Tim finally published his book and has made it available on Amazon. (Support my link on the image!) I used this book while as a medical student, and it was very informative.
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Every year, the Academy of Ophthalmology holds an annual meeting that most ophthalmologists attend. Those that are usually left behind are junior surgeons who end up covering the on-call pager.
I was unfortunate to be covering the primary pager for the hospital this weekend, which is Academy weekend. Generally speaking, this is the worst weekend to have an eye problem, because your primary ophthalmologist is probably out of town in a meeting (or getting drunk). My pager rang early yesterday morning with a long distance callback number. Bad news. When the emergency room or floor resident pages me, I usually receive the hospital extension. A long distance number always means that you’re getting shit that you don’t want to (and should not have to) deal with.
The call turned out to be from one of my attending’s wife. She woke up with an itchy eye and foreign body sensation. Her husband was at the AAO meeting in San Francisco, and she did not wish to bother him with a call. Her son-in-law, daughter, nephews, and nieces were all ophthalmologists at the meeting as well. Her primary ophthalmologist was in town, but she did not wish to bother him either because it was Saturday (Jewish sabbath).
WTF?
I suppose that leaves me, the on-call resident. I offered advice to the best of my abilities over the phone and offered to see her in the emergency room (the one where patients wait 4 hours to be triaged). She politely declined.
Lesson to be learned: if everyone in your family is an ophthalmologist except you, you should go with them to the Academy meeting.
One of my attendings mentioned that she examined inmates routinely during her residency training. These criminals would often sit in the same waiting room as regular patients, of course with supervision. After all, everyone needs eye care, right?
That anecdote reminded me that residents at one of the Georgian ophthalmology programs actually had a clinic in the local penitentiary. One day a week, the resident on service would sign in cataracts and other surgical cases in the “jail clinic”. In retrospect, it actually doesn’t sound too bad–no insurance issues to deal with (I’ve had my surgeries canceled because my patient didn’t have the right insurance) or accidental consumption of breakfast the day of surgery. Having prison inmates as your patients is a great system. They actually show up to your clinic on time and do what they are told. As their physicians, we’d be contributing to the governmental system.
In fact, my residency shares many similarities to that of a prison clinic. Last month, I examined an open globe laceration in the ED, similar to what I’d see in prison fights. Another one of my clinic patients came into the ED handcuffed (and foot-cuffed) to the exam chair. The only difference between my patients and those at the prison is that the cops guarding my patients are smoking outside the hospital while I am alone examining the criminal. What fun.
Indeed this is an exciting moment in my training career…
Ophthalmic pathologist Mort Smith sports a tablet PC for his lectures. I suppose that a nifty touch screen can come in handy when you’d like to circle some Merkel cells in your presentation for emphasis. Tablet PC’s are traditionally geared toward the mobile user who simply needs technology for note-taking and flashy presentations. These systems typically range from the 2lb-<4lb range, with limited video acceleration and slower disk platters (with the exception of those with solid-state drives).
I don’t find that tablet PC’s are entirely useful for medicine, since netbooks and superlights a la MacBook Air are plentiful. However, there is potential for tablet PC’s to be useful for the niche market of ophthalmology. We draw. We label diagrams with color, all in our progress notes. A touchscreen serves as the bridge between the ophthalmic exam and EMR. This union is not novel–Mayo Clinic’s ophthalmology department implements its own ophthalmic EMR that synchronizes seamlessly with the entire hospital’s records.
TabletPCreview.com, the de facto standard review site for tablets is a good starting point to explore the current product line. These systems do command a higher price tag than their non-tablet counterparts, but it is impressive how much power you can fit into the package. I’ve been entertaining the idea of acquiring a tablet for a while, and I almost made the jump until rumors surfaced about Apple’s venture into the table realm. That is a killer hardware that I’m itching to get my hands on.
It will be an interesting product cycle in the upcoming year…
I saw my first retinal detachment a few weeks ago. I have a slit lamp photo I took of my patient in the emergency department using my digital camera. His anterior vitreous was littered with a mix of pigmented and white cells. This finding is dubbed, ‘Shafer’s sign’. Its presence highly suggests a retinal detachment.
For those of my colleagues, this is named after Donald Shafer, of MEETH. Don Shafer graduated from Columbia University and Cornell Medical College. Some texts misspell his name as “Shaffer”.