i did not do an eye exam on someone with a bs of 700. a 14 year old girl was brought into my clinic by her parents who were scared to death because she had suddenly lost her vision. took a quick look through slit lamp and 14 yr old with completely opacified lenses. hmmm i relied on my completely inadequate training and took a random blood glucose in the office wow is 700 high i don't know, didn't do a 6 week endocrine rotation what to do, what to do?? then I thought maybe 700 is high in fact so high that it caused her sudden cataracts and the opaque crystalline lens could have caused her sudden vision loss. couldn't see the retina through opaque lens and I don't have a B-scan to check the retina at my office but i wasn't trained to use those so i just went on a hunch. guess what i did, i did what every ophthalmologist would do i started her on metformin and had her follow up in two weeks? no straight to ED.
Dude, let me get this straight... You saw a patient in clinic who presented with a blood sugar of
700 and you thought it was appropriate to simply start her on some metformin and send her home?
A blood sugar of 700 constitutes a life threatening medical condition. You should have sent her to the ER, which would have resulted in a short hospital stay for IV fluids, insulin therapy, serial labs, and further diagnostic work-up.
Unbelievable.
This is what drives physicians absolutely bonkers when it comes to these scope of practice issues. You presented this situation as evidence of your clinical acumen vis-a-vis physicians--that, somehow, your management of this situation proves your ability to medically manage patients just as safely as an ophthalmologist. Yet, what you did would be considered medical malpractice by any reasonable physician. You're lucky that no adverse events occurred as a result of your decision. You dodged a bullet on that one.
The problem with nonphysicians vying for expanded scope of practice is that many of these people
lack an accurate awareness of the limitations of their knowledge base, The case that you presented is a classic example of this self-awareness issue. As an optometrist, it's unlikely that you've ever had to manage a patient with hyperosmolar hyperglycemic nonketotic syndrome on the wards (i.e., see them in the ER, admit them to the hospital, write the appropriate orders, interpret the labs/studies that you order, round on the patient twice daily, etc.). Thus, you've probably never been exposed in your training to the extraordinary danger of this condition. Ophthalmologists, in stark contrast, have actually managed these patients on many occasions through the course of their training. Every medical student sees these cases on the wards. Every intern, at some point, manages these patients, too. This is just one difference, among countless other examples, in the training of a physician vs. other health care professionals.
Sometimes I think that all of the nonphysicians seeking full professional autonomy should just get what they're seeking, because patients will eventually realize the value of seeing physicians. But, situations like the one you mentioned, make me question that stance, because it endangers patients. Plain and simple.
The scope of practice issues in this country are just infuriating to me as a physician. They represent an
appalling disregard for patient safety.
. I know many ophthalmologists who have not set foot in a hospital in years, ever heard of outpatient surgical centers..in fact so popular many ophthalmologist are part owners in these little beauties. I would like you to prove the difference in management for GCA between OMD and OD who are both held to the same medical standard of care. come on lets all be honest..how many average private practice ophthals see temporal arteritis in their private practice so much that they don't do a little quick consult with Dr. Wills every now and then. I know this is true, I hang out with many cool ophthalmologists.
) whenever it comes to anything beyond getting a new eyeglasses prescription.
