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kassie

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4 months my eager friends and the AAO membership will be yours! BUT MORE IMPORTANT, SO WILL THE OPHTHALMOLOGY CONSULT PAGER ;) .

I can't wait!!! I even stopped by my future program the other day during vacation/meternity leave with baby for a motivation to return to internship next week!

I'm looking forward the the consult pager in place of the code and backup pagers! :D
 

eyedr

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I can't wait!!! I even stopped by my future program the other day during vacation/meternity leave with baby for a motivation to return to internship next week!

I'm looking forward the the consult pager in place of the code and backup pagers! :D

The inpatient consult pager is the least desirable job in ophthalmology in my opinion.
 

RetFellow

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The inpatient consult pager is the least desirable job in ophthalmology in my opinion.

That is indeed the worst.

Well, let me clarify. Having to deal with eye consults incompatible with common sense is the least desirable job.

I could not stand it during my first year. One of the "compensations" my co-chief gave the first year resident who provided him the most cataract sign-ups at our county hospital was to take day call (=inpatient consults) for one day. He must have been way desperate for more phacos.
 
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The inpatient consult pager is the least desirable job in ophthalmology in my opinion.

My classmate got a call from a primary team for patient with "bilateral orange spots in the visual field x24hrs"

Primary team (PT): You need to get here quick and r/o bilateral retinal detachments!
Consult Resident (CR): Does the patient see orange spots after looking at the ceiling light for a while?
PT: Not sure, but there are several ceiling lights in the room.
CR: What's the vision?
PT: We don't have a near card, can't check it
CR: Probably not an RD.
PT: But our attending wants you to see the patient STAT!


Ah..... We'll always be in business, boys and girls.
 

eyedr

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My classmate got a call from a primary team for patient with "bilateral orange spots in the visual field x24hrs"

Primary team (PT): You need to get here quick and r/o bilateral retinal detachments!
Consult Resident (CR): Does the patient see orange spots after looking at the ceiling light for a while?
PT: Not sure, but there are several ceiling lights in the room.
CR: What's the vision?
PT: We don't have a near card, can't check it
CR: Probably not an RD.
PT: But our attending wants you to see the patient STAT!


Ah..... We'll always be in business, boys and girls.


What irritates me the most is not that they didn't check a vision, but even more irritating is when they act like they never learned how to check a vision. When asked to use their Maxwells (the medicine folk are like "what's that") I thought the Maxwells was to medicine what the pccket rosenbaum is to ophtho
 

Visionary

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My favorite is the consult for completion of an interesting patient workup. For example, we have received multiple consults from GI to examine patients with hepatic failure of undetermined etiology for Kayser-Fleischer rings. How about just drawing a serum ceruloplasmin, folks?

A close second is the inpatient diabetic screening exam, because "this patient will probably not follow up in clinic." Well, that will make any potential retinopathy treatment difficult, won't it?
 

rubensan

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:D :D :D
I can't wait!!! I even stopped by my future program the other day during vacation/meternity leave with baby for a motivation to return to internship next week!

I'm looking forward the the consult pager in place of the code and backup pagers! :D
 

rubensan

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at hopkins??? i'm shocked!;)

My classmate got a call from a primary team for patient with "bilateral orange spots in the visual field x24hrs"

Primary team (PT): You need to get here quick and r/o bilateral retinal detachments!
Consult Resident (CR): Does the patient see orange spots after looking at the ceiling light for a while?
PT: Not sure, but there are several ceiling lights in the room.
CR: What's the vision?
PT: We don't have a near card, can't check it
CR: Probably not an RD.
PT: But our attending wants you to see the patient STAT!


