re: Optometry: LA HB 1065/SB 568: What if your Louisiana Eye Surgeon is NOT an MD?

And what if it requires a certain dosage of Medicine that is different opposed to person b, will they know it? That's like my cousin going to a psychologist to get his ocd meds. FYI, he's taking a completely wrong dose.

You want to do certain things in medicine, you go into that field for it. I don't want my pcp doing surgery if he doesn't know or have been trained to do it.

A person's capacity for knowledge doesn't mean they should have the ability to act on it all because of a law.

Claiming that a laser (which destroys human eye tissue inside the eye) is not surgery is completely false. That's just plain inaccurate. If we didn't know how the procedures/surgeries worked we would not speak up. Noninvasive makes the patient think it's harmless and has no potential complications. You need to read up on this stuff

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to come across as equals

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So this is where that God complex comes from.

Was not meant to be offensive and shouldnt be taken that way.

edit: Also i think its pretty telling, that from my whole post, the only part you point out is that im (allegedly) trying to say ODs and (O)MDs are "equal". And that has nothing to do with my post or this bill, but i sense that's what most of the MDs are concerned about. And it has very little to do with patient concern or competence.

Argue for us how the "treatments" are noninvasive...

I think you could make an argument that shooting a hole in the membrane behind the natural lens of the eye is actually more invasive from an anatomical standpoint then the extraction of said lens (ie cataract surgery) while keeping that membrane intact. Tell me where I'm going wrong

So can they do it?

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If you wanna be a doctor, go to med school. It's that damn simple.

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Seriously? Then why are there plenty of students with good grades and test scores that don't get accepted to medical school each year? Many of which that inevitably choose to fall back on a program like optometry.

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Seriously? Then why are there plenty of students with good grades and test scores that don't get accepted to medical school each year? Many of which that inevitably choose to fall back on a program like optometry.

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Perhaps they should improve their scores and resume and reapply. If you want to do something else, that's fine. But don't demand an equal scope of practice for inferior training that was not designed for such. They knew the rules when they applied. Quit bitching and do your job or go to med school. That's just how it is. There was a reason they didn't get in. Superior students with no criminal backgrounds or obviously behavioral disorders get in. If they didn't, they were borderline. In those instances, they give the edge to those that have applied before. It shows a dedication to becoming an MD. Trust me, I've been on a selection committee before. And more goes into it than just grades. We do FBI background checks on all applicants. Many of the "lesser schools" do not.

ETA-and here is AR, we have to take a certain percentage of each class from each congressional district and students that have matched with underserved communities to do primary care will get the nod over equal students that do not. And we have to weight decisions for minorities. So, many qualified students get displaced by less qualified minorities. Although we can expand a class to include minority minimums to prevent having to turn down exceptional students.

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It's really not bitching. It really is genuine concern. Here's an example: Not too long ago, I had a patient come into my office from an optometrist's office because he had a growth on his eyelid. It had been present for more than 3 years, and, in the patient's estimation, it had grown only very slightly in that time frame. The optometrist told him she thought it was a skin cancer. Given the appearance of the lesion and the history the patient gave me, I really doubted that diagnosis. I removed it, and it was benign. In the end, everything worked out great. This optometrist wasn't able to correctly assess the situation because she didn't have the necessary training or background to realize it was unlikely to be cancer based on the history and appearance of the lesion. Under this bill, the optometrist could go ahead and remove the growth, but if it does turn out to be cancer, then there's a completely different procedure that needs to be done that an optometrist won't be allowed to do under this legislation. That would mean the patient would have to undergo 2 procedures because of the optometrist's incorrect diagnosis. These types of issues can't be addressed easily...it takes a good bit of additional training to be able to learn these diagnostic skills.

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This is a very good example. Unfortunately, it's also a very good example of how big of a disconnect there is between the public's perception of medicine and how medicine actually works. Medicine is just too complex to explain intricacies like this to the common Joe. An example: I saw a woman yesterday who complained of trouble breathing so she went to the ER. She has no PCP. They CTed her (and, of course, assessed her pretty well before this, I am sure, and were doing a final "not a PE" assessment...or at least I hope that's what they were doing. She's a poor historian, but regardless...), and sent her home.

She became irate that they didn't call her back to follow up or explain things to her. She didn't understand that that's not how ERs work. "If you're not sick enough to go into the hospital, once you leave the ER, you go to your PCP in the next few days, preferably tomorrow" isn't a concept that she understood. Even when I explained it to her, she didn't really get it. She continued to be upset with her lack of follow up from an ER visit.

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Why not advocate that they get the proper training to do the more basic procedures?

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The majority of ophthalmologists I have spoken with do advocate for more proper training for them to do more basic procedures. The requirements are already there under the LSBME for ophthalmologists. It would be as easy as asking the LSBME for permission and then the ophthalmologists that want help with these basic procedures to take on optometrists in an informal fellowship setting. This assuming the LSBME, who is for the safety of the patients in this state, to agree that it is safe. I have very little doubt they would agree to this.

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The only real difference is the residency process

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That's also the only real difference between a neurosurgeon, an OB/GYN, and a pediatrician, if you want to look at it that way.

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I'd actually argue that optometrists get more formal focused training on the eyes prior to the residency.

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There's no argument. They do. But in the 4 years of residency, it's not like the residents are thrown right into eye clinics and performing surgeries on Day 1. There is tons of formal eye-centric lectures and didactic sessions that occur during this time. So an Optometrist who has just graduated 4 years of OD school is most definitely far more advanced in his ability to take care of the same patient than an MD Ophth Intern. They're even a leg up on the majority of 2nd year ophth residents (because the majority of PGY-1 years that I have looked at are general medicine years with little to no ophthalmology, but this is changing). Even still, the following 3 years are very intense training in the eye that is not matched by 4 years of Optometry school. The hours and responsibility are much greater. In the end of these 8 years, the OD is actually probably better at refractions than the MD, but the MD is going to be tremendously better at path and surgery. It's not because one group is better/smarter/more capable. It's because that's what the training is designed for (this is, of course, a nutshell. I'm not suggesting an OD's strengths stop at being a refractionist).

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The only reason why I cared about this thread is because my brother is in optometry school.

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I almost went to Optometry school as well. I wanted to go because I like the idea of primary care for the eye. I did think it was ridiculous that I technically wouldn't have been able to pull an in-turned eyelash from a patient's eye. I never dreamt of wanting to perform derm procedures around the eyelids. That wasn't what interested me. I liked eye pathology, sure, but not the adnexa. And that's not what optometry schools teach, generally, either. It's not in the scope of the field. I later realized I preferred the field of ophthalmology because I wanted more responsibility (tough calls on whether or not surgery is to be performed, rather than referring out as well as actually being the one performing the surgery instead of saying "I think you need it. This guy is good, go see him." I'm not suggesting there is anything at all wrong with this; heck, never being the one who caused harm to another with his own two hands is kind of a dream in the medical field. It just wasn't for me.)