My suspicion was confirmed recently during a friend’s wedding. A portion of the wedding lunch was dedicated to “wedding trivia”. It wasn’t the typical trivia about the bride and groom one would know from being their acquaintances, but rather hardcore minutiae a la trivial pursuit.

Topics included politics:

What is the term used to describe unintended civilian consequences resulting from covert operations from an aggressor government?

And science:

What is the name used to describe the first primitive bird considered to be descended from dinosaurs?

The teams were divided by dinner tables. My table consisted of internists, nephrologists, and other physicians. We placed near the bottom of the competitor list, behind the lawyer table (trivia nights at the pub must have given them an advantage) and all of the tables with PhD’s.

Conclusion: We spend too much time studying diseases that have no cures.

Note: The answers to the aforementioned questions are “blowback” and “Archeopteryx”, respectively.

Wrong.

In some cases, it is obvious that someone is myopic by the disproportionate size of the eye. To me, most of the cases are not obvious at all.

Years ago when I was still a medical student, Harry Knopf, one of the private attendings at WashU had told me to look at the temples, not the eyes. The refractive error can be estimated by looking at the temple border.Look at this example:

The border of the face behind the glasses is shifted medially, as shown by the dotted lines. This is a myopic correction.

In contrast, look at this photo of Ryan, from The Office:

The line behind the lens is continuous with his face. This joker is wearing a plano lens (no correction). Likewise, if the face behind the lens appears to extend outside of glasses, then there is hyperopic correction present.

This finding is not entirely obvious, yet intuitive. However with practice, you may be able to approximate an exact dioptric power. Try it out, and you will impress.

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.

I began with more questions (in broken Spanish):

Me: Which eye is the better eye?

Patient: [points to right eye]

Me: Has your vision in your eyes changed in the last year?

Patient: No, but he said my left eye was bad.

Me: Who?

Patient: The doctor

Me: What doctor?

Patient: The doctor on 186th street.

Me: What kind of doctor is he?

Patient: eye doctor

Me: As a child, did you see well out of your left eye?

Patient: No, but the doctor said I don’t see well.

Me: What doctor?

Patient: That doctor. [points out to hallway where the ED physicians work]

…

The dialogue continued for 15 more minutes with uninformative dictum speckled with non-sequiturs. I now envy those folks who specialize in pathology or radiology.

Interesting use. Could someone elaborate?

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.

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!

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.

“Stomachin: Chang Kuo Chou Strong Stomachic Powder”

I found an online store that sold an equivalent concoction of health. It appears that this medicine is intended to remedy gastritis, given that licorice and sodium bicarbonate account for the bulk of the powder. I assume that this medicine may actually be effective, given that almost a billion people have probably taken it at one point in their lives (This is a Chinese medicine).

*Note: I am not affiliated with this product. I do not endorse the use of this product either. I have neither prescribed this product nor used it myself. *