Ah..... We'll always be in business, boys and girls.
 

rubensan

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:clap: i equate this to calling a cardiology consult without an ekg or a renal consult without checking a BUN/Cr

What irritates me the most is not that they didn't check a vision, but even more irritating is when they act like they never learned how to check a vision.
 

eyedr

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:clap: i equate this to calling a cardiology consult without an ekg or a renal consult without checking a BUN/Cr


On that note....when I do get that dumbfounded response about visual acuity and ophthalmic history, I usually say, "Would you call a cardiologist without listening to someone's heart sounds, or place a gen surgery consultation without palpating the abdomen?"Please check these vital ophthalmic signs for me so I can better triage the importance of your consult since I have 10 other urgent ones pending!" Boy does that get their blood boiling, but they have no foot to stand on! :)

Sometimes though, its just faster at this point in the year to go dilate and examine the patient yourself
 

orbitsurgMD

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My favorite is the consult for completion of an interesting patient workup. For example, we have received multiple consults from GI to examine patients with hepatic failure of undetermined etiology for Kayser-Fleischer rings. How about just drawing a serum ceruloplasmin, folks?

A close second is the inpatient diabetic screening exam, because "this patient will probably not follow up in clinic." Well, that will make any potential retinopathy treatment difficult, won't it?

Those consults should be referred to the residency outpatient ophthalmology clinic service. Your attendings should back you up on that. The issue of whether the patient is thought reliable is irrelevant, the reason for consultation does not merit inpatient consultation, and you should just say so. A bedside exam is sub-optimal, and if the patient is ambulatory, they can be sent to the clinic.
 

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Those consults should be referred to the residency outpatient ophthalmology clinic service. Your attendings should back you up on that. The issue of whether the patient is thought reliable is irrelevant, the reason for consultation does not merit inpatient consultation, and you should just say so. A bedside exam is sub-optimal, and if the patient is ambulatory, they can be sent to the clinic.

Oh, believe me I do! Did even as a 1st year resident. I'm not into wasting my time.

Here's another one: NICU calls on a newborn with suspected septo-optic dysplasia. Got that one 3 times in 2 months. You kidding me?
 

eyedr

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Oh, believe me I do! Did even as a 1st year resident. I'm not into wasting my time.

Here's another one: NICU calls on a newborn with suspected septo-optic dysplasia. Got that one 3 times in 2 months. You kidding me?


NICU's are infamous for fishing for eye pathology. My NICU consults thus far have been r/u Lisch nodules for suspected NF (genetic screening was still pending), rule out retinitis pigmentosa (baby is intubated and sedated...they insisted on a bedside ERG, and came to reality when asked how it was going to change their management)

My favorite consult this year was for a long term diabetic with poor vision x 1 month who was admitted for something cardiac. Turns out this patient was well known to our clinic with h/o PDR s/p PRP OU and CSME OU despite FML and kenalog and TRD OU and he complained fluctuations in his vision to the primary team. After reviewing his previous clinic note (from just two weeks prior) I tell the primary team, no need for me to consult (oh and I checked is vision which was better than his last documented vision). Told them to have the patient follow up after discharge. I also dropped a note stating this in the chart. My senior gets a call several hours later that I was being negligent and refused a consult!!!!

It was a great feeling when my senior stood up for me and told the medicine attending that I had made the right call and there was no need to re-examine this patient in house.
 
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As a resident, I was consulted by the renal team on a patient that had a "fixed, dilated pupil". The patient was a) well-known to Ophthalmology and had last been seen THAT DAY b) was putting in Atropine in the eye in question and c) this fact was KNOWN by the consulting team. None of these points were accepted as reasons not to perform a consult by the Renal attending who wanted to "just make sure everything's okay". Man am I glad those days are over!
 

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As a resident, I was consulted by the renal team on a patient that had a "fixed, dilated pupil". The patient was a) well-known to Ophthalmology and had last been seen THAT DAY b) was putting in Atropine in the eye in question and c) this fact was KNOWN by the consulting team. None of these points were accepted as reasons not to perform a consult by the Renal attending who wanted to "just make sure everything's okay". Man am I glad those days are over!

