Obtaining a concise and accurate medical history is an art, and it often takes a lifetime to master. For the majority of us, we train for it daily in our clinical practice. On most occasions that we successfully arrive at a diagnosis through the history, the feeling is bliss. Rarely, however, it elicits anger.
Several weeks ago while I was on primary call, I was called by the emergency room (ER) attending physician about a woman who had left eye pain. The ER doc had dutifully checked the vision in her eye and found it to be 20/200 while the unaffected eye was 20/20. He added that she complained a sudden loss of vision in that eye as well.
I had just stepped into my apartment right before getting called, around 12:02am. Painful loss of vision is concerning by all means, and I rushed back to the ED while glancing through my Will’s Eye Manual for help.
My patient was a 40-yr old woman comfortably sitting in the exam chair. Her eyes were white, and on first glance, I could not determine which eye was in question. On brief exam, her vision in the left eye was indeed poor, although she did not have an afferent defect or a shallow anterior chamber. The fundus on the left eye was clearly severly myopic compared to that of the other eye. I suspected that she had poor vision in the left eye all along. Read more…
misc
medicine, rant
On average, I’d say my clinic patients spend at least 3 hours in total at every appointment. Sometimes they are here even longer, if I send them for imaging. Most of the time in the clinic is spent waiting. Additional, many patients arrive at least an hour before their scheduled appointment, adding to the wait.
I try to explain to them that there is no need to arrive so early, especially if the normal wait is already painfully long. Apparently there is a loss of communication. I suspect that there is a rumor among the patients that arriving early at an appointment translates to leaving early. This is as likely to happen as winning at Pai Gao Poker.
I once had a patient who I needed to follow daily for a herpetic corneal ulcer. After four days, he simply stopped showing up. Later, he told me that it was impossible for him to work if he spent hours at the eye clinic daily. Other patients of mine come to clinic ad lib, for prescription refills only. Then there’s the majority of them who sit patiently for 3 hours in the waiting room to be sent to fluorescein angiography for 2 more hours for a proliferative diabetic retinopathy (PDR) workup.
Indeed, to be a clinic patient is to be a special patient.
medicine
medicine
Several months ago, I signed up for TruthOnCall, a new VC company designed to survey physicians on commonly asked questions. As a physician, you can offer to complete surveys via SMS for reimbursement $10 apiece. From a financial standpoint, the deal sounded potentially lucrative, depending on the number of surveys you complete.
Unfortunately, I have yet to receive any surveys in the months that I’ve enrolled. Perhaps they are a front to harvest physician data? Or have they run their fund dry?
In actuality, I think that there is a limited market for ophthalmology-based medical opinions. The service appears to mediate data harvesting. In order for the physician to receive a survey, there much be a client investor on the other end to field medical questions. No funding, no money. Simple as that.
Are there any other physicians out there who have actually received surveys or been paid by TruthOnCall? Let me know!
medicine
medicine
I saw a guy in the clinic several weeks ago who sprayed Hongo Killer in his eye. He had a 100% epithelial defect with descemet’s folds. The cornea was pretty much in endothelial shock, although he was not hypotonous.
I chuckled when he showed me the bottle. I suppose that it was entertaining only because of my limited Spanish knowledge and I had been basking in our underground clinic’s flickering fluorescent lights the entire day.
medicine
medicine, ophthalmology