Worst Record Keeping Ever? Refracting MD in Canada

[armstrong77]

Some of you know of "refracting MDs" in Canada (and in particular, Ontario). These are MDs who are not ophthalmologists, but who write spectacle prescriptions (usually off auto-refraction). They can be emerg docs, Obgyns, you name it.

This is an example of a form from an optical where one of these folks worked. I didn't "cherry pick" for this form - they were all recorded in basically the same manner. The bottom right blackout is their signature.

I'm not making this up.

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[blysssful]

Thorough.

 

[jefguth]

wow, had no idea that they were that bad!

Did you hear about the MD in Ontario that was disciplined b/c he did not routinely measure IOP, and when he did he would do it with a tonopen on the SCLERAL, without anesthetic, and then divide the measurement by two?!?!?

Do you mind PM'ing me with the name/location of this "doctor?" I'd be interested to know just which one it is.

 

[PBEA]

yep.......that's about all an MD is capable of. It may seem sad, but c'mon guys, cut them some slack, I mean they get like maybe a month in the eye clinic with the "world famous" retinologist. What did you expect? Besides, it's not like they would just treat a sensitive organ system, like the eye, based solely on empirical evidence.........would they?


omigosh!

they do

 

[Dogod]

http://www.optiboard.com/forums/showthread.php?t=21071

For further reference and examples of the level of care provided by refracting MD's there is extensive disussion in the thread:""The end of refracting-MD's?" on optiboard.
The real issue is the college of physicians allows them to perform a lower level of eyecare than eye doctors. In a ruling against a refracting MD, a precedent was set when the CPSO determined that a refracting MD must only meet the standards of a "general practitioner performing eye exams, " (whatever that is - there are no set standards) NOT those required by an eye doctor and specifically states they are not required to perform dilation. A similar scenario has existed for cosmetic surgeons (ie GP's) vs. plastic surgeons in the level of training and care. However, people have died in this field so the CPSO has recently bowed to public and media pressure, and gone through the motions of changing the rules when it comes to cosmetic procedures.
A loophole exists in Ontario in which a GP can basically do almost any medical or health procedure they want even without specialized training.

 

[Meibomian SxN]

http://www.optiboard.com/forums/showthread.php?t=21071

..The real issue is the college of physicians allows them to perform a lower level of eyecare than eye doctors. In a ruling against a refracting MD, a precedent was set when the CPSO determined that a refracting MD must only meet the standards of a "general practitioner performing eye exams, " (whatever that is - there are no set standards) NOT those required by an eye doctor and specifically states they are not required to perform dilation. A similar scenario has existed for cosmetic surgeons (ie GP's) vs. plastic surgeons in the level of training and care. However, people have died in this field so the CPSO has recently bowed to public and media pressure, and gone through the motions of changing the rules when it comes to cosmetic procedures.
A loophole exists in Ontario in which a GP can basically do almost any medical or health procedure they want even without specialized training.

Here in the USA, only an ophthalmologist or optometrist can prescribe visual medical devices (glasses/contacts). There are several cases that I know of internists trying to prescribe glasses. They can get away with it up until someone blows the whistle.

Maybe the ODs should fight back and start offering flu vaccine shots tec in office

 

[Meibomian SxN]

Some of you know of "refracting MDs" in Canada (and in particular, Ontario). These are MDs who are not ophthalmologists, but who write spectacle prescriptions (usually off auto-refraction). They can be emerg docs, Obgyns, you name it.

Question: What happens when the 0.75 is prescribed but 1yr later Mr. Jones is diagnosed with endstage AMD? Is the prescribing doctor held accountable in court?

 

[lazerlight]

Wow. No VAs either.

 

[jefguth]

Question: What happens when the 0.75 is prescribed but 1yr later Mr. Jones is diagnosed with endstage AMD? Is the prescribing doctor held accountable in court?

THe problem is that Canadians just don't sue their doctors very often, so these rarely end up in court.

If a patient did sue then you can bet this doctor would be in it deep - hell he/she didn't even record any VA's so he can't prove that the patients vision was normal.

 

[lazerlight]

OCCULAR

I.O.T.

This person doesn't even know how to spell.

This case report form is so bad, I wouldn't even have the creativity to invent a story like this.

 

[Dogod]

Often patients don't even know the doctor's name. These refracting MD's usually do a rotation of several optical stores around the Toronto area. Due to this patients will usually not even see the same doctor twice in these optical store situations.
Unfortunately, refracting MD's are usually assumed to be optometrists. With the underlying confusion regarding the 3 O's, and the patient not knowing the doctor's name, it is difficult to know which college to even complain to, let alone who to sue. Even if you did complain, most of the refracting-MD's are retired GP's graduating from med school in the 70's or earlier. So they would just go back into retirement if they had to.
The money is great for them - the optical gets them booked solid for the day they are scheduled. Appointments slots likely 5-10 minutes, they are often paid per exam by the store in addition to keeping any eye exam fees (OHIP pays $39 for kids and seniors) from patients, with no overhead and little liability judging from the case depicted on optiboard. Nobody dies from missed eye disease which is often symptomless and not immediate. For example patients would not associate the missed diagnosis of glaucoma when there vision loss didn't occur until months or years later. Even retinal disease often doesn't have immediate effects. Other medical specialties such as cosmetic surgery, have been under scrutiny, either because patients have died. or the effects of poor care are immediate - pain and permanent disfigurement. These effects are then easily associated by the victim directly to the procedure. This typically is not the case for eye exams with no pain and a delayed effect on vision loss.
In some cases, there is the bargain effect as well. When the exam is free with glasses only takes 5-10 minutes they realize that it is a cheap exam and don't have the same expectations. If an eye doctor does what is perceived to be a thorough exam taking more than 20 minutes and misses something that is a different story.
The real concern is that there is a large number of patients who have never had a real eye exam, and without having anything to compare it to, believe that the 5-10 minute sight test is a full eye exam .
The exam provided by the refracting MD is basically a sight test similar to what a refracting optician would provide. No wonder a number of refracting MD's banded together to oppose stand alone refraction by opticians . They practice only in optical stores, and a number of them moonlight from their offices as a family doctor. And there has been a shortage of family doctors for a few years already.

 

[jymezg]

this guy prob just spun the phoropter like wheel of fortune...