Whose Skill? by Pat Conrad MD
Last week I was visiting my dad, and he wanted to show me a new gadget. An ophthalmologist for over four decades and still a practicing surgeon, the old man likes to keep up; his new thing-a-ma-bob is a 3D ultra high speed ocular ultrasound that takes about 70,000 images in 3 sec and compresses them for cross-sectional, 3D, and dynamic viewing. Seems that in some inflammatory states (think auto-immune diseases, among others) a new epithelial membranes is laid down over the retina, creating adhesions, and disruptions of the visual input. This picture is of one such adhesion (retina on the bottom), that will then be sent to the retinal surgeon who will then – gulp – manually excise and correct the problem.
I’m a reasonably well-trained, and competent primary care and emergency physician. I know where the parts of the eye are and what a lot of them do. Having spent more time on computers and playing video games, I could probably learn to work this machine even faster than than my dad picked it up. Probably. But even with this awesome diagnostic tool, I would be completely worthless to the patient and consultant, both of whom need the right diagnosis and referral.
For years now Doug has made a point in the pages of P.J. and on this blog to advocate for better primary care pay, without denigrating the specialists or turning the cost of health care into a scraps war. He is absolutely right, and we primary care-trained folks can look at this picture and remind ourselves how vital are those who put in the extra years of residency/fellowship, and the extra capital investments to provide safer colonoscopic procedures, Moh’s surgery, improving outcome rates for stents and CABG’s, and the addition of quality years to those whose retinae need a little nip and tuck. It is the height of arrogance to think we can get this sort of skill on the cheap.
I just had one of these procedures (performed by one of the Technicians) prior to scheduling cataract excision and lens implant. I have had OU cataracts followed for the past year but (as far as I recall) only had this done recently. I am a high myope and have been wearing corrective lenses for 50 years (UNTIL NEXT MONTH!) and recall when Ophthalmologists only used a few tools and toys which were all in the same room. Diagnosis, treatment and recommendations… DONE.