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Interesting interaction with outpatient doc

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  • Interesting interaction with outpatient doc

    As a purely inpatient doc, i dont always know how things work on the "outside".

    My father went to an ophthalmologist(not optometrist) who recommended a battery of imaging studies of the brain, carotids, echo etc. He then proceeds to tell him to get these ordered by his primary doc. Aren't optho's MDs? Cant they order all these imaging studies? Is this how outpatient works?

    It just seemed odd that this doctor referred to another doctor to do order the tests.

  • #2
    As a PCP, this is NOT something I usually encounter, and I would probably refer back to the ophthalmology. This is not typical and something that drives me crazy. I see it more often from ophthamology/optometry for some reason (findings abnormal on exam and then refers back to me to "follow-up" and get additional testing).

    I agree. Anyone who is a licensed physician can order these tests. Punting everything back to PCP is lazy, IMHO.

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    • #3
      As a family med physician, don’t get me started on this. This is definitely not how it should work, but unfortunately some rare specialists think it should work this way. It’s just laziness. If you want a test ordered, order it yourself. Whenever I get this request from a specialist, I refuse, send the patient back to the specialist, and usually don’t use that specialist again. I didn’t go to medical school and complete a residency to be your assistant. /end of rant.

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      • #4
        This used to happen all the time but I punt it back and now it does not happen any more.

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        • #5
          We have an ophthalmologist group in town that does just that. All they care about is laser eye surgery. I don't recommend that group to anyone at this point.

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          • #6
            ok so it seems this is not uncommon. In this ophtho defense, he messaged my fathers other doc and he was able to get the script fairly quickly to not delay care but it still seems ridiculous.

            I almost became confrontational my dad insisted i not be rude

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            • #7
              It's lazy but it's likely also someone who doesn't want to follow up on the results and/or have to act on them.

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              • #8
                Originally posted by NumberWhizMD View Post
                As a PCP, this is NOT something I usually encounter, and I would probably refer back to the ophthalmology. This is not typical and something that drives me crazy. I see it more often from ophthamology/optometry for some reason (findings abnormal on exam and then refers back to me to "follow-up" and get additional testing).

                I agree. Anyone who is a licensed physician can order these tests. Punting everything back to PCP is lazy, IMHO.
                I would have and have stopped referring patients to someone who does this.

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                • #9
                  I see this all the time, I just assumed that the Optho thought that the problem was not necessarily and eye problem but more a manifestation of a system disease or condition and did not want to assume management for this condition, I also would not expect them either to do this either. At times I will get a call, saying I think so and so has a vascular problem, I would like them to go for further testing. What burns me up more is someone ordering a test , and having their staff , say " call your primary to go over the results"

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                  • #10
                    Originally posted by CordMcNally View Post
                    It's lazy but it's likely also someone who doesn't want to follow up on the results and/or have to act on them.
                    100% this, which is...lazy

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                    • #11
                      Originally posted by chucki View Post

                      100% this, which is...lazy
                      That and I think we also like to think we're really smart as physicians and don't like to admit we don't know what to do in certain situations. I think an ophthalmologist getting echo results and being expected to act upon them would probably fall under that category. I know there's lots of stuff I don't know what to do with and I know it makes me uncomfortable when I'm put in that situation.

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                      • #12
                        Generally I agree with this sentiment that ophtho needs to be more involved with systemic disease workups (especially for uveitis). But it really depends on the need for the underlying tests.

                        why are the tests being ordered? Was there a hollenhorst plaque or a retinal artery occlusion?

                        for a retina artery occlusion guidelines state that the patient needs to be sent to the ED immediately, just like a stroke or TIA because of the high risk of stroke.

                        for an asymptomatic hollenhorst plaque the workup is less urgent but the workup is still to look for systemic disease that might lead to stroke or require a statin, etc. There’s no reason to do these tests for ocular management. I hate to say it but, what’s far worse, is that I think a lot of eye doctors just ignore the fact that they see signs of systemic disease on the eye exam - either that or they’re blind themselves).

                        There’s a ton of information regarding systemic health to be found on the retinal exam (honestly it would be the most informative part of the physical exam). Unfortunately funduscopic exams are a lost art amongst non-eye doctors. And if eye doctors were to do the full workup for everything they see, they’d basically become primary care doctors.

                        i guess the question is how long should the eye doc be acting as the middle man for? Because eventually the results of these tests will need to go to and be acting on by the PCP.
                        Last edited by Dusn; 03-10-2022, 09:14 AM.

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                        • #13
                          Apologies for inviting a possible generational war, but what generation is this ophtho?

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                          • #14
                            If they feel workup is needed for something outside of their area of expertise they should tell the patient to discuss the issue with their PCP who can then decide what tests/consults are appropriate, not tell the patient to request specific tests from their PCP. If it’s within their area of expertise they should order it themselves.

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                            • #15
                              Originally posted by burritos View Post
                              Apologies for inviting a possible generational war, but what generation is this ophtho?
                              hes older. 60s I am guessing

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