Transcript

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Visit aka. ms slash knock, knock high again. That’s AKA. Dot m s slash knock, knock. Hi. Knock,

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Welcome everybody to knock, knock. I with me, your host, Dr. Glaucomflecken. I’m flicking your one stop shop for all things eyeball. Even though I am wearing my ortho cap right now, the reason I’m doing that. [00:01:00] Is because I just got back from an orthopedic surgery conference. I I’ve, I’ve been to almost like every specialty conference at this point.

I, you’re doing a lot of speaking and, uh, not all of them, but you know, a good amount. Uh, I’ve seen the wide variety of different like meeting types and events. And, uh, I saw something at this ortho, uh, conference that, um, that I’ve never seen before, uh, pickleball courts in the exhibit hall, they had three, they were having a pickleball tournament.

Apparently in San Diego, there’s like a, the, the professional pickleball association, which is a thing I didn’t know. I know you could play professional pickleball, um, is, uh, uh, their headquarters, I think are in San Diego. And so they sent over a pro, uh, and, uh, I, I got to go and I record a little video, uh, with [00:02:00] them and it was a lot of fun, but I’ve never seen that before.

And I’ve seen everything. Like I went to an emergency medicine conference once and they had a donut wall. This was, this is pre COVID. There’s like a, like a peg board. It was a giant peg board. And, uh, on each peg was a donut. You can just go grab a donut off, off the, and there was like a ladder. Uh, I don’t, I don’t think that, I don’t know if it was that tall.

In my mind, it was like a 40 foot tall peg board of donuts, but it probably wasn’t that big. Uh, in, in reality, but I was very impressed by that. And so, um, a great job orthopedic surgeons on getting your, your, your physical activity done during, during your, I would expect nothing less from orthopedic surgeons.

It was a great group, great. Uh, I had a lot of fun and so I wanted to wear my ortho cap for you guys. This is the ortho women. If you’re watching, obviously you gotta be watching on YouTube to see me wearing this thing. This [00:03:00] is my, uh, the one I wear in all my videos. With ortho, uh, it was given to me by somebody, I think in Sweden, uh, it was mailed to me.

I didn’t go to Sweden. I’ve never been to Sweden, but, um, it was mailed to me, uh, by a, a, a, a woman, uh, in orthopedic surgery. And it says ortho women. It has a picture of a hand. With a drill. I love it so much. It’s great. And so I try to wear that every single time I play the orthopedic surgeon. I’m wearing this thing.

Um, so thanks to all the ortho bros out there. Uh, and ortho lady bros out there. Uh, I had a great time. Uh, So here’s what we’re going to do today. I’m going to talk for a few minutes about private equity. I got, I got some things to get off my chest. All right. When it comes to private equity, I always have something to get on my chest about private equity, but, uh, we’ll do that and then, uh, get into some, uh, it just, uh, some, some questions you guys left for me on the YouTube channel at Glaucomfleckens, uh, some, [00:04:00] some, some things to address, some great questions, some funny comments.

Uh, so, uh, we’ll get to that here in a bit. All right, first let’s talk private equity. Um, so first of all, this, this has been on the forefront of my mind because of what’s going on with Southwest airlines, RIP Southwest, I grew up in the Houston area, and so I, you know, I’d say that’s probably the most popular airline in Houston.

For, for years and years, because it was so easy to go Houston to Dallas. I would go Dallas to Lubbock because I went to college at Texas tech university. Uh, Austin is just, that’s, it was so easy, you know, their hubs in Dallas. Uh, and so very easy to fly. Uh, and I would always remember the. The, the one I get away, that was my go to whenever I had no money.

Uh, and the one I get away airfare, I swear, I don’t know if I’m just like misremembering this, but I swear to God, I would find like one way flights for like [00:05:00] 39. And this, what this was like in 2000, probably 2007 or something. So a while back, I mean, it’s, it’s been, you know, almost 20 years, but not like so far back, I still think 39 was crazy cheap.