I've got a better fixed, dilated pupil for you: turned out to be a prosthetic eye!
 

rubensan

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by request, i have moved our cazy ophthalmology consult testimonials to a new thread.

kassie, don't let us get you down. you should look forward to ophthalmology residency! it is a much better year than internship in many ways. one moderator of this forum once told me when i was in your shoes that the pain will still be there during opthhalmology residceny, it has just morphed from endless insulin sliding scales and the feeling of being a hospital dumping ground to becoming a nice little package called the ophtho-on-call pager.

i guess my problem is not that i mind carrying the consult pager to r/o the kayser-fleisher rings that ended up being arcus even when the primary team neglected to check a ceruloplasm or the NICU consult on a tiny 31-weeker to r/o ocular toxo because the mom's "toxo IgG was potitive." nor did i mind stumbling down to the trauma bay at 300AM to do a canthotomy cantholysis on a pt with a "retrobulbar hemorrhage" that ended having both pupils fixed and dilated OU with IOPs 10,12 OU dx: dead patient.

rather, i feel like my propmt attention to matters is not reciprocated by other services, esp rheum. for me, it's like pulling teeth to get this service to see anybody esp my pts with thinned out Ks secondary to PUK that need systemic immunomodulators or getting outpatient internal medicine f/u on pts with CRVOs that have BPs 180s/70s and HgA1cs of 9.5.
 

eyedr

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by request, i have moved our cazy ophthalmology consult testimonials to a new thread.

kassie, don't let us get you down. you should look forward to ophthalmology residency! it is a much better year than internship in many ways. one moderator of this forum once told me when i was in your shoes that the pain will still be there during opthhalmology residceny, it has just morphed from endless insulin sliding scales and the feeling of being a hospital dumping ground to becoming a nice little package called the ophtho-on-call pager.

i guess my problem is not that i mind carrying the consult pager to r/o the kayser-fleisher rings that ended up being arcus even when the primary team neglected to check a ceruloplasm or the NICU consult on a tiny 31-weeker to r/o ocular toxo because the mom's "toxo IgG was potitive." nor did i mind stumbling down to the trauma bay at 300AM to do a canthotomy cantholysis on a pt with a "retrobulbar hemorrhage" that ended having both pupils fixed and dilated OU with IOPs 10,12 OU dx: dead patient.

rather, i feel like my propmt attention to matters is not reciprocated by other services, esp rheum. for me, it's like pulling teeth to get this service to see anybody esp my pts with thinned out Ks secondary to PUK that need systemic immunomodulators or getting outpatient internal medicine f/u on pts with CRVOs that have BPs 180s/70s and HgA1cs of 9.5.


I agree with Ruben, the comments about ophthalmology consults are merely posted for amusement purposes. I love my job and love the patients whom I take care of. Consults are <5% of my day and although they are the most irritating because of shear ignorance on the part of the requesting service (also because things are so routine/second nature to us), when I am consulted for something legit (like bilateral iris colobomas in the NICU or a K ulcer), its very satisfying to be able to add to the diagnosis and management and help with an area that most people find intimidating. We are all very proud and enthusiastic to be in ophthalmology and I personally could not have chosen a more satisfying profession.

For those of you who chose to pursue ophtho or are looking forward to starting ophtho residency, you have chosen a great specialty. :thumbup: :thumbup:
 

kassie

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I still hope it's better than getting paged for renewing heparin or tylenol orders and having to go up/down a few flights of stairs to stamp an order!

I'm hoping my husband matches in medicine at the place I'm going so that he can educate on some of these consults! I've only called ophtho twice - one was a social consult and the other was 2 days postop and he was lost to follow-up and not getting d/c'd ever - going to a NH. I think I deflected more than 10 "blurry vision" consults. Mostly not blurry just wanted new glasses in house or finger sticks...
 

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I have to agree with the above sentiments. It's fun (in retrospect, of course) to talk about ridiculous consults, but there's definitely no specialty I'd rather be in than ophthalmology. Most of the consults I receive are legit. I've found that the illegit consults are better approached as opportunities to educate those requesting the consults. I try and be nice about it, simply explaining the rationale for denying the consult or demonstrating examination techniques that may help avoid such consults in the future. After all, you'll be working with these folks for the next few years, at least. You don't want to get the wrong reputation. :cool:
 

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I agree with the above notes regardig inappropriate consults, but I think this is true for all specialties, although it might be to a lesser extent.
This is normal.
For example, you don't expect a general surgery resident to know how to manage alcohol withdrawal or an arrhythmia, while it's bread and butter for a medical resident.
Same thing, a 2nd year surgery resident inserts a chest tube in less than 5 minutes while it is intimidating for a non-surgical resident, not because it's a rocket science, but simply because they don't get trained in it, and one always tends to be intimidated of anything he doesn't know.
 

