OD needs advice about PA

[TomOD]

Hello,

I'm an Optometrist and have my own practice. I am fortunate enough to get referrals from an Urgent Care clinic down the road from my office on occasion that is owned and run by a few P.A.'s (and a phantom M.D.). I also have a branch optometry office inside another medical clinic that is ran and staffed solely by a P.A. (with a supervision M.D. across town). I have great respect for each of them.

My question is how to approach the P.A.'s at the urgent care clinic about the care they are giving pt.s with eye problems. Too frequently, they will rx a weak antibiotic (sulfacetamide) to any person who walks in with a red eye. (I guess hoping that they will get lucky and it will go away on its own). I have had them treat a retinal detachment with antibiotic drops on one occasion. Another time it was iritis with sulfa-drops. Today they sent me a referral (finally) with a red eye x 4 days. She was a contact lens wearer who admited to sleeping in her lenses. The P.A. diagnosed a corneal abrasion and once again gave her sulfa gtts., and pressure patched her eye!! The first RULE in treating a C.L. wearer with a red eye is to NEVER patch. When she finally made it to my office ($215 later) she had and iritis with a peri-central corneal ulcer with peripheral infiltrates. She needed intense antibiotic therapy (q 15min. and you can't do that with a patch on), a cycloplegic and a few days later after the epithelium heal she will need a steroid for the iritis and to prevent corneal scaring. As it stands this young lady will be left with a fairly large scar just off of her visual axis (luckly).

I an not picking on P.A.'s in general because I also see this regularly with M.D./D.O.'s.

The eyes are a precious thing.....too much so to guess therapy.

I ALWAYS write the referring doc. a letter as a courtesy. I don't want to lose a referral source but I also don't want patients put in unnecessary harm. I don't try to treat ear infections or set broken bones....so how about leaving the eye problmes to eye doctors (OD or OMD's).

Thanks for letting me vent here.

Tom, OD

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[deleted6669]

Tom-I'm sorry that you have had a few bad experiences with p.a.'s and eye care.
as you said these things also happen with md/do patients....
keep in mind that many p.a.'s(especially those with an ER background) do know how to use a slit lamp and can dx and tx many routine eye problems.
from an ER setting we probably do send more folks on to specialty care than our primary care colleagues. I have consulted ophtho many times for iritis, glaucoma, retinal detatchment,globe trauma, etc.
as a rule our group(md/do/pa) tries not to use sulfa drops at all due to the high rate of allergic manifestations including itching/redness/pain. we use erythromycin ophthalmic ointment for most patients with conjunctivitis and corneal abrasions (without patching).also as a rule the pa staff in our group do not rx ophthalmic steroids without ophtho consult due to risk of missing/worsening herpetic infections. all patients presenting as iritis or glucoma are discussed with ophtho.
best of luck in your practice-emedpa

 

[CVPA]

Tom:

I share your frustration with this situation for two reasons. First, and most importantly, is the disservice that the patient's you described received. Secondly, it is frustrating and disturbing to hear of PAs who are practicing in the independent fashion which you have described. In my opinion, PAs should not be practicing under the "supervision" of "phantom MDs". Using phantom MDs is a way for some PAs to beat the system that requires real and legitimate supervision. This is totally inconsistent with the original design and philosophy of the profession. The cases that you have described are testament as to why PAs should not be practicing independently, although as you say you commonly see this with physicians as well. This type of scenario, however, is bad for our profession and counterproductive to good patient care. Additionally and unfortunately, this type of unique situation will also feed those who believe that PAs in general are inherently bad for medicine. I can hear it now......

As far as how to approach them is concerned, I have an idea that may serve two functions for you. Contact the group and ask them if you could provide a 1-hour Lunch/Seminar addressing "Common Opthalmic Pitfalls", or something like that. Put a little presentation together that addresses issues that you feel would be relevant to their practice. It will help educate them about common opthalmic conditions that they may see and how they should or should not be treated, while at the same time promote your services. I realize that 1-hour is not a realistic time frame in which to cover such a vast topic as opthalmic injuries/pathologies, however, it will be of some benefit and it will provide you the forum with which to address some of your concerns that you have expressed here.

Good luck.