I don’t know if I’m just making that up, but I really think that there, I was, you were able to get super, super low fares that has since gone away. Um, I think last summer they did away or, or, or maybe a few years back, they did away with the one to get away. Type of like cheap airfare. You got to go to spirit for that.

Um, and, and now I think they have like assigned seats now. Uh, uh, maybe, uh, I don’t know. Uh, it was just back when I was flying Southwest, you just, everyone, they started doing the numbered system. Like. You’re a, you know, 30 or C 15. And so you’d line up based on that, but it was like, you’re with your own, you’re a cohort of C people.

[00:06:00] And so you’d all like go together and just kind of first come, first serve on, on seats, um, uh, within your group. But recently it was announced that Southwest would do away with two, uh, free bag, bag, uh, free bags, two free bags you could get, this was like, I haven’t flown Southwest since I’ve moved out of that region.

You know, there’s really no reason for me to fly Southwest. They don’t come up to Portland, Oregon very often. Uh, and so, but my parents, oh, they, they’ve, they’ve been Southwest. In fact, there was, I keep telling them, like, when you come to Portland, you can, you can fly Southwest, but it’s, it’s like double the time of the trip.

But they’re so insistent. It took them forever to try a different airline. People are very attached to their airlines. People in Texas, very attached to Southwest airlines. And part of the allure is like, Oh, two free bags that saves you like a hundred bucks. And, and, and, and so they went away from that. And so the [00:07:00] question everybody’s asking is why other than just, is this just a money grab?

Well, yeah, of course it is. And so, and you know why? Because, uh, this is what I think, and is probably the case is that, uh, uh, about, I think a couple of years back, uh, they received an outside investor Southwest airlines did of like 1. 2 billion or something from, uh, from something called an activist shareholder, which I had to look this up, but basically an activist shareholder is someone who buys a big stake in the company.

It becomes shareholder status in a company with the. Purpose of being an activist, which in this context means influencing the company’s direction and performance. So they get this big stake in the company. Maybe they’re not a majority shareholder, but they’ve got a big enough stake that they can throw their weight around a little bit and, and, and turn the company in one direction or the other.[00:08:00] 

Well, this, which honestly, if you’re thinking, it kind of does, it sounds like private equity and then going further. Um, uh, these types of activists, they can be just individuals that can be hedge funds or they could be private equity firms. So I don’t know if this particular group that bought this stake in, in Southwest airlines is quote unquote, a private equity firm, but they’re acting like a private equity firm would act.

And what does that mean? That means you get a big stake in the company. Um, and then you, you just slash, they already had, they, they laid off a bunch of employees at Southwest, you do everything you can to try to, to, uh, to cut costs and generate profit as quickly as possible. And so here you have it. And the reason I’m bringing this up is because how much more evidence do you need?

And now I’m talking to people in healthcare, I’m talking to physicians, I’m talking to [00:09:00] administrators, executives, uh, how much more, how much more evidence do you need to know that private equity ruins everything it touches? There are no redeemable qualities about private equity taking over a company.

It’s slash and burn. It is short term profit. At the expense of everything else, the customer experience, the employee experience, why would it be any different in healthcare? Why? And, and, and, and what really irritates me is because I mentioned, I go to all these conferences and this is not something that happened at this orthopedic surgery conference.

I don’t think, I mean, private equity is everywhere, but I don’t even, I don’t know if like ortho is even in the top 10 of specialties that have a private equity influence. Maybe they are because it’s a surgical field. And so you’re going to [00:10:00] have a lot of private equity interest and high paying high reimbursement fields.

But, um, this is something I’ve seen in my own specialty ophthalmology conferences. Where you have a, a panel or a seminar that’s like pros and cons of a private equity owned practice. And the reason they have these types of events is because they do it for residents, for fellows, for young physicians trying to figure out what kind of practice they want to work in.

