What specialty items do you own and use?

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Atlas Shrugged

Family Medicine
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I was thinking of buying a derma-/dermatoscope and prices are fairly reasonable for something I would use often (and would obtain training to properly utilize). I also looked at a tonopen for eye pressures that seemed less reasonable (thousands of dollars) which I wouldn't use very often.

Which items do you own that aren't a part of a typical examination room?

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I have a DermLite DL100. It's pretty much a no-brainer on the cost/benefit scale, assuming you know what to look for.

Eye stuff gets referred out (unless it's very straightforward).
 
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I’ve asked for a Tonopen, but then backed off on the request for now until I see how often I may actually use it.

I’m rural and we don’t have an optho in the county. I’m trained and able to dx acute glaucoma and administer gtt’s to Lower pressure and then send to the referral center 1.5 hours away, but I’ve got to get a tonopen.

There’s an OD across the street that has some sort of extra training who has equipment and can deal with a lot of eye emergencies but I feel weird referring to anything other than Optho when sight is on the line. Something tells me a slick lawyer could convince a jury that I provided sub-par care in doing that.

Luckily I work for a big system, I pretty much get what I ask for because they’ve got almost anything you could want in bulk in a warehouse somewhere.
 
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Atlas Shrugged, I would definitely recommend purchase of a cheap Dermlite dermoscope (the DL100 goes for around $300 on certain medical device websites). If you have an educational stipend, it would be money well spent.
 
I’ve asked for a Tonopen, but then backed off on the request for now until I see how often I may actually use it.

I’m rural and we don’t have an optho in the county. I’m trained and able to dx acute glaucoma and administer gtt’s to Lower pressure and then send to the referral center 1.5 hours away, but I’ve got to get a tonopen.

There’s an OD across the street that has some sort of extra training who has equipment and can deal with a lot of eye emergencies but I feel weird referring to anything other than Optho when sight is on the line. Something tells me a slick lawyer could convince a jury that I provided sub-par care in doing that.

Luckily I work for a big system, I pretty much get what I ask for because they’ve got almost anything you could want in bulk in a warehouse somewhere.

If you're worried about lit, than shouldn't you just refer regardless for this? I'm sure you're trained in it, but that same slick lawyer will somehow find a way to compare it to an optho..
 
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If you're worried about lit, than shouldn't you just refer regardless for this? I'm sure you're trained in it, but that same slick lawyer will somehow find a way to compare it to an optho..

I don’t think I was clear in what I meant.

If I have a tonopen, I can dx acute glaucoma, and use drops to bring the pressure down acutely, then send the patient immediately 1.5-2hrs north to the ED or directly to Optho office to be seen by an Ophthalmologist. This is what optho preceptors in residency suggested when I trained with them and they knew where I’d be practicing.

But traditionally providers here have sent people across the street to the Optometrist office for these types of things. I can see an argument being made in court that sending such a patient to optometry (even one who’s got some extra training) is substandard care and exposes me to being considered at least partially responsible for any poor outcome.
 
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I don’t think I was clear in what I meant.

If I have a tonopen, I can dx acute glaucoma, and use drops to bring the pressure down acutely, then send the patient immediately 1.5-2hrs north to the ED or directly to Optho office to be seen by an Ophthalmologist. This is what optho preceptors in residency suggested when I trained with them and they knew where I’d be practicing.

But traditionally providers here have sent people across the street to the Optometrist office for these types of things. I can see an argument being made in court that sending such a patient to optometry (even one who’s got some extra training) is substandard care and exposes me to being considered at least partially responsible for any poor outcome.

I agree with you, FWIW. I never refer to optometrists. Whether or not sending a patient to an optometrist for something within their scope (they can test for glaucoma, even if they can't treat it) leaves you open to legal recourse is debatable (after all, we refer to other non-physician providers all the time, and it's not your fault if the other guy screws up), but I just prefer an MD/DO for potential eye pathology.
 
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I’ll send some things to opto which is located in a building attached to our office and I can make sure they are getting initial care for things in their scope of care but anything that’s going to need surgery or has symptoms of vision loss I’m sending on the 1.5-2 hr drive for the optho
 
I agree with you, FWIW. I never refer to optometrists. Whether or not sending a patient to an optometrist for something within their scope (they can test for glaucoma, even if they can't treat it) leaves you open to legal recourse is debatable (after all, we refer to other non-physician providers all the time, and it's not your fault if the other guy screws up), but I just prefer an MD/DO for potential eye pathology.
Optometrists can treat glaucoma in almost all states (they can in yours).

The trick is, it's hard to tell the good ODs from the crap ones. I refer most of my DM screenings, headaches that might be vision related, and red eyes that I'm not actually that worried about to a handful of ODs that I know are good. Stuff I'm legitimately worried about or may be surgical, I have an MD I like.
 
I don’t think I was clear in what I meant.

If I have a tonopen, I can dx acute glaucoma, and use drops to bring the pressure down acutely, then send the patient immediately 1.5-2hrs north to the ED or directly to Optho office to be seen by an Ophthalmologist. This is what optho preceptors in residency suggested when I trained with them and they knew where I’d be practicing.

Okay, that's totally fair, as with anything that requires hire acuity, stabilize and ship
 
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