DÄ internationalArchive8/2016Important: Asking Patients About Lead Symptoms

Correspondence

Important: Asking Patients About Lead Symptoms

Dtsch Arztebl Int 2016; 113: 136. DOI: 10.3238/arztebl.2016.0136a

Wedig, M P

LNSLNS

Optic neuritis is a textbook case for coordination between a vigilant primary care doctor and a critical ophthalmologist. The more time has passed since a practicing physician completed his/her original medical training, the more it will be the case that the only thing that remains in their minds about the symptoms of optic neuritis in non-eye-related disciplines is the mnemonic: “The patient can’t see anything, and neither can the ophthalmologist.” This mnemonic exaggerates and distorts the distinctive complex of symptoms consisting of pain on visual movements, the need for unfamiliar lighting for precision work/reading, and reduced perception of color. During the medical training of students, the swinging flashlight test to elicit a patient’s pupillary reaction is embedded in association with optic neuritis.

In more than 20 000 consecutive cases in my medical practice I have not observed a single case of acute optic neuritis in primary care. By contrast, on taking over the continuation of previously initiated treatment in 30 000 (20 000 patients with a mandate for diagnostic evaluation, and, over time, 10 000 patients added in with a mandate for treatment), I have treated optic neuritis by continuing parenteral steroid treatment. This provided opportunities to ask for the lead symptoms.

I find these clinical questions reflected in the CME article (1). The question on how to assess the success of training has an easy answer. Reading the complete article requires more time than a cross-section of the CME article: the eye and its appendages (2) provide access to the person and to their likely pathology. Screening examinations of cohorts provide welcome training for doctors in many disciplines (3) and lay the foundations for clinical practice.

DOI: 10.3238/arztebl.2016.0136a

Dr. med. Martin P. Wedig

trunc@gmx.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Wilhelm H, Schabet M: The diagnosis and treatment of optic neuritis.
Dtsch Arztebl Int 2015; 112: 616–26 VOLLTEXT
2.
Wedig M P: Malignes Melanom. Dtsch Derm 1990; 38: 442–52.
3.
Wedig M: Weichteiltumoren der oberen Extremität. Wehrmed Mschr 1989; 33: 508–9.
1.Wilhelm H, Schabet M: The diagnosis and treatment of optic neuritis.
Dtsch Arztebl Int 2015; 112: 616–26 VOLLTEXT
2.Wedig M P: Malignes Melanom. Dtsch Derm 1990; 38: 442–52.
3.Wedig M: Weichteiltumoren der oberen Extremität. Wehrmed Mschr 1989; 33: 508–9.

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