I'm sorry I cant help, but maybe you could share what you find on this subject. I'm personally interested in how a PCP actually manages to provide examination of the eye. Specifically, I would like to know what objective powers of observation they exert while performing an "eye" exam.
Most urgent site/life threatening conditions are taught to PCM's. They know what the red flags are for referring patients to optom/ophtho. Also, how often do they present exactly like a typical case of conjunctivitis?
You're speculating. As mentioned earlier, I doubt that eye drops contribute a significant amount to abx resistance. Also, you don't really have too any stats to back up your assertion. I will say that most PCM's practice very defensively due to the litiginous nature of medicine these days. Most eye primary care doesn't lead to horrible outcomes. So as optoms your don't realize how high stress primary care can be in that regard. My point is, these docs typically have a low threshhold for referring out anything they aren't comfortable with.
wtf?? your asking questions, then answering them with "It cant", then you finish your post by contradicting yourself. To wit: tapering the abx can very definitely lead to superbug (we agree), hence misapplied abx CAN lead to resistance (do we agree?). The large population of bacteria doesnt necessarily come from one pt or tx anyway. The large population of bacteria is actually the multitude of pts and txs over time. I tend to agree with your example though, I'd love to see any pretx history (especially self tx, or PCP applied tx) for conjunctivitis prior to ce as a risk factor for endophth (or not), but I'm afraid the corporate conspiracy theory is more plausible in this case. I guess I will have to continue to be a paranoid, cynical bastage. Go ahead and invest in the 5th gen quinolone (or is it already here?), your bound to do well.
dude!!
i'm not sure how to even redirect this thread, but i want to clairfy a few things. i think you are correct in asserting the value of slit lamp examination and for highlighting how eye providers overuse abx. i also think there is value in being a "purest" about such things in an academic setting. however, for better or worse, in today's practice environment purism (evidence based medicine) has been replaced with "CYA (cover your a#$)." the 6 year old with viral conjunctivitis is rarely diagnosed by an ophthalmologist or optometrist. rather, the worried parent takes their kid to a pediatrician who sees a red eye. if we don't teach our PMD colleagues how to triage these types of cases by checking vision, looking at pupils, then everyone suffers. our creed is medicine is "do no harm." can we fault the pediatrician for starting a kid on occuflox q 6 hours and having him follow up with us in a few days? did he really do harm to the patient? do i fault the ER physician for seeing a diabetic in the ER for "blurry vision" taking the initiative of checking vision, pupils, actually dusting off the direct ophthalmoscope, turing it on and looking at the fundus saying "everything looks normal, maybe i see a dot blot hemorrhage or two" and having the patient follow up with me within a few days? i confirm the patient has refractive error and mild NPDR and they get followed regularly q6 months. do i see the patient with a painful red eye, down vision and a fixed middilated pupil ASAP? yes I do! as community ophthalmologists, we are rarely on the front lines. rarely, are there such things as "eye ERs" outside of major academic centers. rather, we count on our PMD colleagues to take an accurate occular history, do a basic exam and refer to us. it only makes sense to teach our colleagues when to refer to an eye care provider.