And, uh, and so of course, like private equity is like the big boogeyman. Uh, for, for residents, for trainees, no trainee wants to be involved in private equity, but still you have these organizations that are putting on conferences that are having events where you have private equity physicians, physicians that have sold to private equity and you have, you’re giving them a platform to go in front of residents and say, [00:11:00] there’s some cons to private equity, but Hey.

Here are some pros. Now you might think, well, what’s the big deal? That’s not like, it’s okay. They’re showing the pluses and minuses. Well, my problem is that there are no pros to private equity and healthcare. We need it out of healthcare. So I don’t want anybody sugarcoating private equity owned practices as a, as something that’s just as viable.

Of an option that’s just as good in some ways might be better. According to these doctors as a physician owned practice, they’re not on the same level in one. You have a physician’s owning a practice physicians who got into medicine because they do have patient interests at heart. We take an oath.

There’s still some part of every physician that wants to do right by the patient versus private equity on practices. that are just in it for profit. [00:12:00] Yeah. Doctors want to make money. Doctors who own practices want the practice to make money. They want to keep their employees. They want to have a nice living.

All right. And they do, but there’s a difference between having a motivating, uh, having motivation to do right by your patients. And that, that central tenant, uh, it influences the decisions you make. Maybe you, you, you could do things, you could make a little bit more profit, but you, you, you don’t make that decision because it’s not right by the patient versus private equity.

None of that matters. They are not in it. They’re in it for short term gain. They want to flip that practice to another private equity firm for profit. It’s so I, I hate. I hate it when people just present the idea of private equity as, oh, there’s some bad things, but there’s also some great things. No, stop.[00:13:00] 

There are no good things about it. It’s ruining healthcare, just like it ruins every other industry. It finds itself in, it takes over and if it doesn’t outright bankrupt a practice, which we’ve seen emergency medicine has had private equity involvement, and we’ve seen those, those practices go bankrupt.

Uh, it’s happened in, in, in the world of anesthesiology as well. And part of that’s because those are specialties where, uh, you can’t limit what type of patients you see, because that’s a big calling card of private equity firms, they want to, they don’t want to take care of the patients that have no insurance, they don’t want to take Medicaid.

All right. Well, sorry, you got M Tala with emergency medicine. So you’re going to have to see everybody that comes in. And, uh, and that obviously makes it to where it’s a less profitable venture for private equity firms. So they go bankrupt, [00:14:00] they run it into the ground. And so the, and the thing is, and other specialties like ophthalmology, you don’t quite have that because you can get away.

With not seeing Medicaid, you can turn Medicaid patients away. I think that’s wrong. I think you owe it to your community to see any type of insurance someone can, if they have a method, a way to pay, uh, and in some cases, even if they can’t pay, all right. Uh, it, I, it’s, it’s, you have to do what’s right by your community.

And so like in our practice, we take all insurances. We’re constantly renegotiating with insurance companies to try to get what we’re, uh, what we Uh, well, we should make from them and sometimes we have to threaten them that we’re not going to take their, their, their insurance, their, um, their patients anymore.

And usually we, and we almost always work it out, but, but you can’t just, I’ve got a big problem with just blanket, like [00:15:00] no more Medicaid, like that’s not the way to practice as a physician. I think it’s, it’s harmful for your community, especially if you’re a big practice, but it’s, it’s the, the private equity thing we need to be.

Every professional organization needs to just be, we should be all on the same page with this. Like it’s bad. We need less of it. We need to try to. Create legislation and rules or whatever you want to go guidelines, something that makes it easier for physicians to own their own practices, to stay in private practice, to join private practices, um, take away some of the reasons why physicians will sell the private equity.

Sometimes it’s just a money grab. You want to check out, you want to retire. Sometimes they don’t have a choice. I get that. And that’s, it’s not the decision. There’s a different conversation to be had about the decision to sell to private equity. That’s really not what I’m, [00:16:00] I’m talking about right now, because that that’s, I don’t want to litigate that at this point because people have their reasons who among us would turn down a check for 8 million or something like that.

