD? While there is some merit to this argument, I still say an OD does not receive adequate training in clinical pharmacology especially in terms of contraindications and interactions of various drugs. If your patient presents with allergic conjunctivitis, and you prescribe an antihistamine like Olopatadine, which to my knowledge doesn't have any significant contraindications or interactions, would you really and truly understand if there were contraindications? What if you prescribed a topical that interacted with an ACE inhibitor for HTN or a TCA/SSRI? What if your patient is menopausal and taking Estrogen supplements? What if the medication(s) you prescribed caused some detrimental side effects? If the eye itching and burning progressed into significant edema, would you know what to do? If the antibiotic you prescribed caused severe diarrhea with abdominal distension/bloating, epigastic pain, and dehydration, would you refer the pt. to the ER or PCP? Does an optometrist fully understand the various possible drug interactions and contraindications? What about side effects? Dangerous side effects? You can pick up a PDR and investigate, but chances are, most serious side effects and contraindications would be way beyond your knowledge and scope of practice. I highly doubt you would. I guess, in the scheme of things, simple RxPs for ODs doesn't bother me too much, but what you guys should be allowed to do should be highly restrictive and require significant additional education.

    I would think as professionals ODs would want to avoid the liability doctors and dentists have, but being that optometrists seem to be actively seeking professional enhancement through expanded scopes of practice, you guys may very well be entering into an area where you really don't want to venture. With increased scopes of practice comes increased liability and culpability. Malpractice attorneys are going to love you guys: undertrained, enhanced scopes of practice, limited malpractice insurance coverage. Optometry will be ripe for litigation. I can just see the cross-examination in court.

    Your place is not medical treatment; it is refraction. If you want to provide medical services to your patients, go back to school and obtain an MD or DO, or...an MSN and become an NP. I would feel more comfortable with an NP prescribing an antibiotic or antihistamine than I would an OD.

    Psychologists also want RxPs. Soon audiologists will want to Rx meds to treat "basic" aural conditions like otitis media. They will argue that if an OD can Rx for conjunctivitis, why shouldn't they have RxPs to treat similar conditions like OM? I can understand the defensiveness most ODs have and view my comments as an attack, but honestly, an OD is not trained to be a physician and should not delve into practicing medicine without first obtaining an MD or DO. An OD is, and should remain, a professional technician whose job is to perform basic ocular exams and prescribe the appropriate corrective refraction. Your profession is an honourable, ethical, and skilled one, but it is not medicine, nor is it even comparable to medicine.

    To quote Capt. Jean-Luc Picard in "Star Trek: First Contact", "The line must be drawn HERE!"
     
  8. Ben Chudner

    Ben Chudner Senior Member
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    Zack, I can respect your need to lobby against allied health professionals trying to gain additional priviledges. The flaw in your arguement, however, is that in the states that allow unlimited orals and injectables (which is really what most states are lobbying for) there is not an increase in malpractice litigation against OD's. The malpractice insurance is not any higher in those states than it is in highly restrictive states. Until the MD's can prove that patients in states such as NC and OK have been harmed by allowing OD's to practice at that level, you really have no basis for your arguement. And before you shoot back the usual retort to that statement "you have no proof there has not been any harm to patients", just know that I have no interest in trying to prove a negative. You might as well ask me to prove there is no God.
     
  9. HOLLYWOOD

    HOLLYWOOD Senior Member
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    you just proved my point. thank you
     
  10. HOLLYWOOD

    HOLLYWOOD Senior Member
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    i'm not telling you to apply to med school. if you want to be a medical dr. then apply. i'm just telling you it's not all pathology out there
     
  11. HOLLYWOOD

    HOLLYWOOD Senior Member
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    the problem with optometry school is not the didactic part its the clinical. i only saw about 2500 pts before i graduated.
     
  12. sco1styear

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    I would argue that you have not been through the optometry curriculum and therefore lack the knowledge adequate to determine whether or not we are capable or knowledgeable of the above. There's a reason the NBEO has pharmacology questions and a reason behind individual state pharmacology tests that must be passed; to determine if we are capable.
    Now I cannot speak for other schools (optometry or otherwise) but at SCO we have an extremely rigorous pharmacology curriculum. Pharmacology is taught by a MD who graduated from Oxford and has more letters behind his name than should be allowed. He makes sure we understand how serious it is to prescribe drugs. This is a class that will cause some to fail out of school.
    We don't graduate without having a "significant" education.
     
  13. IDOC_2BE

    IDOC_2BE New Member

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    At Nova, we take phamacology classes side by side with dental students.
     
  14. HOLLYWOOD

    HOLLYWOOD Senior Member
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    GREAT POINT. DO YOU TAKE THE SAME TEST? WHEN I WENT TO NOVA WE TOOK IT WITH THE MED STUDENTS. WHAT OTHER CLASSES DO YOU TAKE WITH THE DENTAL STUDENTS? YOU KNOW SOME PROFESSORS TEACH THE PODIATRY STUDENTS AT BARRY UNIV. SAME MATERIAL SAME TEST. GOOD LUCK AT NOVA.
     
  15. rpames

    rpames Optometrist
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    At ICO we have a prof. (not the pharm prof) who took pharm with MD students when she was getting her PhD and she said our pharm is more extensive.
     
  16. KHE

    KHE Senior Member
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    Though I'm an optometrist, I would be skeptical of this claim.

    I guess it's possible that the didactic portion of pharmacology may be more "extensive", but I believe that a substantial portion of pharmacological knowledge comes during clinical rotations and residencies for medical students.

    The end result of this being that I'm sure MDs end up with a much broader and indepth knowledge of pharmacology than ODs at the end of their training.

    Now as to whether or not ODs have enough knowledge and skill to practice to the extent of their licensure is a different story, and for that situation I firmly believe that the answer is YES.
     
  17. Ben Chudner

    Ben Chudner Senior Member
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    Exactly. I realize there is a desire to prove Zach wrong, but this is not the arguement to make. Regardless of how many hours of pharm OD's get in school, for the most part our education is focused on the eye. MD's get a much broader and more in depth education in pharm through their didactic courses and their clinical rotations and residencies than we ever will.

    That does not mean we should be relegated to refractions and contact lens fittings. In my opinion, the laws in OK and NC are probably as far as OD's should go in terms of scope. The MD's disagree, of course, but the inescapable truth is that there has not been a flood of deaths caused by the OD's in those states. Malpractice rates are not on the rise in those states. If there were evidence that an OD caused any harm in those states, you can be sure the AMA and the AO(phthal)A would be all over it.

    Zack has an issue with allied health professions trying to expand their scope without the proper training. The evidence suggests, however, that OD's that practice in OK and NC have the proper training, or at least the proper restraint to only treat what they are comfortable with. We will never convince Zack that he is wrong, just as he will never convince us that we are wrong. My advice is to stop trying to prove our case with the number of hours of pharm and simply demand that we see proof of patient harm at the hands of an OD.
     
  18. rpie

    rpie Senior Member
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    Well stated Ben. Having been on both sides, the basic knowledge and course work is about the same. I also agree with Ken. The difference comes for the clinical and residency training that MD’s get. As far as “educated patient “ not feeling comfortable having an OD treat them, I think it depends on what your practice emphasis is. In our practice, we have MD’s DDs and lawyers that have been having us manage their glaucoma the past 8-10 years. The reason they started to come to us was because they were impressed with how we took care of their patients. I will also add that initially when these “educated patients” started coming to us they though they were coming to an all OD group practice and did not know that some of the OD’s had been to med school.
     

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