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I agree with the above notes regardig inappropriate consults, but I think this is true for all specialties, although it might be to a lesser extent.
This is normal.
For example, you don't expect a general surgery resident to know how to manage alcohol withdrawal or an arrhythmia, while it's bread and butter for a medical resident.
Same thing, a 2nd year surgery resident inserts a chest tube in less than 5 minutes while it is intimidating for a non-surgical resident, not because it's a rocket science, but simply because they don't get trained in it, and one always tends to be intimidated of anything he doesn't know.

Nevertheless, a basic exam like checking the vision, movements, pupils is appropriate. We ALL learn at least that while in medical school.
 

rubensan

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i agree. during my internship, i couldn't even think of calling a GSurg consult without an abdominal exam and CT adomen and pelvis.

Nevertheless, a basic exam like checking the vision, movements, pupils is appropriate. We ALL learn at least that while in medical school.
 

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A close second is the inpatient diabetic screening exam, because "this patient will probably not follow up in clinic." Well, that will make any potential retinopathy treatment difficult, won't it?[/QUOTE]


Too funny!! :laugh:
 

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I've got a better fixed, dilated pupil for you: turned out to be a prosthetic eye!

I had one of these too, on a sedated/intubated trauma pt. I went and got the trauma resident and told him he needed to hurry over because the pt had a serious problem with his eye and I needed some help to do an urgent procedure. The resident came over to the bedside and I put on some sterile gloves and took a Q-tip and pretended to kind of push on the eye and be examining it for a minute. Then I popped the prosthesis out onto the pt's chest and yelled "Oh Sh**!!" when it came out. For a second the resident looked like he was about to pass out, and then he took a second look and realized it was a prosthesis. It was pretty funny.

Then I also got to write a fun consult note: "Pt's eye is fixed and dilated and is likely to remain so as it is a prosthesis. Please reconsult if this eye begins to react to light, as we would like to write it up as an interesting case report."

Loads of fun.
 

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For example, you don't expect a general surgery resident to know how to manage alcohol withdrawal or an arrhythmia, while it's bread and butter for a medical resident.
As a medical student during the surgery rotation, the surgery residents managed alcohol withdrawal all the time without any medicine consults.

In ortho, they consulted a lot. In ophthalmology, the attendings wanted to consult other services for often minor things.

People who live in glass houses should not throw stones.
 

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I had one of these too, on a sedated/intubated trauma pt. I went and got the trauma resident and told him he needed to hurry over because the pt had a serious problem with his eye and I needed some help to do an urgent procedure. The resident came over to the bedside and I put on some sterile gloves and took a Q-tip and pretended to kind of push on the eye and be examining it for a minute. Then I popped the prosthesis out onto the pt's chest and yelled "Oh Sh**!!" when it came out. For a second the resident looked like he was about to pass out, and then he took a second look and realized it was a prosthesis. It was pretty funny.

Then I also got to write a fun consult note: "Pt's eye is fixed and dilated and is likely to remain so as it is a prosthesis. Please reconsult if this eye begins to react to light, as we would like to write it up as an interesting case report."

Loads of fun.

hahaha so immature...yet so brilliant...:laugh:
 

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As a medical student during the surgery rotation, the surgery residents managed alcohol withdrawal all the time without any medicine consults.

In ortho, they consulted a lot. In ophthalmology, the attendings wanted to consult other services for often minor things.

People who live in glass houses should not throw stones.

I was just giving an example. Having gone through a complete medicine residency, I know exactly what I'm talking about. The stupidity of consults coming from certain services is pathetic (similar to a lot of the cases mentioned here on this thread). I'm not sure why you're offended.
 
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