Yeah. I mean, that’s a lot of money for physicians too, but it’s the. It’s the trying to sell, then go after you’ve sold, then to turn around and try to sell it to the next generation of physicians. That’s what I have a problem with. We should not be platforming anybody like that. Right? You made your decision great.

You know, live with, live with the, the massive boost to your bank account. But you don’t get to tell other physicians that with, you know, especially with your, by gigantic conflict of interest, that though they really should consider a, a, a, joining a practice. That’s owned by private equity. Oh, there’s some great parts to it.

That’s the opposite of what we need in healthcare. We need more [00:17:00] leadership and ownership in the whole healthcare system. Uh, with, uh, you know, we need it run by people who actually have patient care experience. All right. We need to get private equity out of it. Anyway, that’s my soapbox. All right, let’s take a break.

We’ll come back with some comments.

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Okay. So, um, I loved a lot of the comments that came in off of the, uh, the most recent episode that was published that was posted, published, like I’m a publisher now, no posted I’ll say, um, which is the, uh, where I talked about. Uh, a number of things. One of them was, uh, rubella, um, and [00:19:00] getting the vaccine and the, the, the anti vax movement, which seems to be just getting worse and worse every day, uh, had some great comments.

So I want to share, I want to share a couple of those. Um, so at Amanda Bevan 6, 3, 3, 1, uh, said my mom shared this with me recently when the news of the first death in Texas came out, by the way, there’s been another death and, um, the, the, there’s just more. Yeah. It’s it’s spreading, which is not surprising because it, it rubella is, um, uh, measles is just an incredibly, uh, infectious disease.

Like just the, what am I trying to say? It’s, it’s, um, contagious. That’s, that’s what, that’s the word I’m trying to say. It’s a very extremely contagious disease. Uh, and so she said, um, uh, she had. Measles as a child pre vaccination, uh, probably in the fifties, I didn’t think anything of the comment about, uh, when I was talking about what I discussed with eye complications, [00:20:00] uh, but here’s the quote from her mom who had measles.

Uh, back in the 1950s, I remember being ill when I had measles had to stay in bed for days in my room. It was totally dark. The light hurt. It can cause blindness. Our family doctor even came to the house to check on me really serious stuff and so contagious. You can catch it hours after someone who has measles has been where you are, which is absolutely true.

It can just linger in the air for hours. And so that just kind of hit me because. As adamant as those of us in healthcare, the vast majority of us are like 99. 9 percent of us are in healthcare about, about vaccinating, about getting the MMR vaccine. Um, I can’t even imagine what people must be thinking who had firsthand, who had this disease, who had a, an entirely preventable disease and still clearly [00:21:00] 70 years later.

All right. This woman can recount exactly what that experience was like. It shows you what kind of effect that has on people. And so, uh, it just, it makes me so angry. You know, uh, I feel like I’m just airing grievances during this episode today, but it’s, it’s true. And so, uh, um, uh, I don’t know. I don’t even know.

You know, I was asked. At, uh, the, this past conference I went to is like, do you have any recommendations on social media for how to, like, reach people about vaccines? I, I had no answer. I don’t, I don’t know at this point. I honestly don’t know. I do know that storytelling is, is very powerful. It’s very big and people are, that’s the way a lot of people are generating their content is through storytelling, either through comedic storytelling like I do, or traumatic storytelling, just.

That, that’s [00:22:00] how you reach someone on an emotional level. I don’t know, a lot of us, especially, particularly pediatricians, they’ve tried the stats, they’ve tried the studies, they’ve, I mean, we have, like, dozens and dozens of studies featuring thousands and thousands of patients showing that there’s no link to autism.

