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The changes in BP and HR seen with phenylephrine, 10%, are short lived and of uncertain clinical relevance.” Stavert B, McGuinness MB, Harper CA, Guymer RH, Finger RP. Cardiovascular Adverse Effects of Phenylephrine Eyedrops: A Systematic Review and Meta-analysis. JAMA Ophthalmol. 2015;133(6):647–652. doi:10.1001/jamaophthalmol.2015.0325 GUEST COMMENTARY, by Richard Edlow, OD The Not-So-Secret Strategy to Turbocharging Practice Growth We were certainly right in thinking the year 2020 would be special for all of us—just not the way we anticipated. 16 REVIEW OF OPTOMETRY JUNE 15, 2020 The Horrors of Medical Malpractice I have had the sad opportunity to be an “expert witness” for a number of optometric medical malpractice cases, so I want to share with you this brief tutorial on how not to be sued. Such events horrifically traumatize both plaintiff and defendant. Most all such cases are easily avoidable, which is just maddening when trying to defend colleagues! There are four basic requirements in avoiding medical malpractice cases: • Truly care about your patients. • Provide competent, state-of-the art care. • Thoroughly communicate your findings and recommendations. • Document those communications clearly in your medical records. First and foremost, it must be stressed that most all cases of optometric malpractice involve misdiagnosis, mostly related to glaucoma and retinal detachments, so be thorough in your clinical evaluations. On the treatment side of this equation is one prime caveat: when treating any unilateral red eye, always remember that herpes simplex keratitis must be considered. So, if the diagnosis is not clearly evident, an antibiotic-steroid combination drop may provide the greatest chance of addressing the condition; however, always tell the patient (and of course, clearly document this conversation in your medical record) to return right away if the condition worsens, or does not resolve. Perhaps better, call the patient in a couple of days to see how he or she is doing. If the patient reports any unexplained symptom beyond the comprehensive dilated examination, always obtain a 30-2 visual field. Measure intraocular pressure at the earliest practical age. The Icare tonometer has greatly facilitated acquisition of this important metric. No psychiatrically normal patient enjoys puffs of air being blown onto their eyes! If you cannot give a definitive explanation for symptoms or decreased vision, maintain a low threshold to obtain a second opinion. Be friendly, nice, polite and palpably interested in your patient’s wellbeing. Such behavior is so appropriate and it protects against lawsuits. Last, if you are sued, be aware that this arduous process often takes at least a year or two. Just remember that most all malpractice cases can be prevented by simply being attentive and by conducting a state-of-theart evaluation. SECTION I: STRATEGIES FOR SUCCESS Protect yourself from the three most fearsome words in all of healthcare: “failure to diagnose.” By Randall Thomas, OD, MPH VISION INSURANCE VS. MEDICAL INSURANCE Whether or not insurance covers eye care is a common area of confusion.
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