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Letters

Managing eye conditions in general practice

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7111.816 (Published 27 September 1997) Cite this as: BMJ 1997;315:816
  1. T Manners, Specialist registrar
  1. Ophthalmology Department, Addenbrooke's Hospital, Cambridge CB2 2QQ

    Editor—Though general practitioners' confidence in diagnosing and managing eye conditions is not high, they can expect 2-5% of all consultations to be eye related.1 Teaching of ophthalmology at medical school is limited in duration and far removed in time from entry to general practice. Less than 5% of general practice registrars do any ophthalmology as part of vocational training (data from Joint Commitee for Postgraduate Training in General Practice), but over 70% do an accident and emergency post, usually for six months. I sent a questionnaire to all accident and emergency departments in England, asking clinical directors and general practice registrars about the amount, usefulness, and potential for improvement of any ophthalmology training received during this period.

    Of 214 questionnaires sent, 104 were returned. Six per cent of new patients presenting to accident and emergency and 11% of those returning have ophthalmological diagnoses, exposing the average senior house officer to 230 new eye problems over six months. All responding senior house officers said that this experience was useful and relevant to general practice. Sixty one of the 102 senior house officers (60%) had a slit lamp available, and nearly all of these considered themselves reasonably competent in its use. Seventy five senior house officers (74%) felt confident in handling most presenting eye problems. This contrasts with established general practitioners, 68% of whom admit to “some uncertainties about eyes” (10% affirm that eyes “scare me stiff”).2

    Over three quarters (78%) of all responding departments offered formal teaching in ophthalmology (although only 68% of senior house officers received it), and 78% of the clinical directors were happy to have responsibility for initial assessment and treatment of eye casualties. Both groups of respondents wished to have more liaison, teaching, and feedback from their local eye department.

    The spectrum of eye disease in accident and emergency differs from that in general practice (table 1,3 4 but there is more overlap than between general practice and an eye clinic.

    Eye problems most commonly seen in accident and emergency departments and general practice4 5

    View this table:

    This survey shows that there is much exposure to eye problems in accident and emergency departments. For most general practitioners this could be their most important period of ophthalmological training, if supervision and training are adequate. Confidence can be gained with basic eye examination and use of the slit lamp (a feasible tool in many group practices), together with a working knowledge of many common eye conditions. Simple improvements in equipment and training and involvement of specialists may improve confidence among future general practitioners. Any moves by individual hospitals to set up eye casualty units staffed by career ophthalmologists must consider the inevitable weakening of general practice training in their area.

    References

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