With the MMR vaccine and yeah, we still have RFK juniors like we’re going to allocate some funds to do a big study to finally put this question to bed. It’s settled. It is it’s it’s science. It’s it’s it’s there. The data is there. What are we? You’re going to, and then saying that in the wake of, of the billions of dollars that are being, that’s being cut from science funding and research funding, uh, by the department of government efficiency.

It’s just none of it’s making sense. And it’s depressing. It’s awful. Uh, and I really feel bad. I feel like every day I see a new post of someone who had a [00:23:00] research fellowship taken away from them, a grant that was taken away from them. Um, uh, one price, the one I saw today, it was someone who had a grant, uh, study, uh, something about fibroids and, you know, just real things.

These are real topics that, that need, uh, that’s how we advance in society. That’s how we, we stay ahead of other countries and to be the, be the, be the forefront and not that that’s the end all be all, but to, to push science forward and, and be, um, and set the example for scientific achievement. Uh, that’s, that’s going away clearly.

Anyway, thank you for that comment. Um, Oh, here’s another, this is a great, great, uh, point here at passion at propagator said, please point out in one of your episodes that rubella, one of the illnesses prevented by the MMR, uh, can cause blindness and a prenatally exposed baby. It’s a great, great [00:24:00] point in the seventies.

I worked as an aid at the Oregon state school for the blind. The deaf blind unit was filled with rubella babies. These kids had profound disabilities and would all need lifelong care. Congenital rubella syndrome is nasty. Absolutely agree. Thank you so much for bringing that up. Um, and so let’s talk about it.

Let’s let’s have that be our big eyeball topic of the day here. Um, so congenital rubella, um, is, uh, probably the is the most common cause of vaccine preventable birth defects. It’s, it’s, it’s extremely common. The way you get this is, um, uh, through infection of the rubella virus during pregnancy specifically.

The first trimester and that increases the risk of getting this constellation of birth defects that constitute this congenital rubella syndrome. Obviously, lack of vaccination, uh, increases [00:25:00] the risk dramatically. Um, uh, as you know, even just a single dose of a rubella containing vaccine MMR vaccine is a great example confers lifelong protection.

So it’s, it’s not hard. To protect yourself from this, uh, yet, you know, the vaccination numbers are, you know, lagging and people are questioning it. Uh, let’s see. So, congenital rubella syndrome, um, the, the most common manifestations are, uh, with, as, um, that have to do with ocular disease would be, uh, There’s, there’s like four different ones.

All right. So there’s pigmentary retinopathy. This is a, an inflammatory disorder of the retina. Uh, and that’s found in probably about half of patients with congenital rubella syndrome. It can be unilateral. It can be bilateral. They have this very, uh, these, these babies have very, uh, classic. [00:26:00] Appearance to the retina.

We call salt and pepper retinopathy. Uh, so this is modeled pigmentation that occurs in the, in the retina. Um, and, uh, and that actually increases over time and you end up getting atrophy. Of the posterior pole of the eye, which is where the most important part of your retina is that what you use for your primary central vision, you get atrophy and pigmentation changes, and it just causes degradation of vision.

Um, so pigmentary retinopathy. Another thing you see with congenital rubella syndrome is cataracts. So you get congenital cataracts, uh, that, um, there’s a whole host of things that can cause cataracts. Congenital cataracts, but usually in the context of other findings and, you know, history of an unvaccinated mother and all the, you can pretty easily put together a picture of congenital rubella syndrome.

Um, so for the [00:27:00] eyes, uh, you know, basically you get these like pearly white cataracts, uh, in the baby and, uh, they’re more likely to be bilateral and congenital rubella. And it’s as high as like 89 percent uh, of these patients have bilateral cataracts. And obviously that’s something that is very tricky to treat as a baby, you know, um, congenital cataracts.

Uh, when you had to do surgery, um, you always have to decide how quickly you have to do surgery and, uh, you want to try to wait as long as possible to allow the eye to grow a little bit and to mature. But sometimes you can’t do that and you got to do surgery pretty early to try to. To save whatever vision you can, but one of the more devastating findings that you can have outcomes from a congenital rubella syndrome effects, I should say, is microphthalmia.

So microphthalmia, um, occurs in a congenital rubella when the baby’s eyes are less than [00:28:00] 16 millimeters. in diameter. That’s a very, very small eye. Uh, and, um, these, this occurs in about 10 to 20 percent of patients with, uh, congenital rubella. Uh, and, um, these eyes typically have very poor vision outcomes because of how small they are.

Uh, there’s a high degree of hyperopia and sometimes with microphthalmia, the eye is just not developmentally a normal eye. Some of the structures are, are don’t, don’t develop properly like the trabecular mesh work, the drainage system in the eye, which can lead to glaucoma. Um, and, uh, and so sometimes you can get glaucoma, uh, as, um, uh, another.

Complication of congenital rubella syndrome. Uh, and so, and that part of that’s just because that part of the eye just doesn’t [00:29:00] develop properly. So, you can see there’s a whole bunch of problems that is so that that occur with congenital rubella. We didn’t even talk about strabismus, uh, uveitis, which is, uh, you get inflammation inside the eye, uh, because of infection with this virus.

Um, it’s, uh, It’s horrible. And it’s it’s the worst part about it is just it’s so preventable. It’s so preventable. Uh, and so, um, uh, You know, prognosis is, is not great and, um, and it’s, uh, I don’t know if I’ve, I’m thinking back even in my, I’ve probably seen a, a couple of kids that had it. I didn’t, I haven’t seen any like newborns with it, but certainly going through my pediatric education and ophthalmology residency, uh, we saw some kids that came through that had a congenital rubella and, um, a lot of times they’re blind.

Uh, a lot of times they’re deaf and, um, because it can affect a hearing as well. So. Okay. Terrible, horrible stuff. Uh, and I wish I [00:30:00] had a better answer to that person who asked me a question. About how we reach people. I just don’t know anymore. Uh, and it’s, um, you know, if someone has a great idea, if you’ve had any success stories of how you’ve like changed someone’s mind about vaccines, please.

Like email me or leave them in the comments on the, or on the YouTube channel at Glaucomfleckens. I will, I will absolutely share anything I get because I would also love to know how to reach people about, about getting them vaccinated, about trying to explain to people. How useful it is and how life saving vaccines are.

And anyway, anyway. Um, so yeah, please reach out to me. I would love to hear people who do this a lot more than me, because there are a lot of, you know, we don’t talk about vaccines a lot in ophthalmology, um, but uh, it, it, it doesn’t often come up, uh, pediatricians. Primary care, [00:31:00] family medicine. Like you guys do a lot more vaccine education than I do.

And so I bet you have a lot more expertise on how to get people to understand the importance of vaccine. So please share that with me and I’ll share it with all my followers. All right, let’s, uh, let’s take one more break. And then I’ve got a few comments, uh, related to the VA story. I told last a couple of weeks ago.

All right. So if you recall, if you haven’t heard this, did you, if you didn’t listen to this episode, please go and listen to a couple of weeks ago, I talked about, uh, this story at the VA where the VA police and somebody actually commented, I didn’t know what VA was because I’m, I don’t live in America.

And, um, and so it’s veterans administration. So all the veterans. Uh, military veterans, they go to the VA to get their care. And [00:32:00] a lot of times it’s either, it’s either free to them or not, you know, it’s, it’s heavily discounted medical care. It’s government funded medical care. Um, and so, uh, the story, just the short version is the VA police found what they call what they thought were vagina pictures, uh, basically pornographic pictures.

in a, in a physician office in the VA, they started opening an investigation to find out who has taken these photos. Turns out the photos were vocal cord photos from the ENT clinic. So, uh, the, uh, um, money put to good use there. So a couple of comments on that story, uh, at. S a Mary lists, uh, says what I am surprised by in the VA story is that no one in the ENT department complained about why all their photos were being, were getting stolen.[00:33:00] 

Good, good, good point, which is why I made the caveat at the beginning of that story when I told it, uh, that. You know, it was, it’s a secondhand story. I don’t know what, how, you know, the whole telephone thing got, how it’s changed and the version that I’m telling you, um, is I think the funniest version of it and it’s the version I heard.

And maybe it’s not the actual version of it, but you know, it’s probably pretty close, but good point, what you, you think they would have noticed, but then again, there’s like a lot of. Like at this point, those photos are probably all like in the healthcare. It’s actually, I don’t know if they’re still, if they’re, if they have that capability at the VA, but in a, in a normal, uh, uh, electronic record system, they would be all digital.

Uh, so, but good question. Here’s the, here’s this one made me laugh at Amanda two, two, four, four said the, the larynx thing literally happened to me when I was in college. I [00:34:00] was in a speech anatomy class. As a speech anatomy major and someone came up to me and told me I couldn’t be studying that in the library.

Oh man, I, like, what do, what do people think vaginas look like? I, I just, to me Those vocal cord photos, they look more like the xenomorph and alien than they do a part of the female anatomy. So I don’t, I don’t get it. I mean, I guess I kind of get it, but not really. Like, I mean, it’s people just are really, I don’t know if it’s like a problem with the education system, um, in our country, but that’s, it’s troubling to say the least, uh, it does remind me though, of being in the library.

Like being in like the general library, not like the medical library or being on a flight and I’m like, you know, as a med student, um, or [00:35:00] even as a resident, I was, you know, studying disease and I’m always like kind of self conscious, like when I pull up a, a terrible, you know, traumatic open globe injury, there’s.

Blood and iris coming out of the eye and it’s just, there’s a big laceration and basically an exploded. I was like, oh man, I bet people are really hating like sitting diagonal across the aisle from me. Cause I’m sure they can see this at some point. You just stop caring though. You just do it. But yeah, I wouldn’t surprise me if people came up, you’re like, oh, can you.

Can you like turn your laptop a little bit or, or look at something else? I don’t know. I’ve never done that to somebody. I would just not look at it, but you know, whatever. That’s just me. Um, what else, what else we got here? Seven. Oh, this is old at old Dion’s seven months of investigation could have been saved by just bringing it up to the head doc the next day.

At least they took it seriously though. Good point. Yes. Uh, I want to say [00:36:00] they maybe just had some time on their hands and it was something that there’s like, Oh, it was something juicy. We can really sink our teeth into and, um, really find, uh, someone doing some wrongdoing when you could have just brought it up the next day.

Good point. Um, oh, and then this is my last question because this, this might take a few minutes to explain. So, uh, at Catherine hall, 2780 is a great, great question. Okay. How do you tell if an er will have an on call ophthalmologist? A friend of mine went to the ER because his eyes, he lost a vision, eyes were blurry and they did not have an on call ophthalmologist.

So just sent him home and told him to see his optometrist the next day. To be fair, that’s like, Probably 75 to 80 percent of the patients with eye problems that come into the emergency department can be seen by an ophthalmologist or an optometrist the next day or the next business day or a few days later.

Um, he did get [00:37:00] referred to the ophthalmologist from there, but I worry the delay may have reduced his chances of having a good outcome, particularly in his right eye. Uh, so, like I said, it’s, it’s, um, we don’t have to go in very often because there’s a lot of stuff in ophthalmology people. People feel like there it’s, it’s more severe than it really is.

And that makes sense because it’s your vision, like you’re, it’s, it’s scary when you all of a sudden you go really blurry in one eye or you start having eye pain. People don’t want to go blind. It’s very scary. Uh, and so they go in to see the emergency department, but usually it’s something that is more sub acute.

We’ve talked about pants patients. That’s what I started doing. These knock, knock eyes was to talk about pants patients. Maybe we’ll revisit that and go over some of those again. You can go back and listen to them though. Um, and, uh, the pants patients are the true emergencies and ophthalmology, the things that will get me out of bed, make me put my pants on to come into the emergency department as an on call ophthalmologist, those things do exist.

So if [00:38:00] you are concerned about your vision or a new change, like it’s okay. To go in to see the, uh, you know, the eye doctor, if you are established with either an optometrist or an ophthalmologist. Uh, particularly with an ophthalmologist, um, I would encourage you to start there with with trying to figure out what’s going on because any eye practice worth a damn will have somebody who you can talk to after hours, whether it’s a nurse or a technician or, you know, at least somebody with some knowledge about eyeballs, Who can triage what’s going on with you.

And so I really encourage you. And if your office, if you’re seeing an ophthalmologist and they don’t, nobody takes call out their practice, like honestly, unless that’s your only option, like finding a different practice, because I don’t think it’s fair or [00:39:00] appropriate to, to be a physician and not take call for your own patients.

Come on, you gotta, you gotta make sure you’re there for, for the people you take care of your community. Uh, but the, to the, to the, to the question here is, uh, is how do you tell if an ER will have an on call ophthalmologist so that it. Any level one or level two trauma center hospital, if they’re a level one or a level two trauma hospital, they have to always have an ophthalmologist on call.

That’s going to cover all of your academic medical centers and most of your like big hospitals in an urban center. There’s going to be, they’re going to be at least level two, but you can Google it. You can search your hospital, your local hospital and find out what level they are level one or level two.

Uh, they will, in order to have that designation, which allows them to, [00:40:00] to I don’t know. Get more funding. I don’t know. I don’t know what the benefit of it is. You can have more residency training programs for sure and fellowships and things. Um, but but they have to have on call ophthalmology coverage 24 7 3 65.

So you will be okay there. Um, for smaller hospitals, urgent cares. Uh, you know, especially, you know, you go further out into rural communities. It’s, it’s much more spotty, but they should have somebody that they can call. They might not have someone that can see you right away. If you have something serious going on, anybody, they can always triage it and they can call somebody, uh, to at least like talk it over and if you need to be seen at a level one or level two, they’ll transfer you over there.

Yeah, it’s, I’ve, I’ve seen it. I’ve been, I’ve been the doctor. Taking those calls from rural communities and told them, okay, yeah, this is serious as a major [00:41:00] traumatic injury with a tractor or something. Let’s send them over. So anyway, um, I don’t want you to be too worried about that. Uh, but start with your local, if you are established at a practice, they should.

At least help you out a little bit. Guide you if they say, Oh, this sounds really pretty bad. Go ahead and go see, um, go to the emergency department. Uh, or, you know, everything’s fine. You’re having flashes. I’ll see you in the morning. All right. So that, that’s, that’s, that’s what, that’s what I would do. If I were, um, having any kind of eye problem, good questions, you guys.

All right, so send me yours again at Glaucomfleckens on YouTube. I go through all of these every week. And so, uh, um, I, I love, uh, hearing what you guys are thinking about, uh, and getting ideas, but didn’t talk about some of you guys are very concerned about that spleens can explode. I don’t know if they can really explode rupture.

I mean, that’s kind of like an explosion anyway. [00:42:00] Um, give me your comments. I love to see those, uh, thanks to, uh, my producers, Aaron Corny, Rob Goldman, and Shaunti Brooke, editor engineer Jason Portizzo. Music is by Omer Binzvi. Uh, knock, knock. I is a human content production. I’ll see you next time, everyone.

Take care.

Thanks for watching the episode. You can find more on that playlist over there. If you prefer to listen or you just had your eyes dilated, you can binge full episodes, wherever you get your podcasts or join the party over on Patreon, where you get early access episodes, hang out with us, get lots of exclusive bonus content, help you subscribe, leave a comment below, let us know what you think.