At least they got the diagnosis right?!? that's kinda good news. Luckily the patient got a huge bill, a CT scan they didn't need, and now will get the $20 antibiotics they needed. Do you know if their ESR was ok? LOL
I have found that the ability for any person not an ENT to diagnose an ear related problem and its proper treatment is no greater than 20%.
Everyone I see has horrible ear infections with "red" drums. When in reality they all have normal exams. And increasingly I'm seeing the shotgun approach to treatment - oral antibiotics and drops.
Man, I'm not perfect. But it feels like the entire world of healthcare skipped learning about ears.
This is true for us too. 95% of ear infections and effusion are misdiagnosed. If you ask someone in urgent care to look in your ear for any reason, you’re going to have an effusion. Guaranteed. All pain on the side of the head (any area) - ear infection. Drum too white? Ear infection. To red? Infection. Can’t see past the wax? Infection. Little sclerosis on there? Infection.
I will point out that the VAST majority of these diagnoses are NPs or PAs.
And yeah, no one knows the difference between a swimmers ear and an otitis media. I love it when the patient has been to urgent care three times and treated with oral antibiotic, then drop, then oral antibiotics and drops. And the diagnosis code is “eustachian tube dysfunction.” Where we are, all ear issues are no longer the purview of primary care. At all. They’re a complete black box. About 10% of the time no ear exam is even documented when antibiotics are prescribed for an ear infection. I’ve gotten into the habit of asking urgent care referrals if someone looked in their ear when they went in for ear pain. The answer would make you angry.
I read a study a long time ago where they took like 200 kids, all of whom got ear tubes for whatever reason. On the morning of surgery they had each ear examined (around 400) by an ENT, a pediatric ENT and a pediatrician and the only question was: is there an effusion? Yes or no?
Then the kids got tubes, so you know for sure.
The peds ENT doc was right about 70% of the time which sounds low, but this was an otoscope exam in an awake kid. So they’re not perfect.
The ENT doc was about 60-something %.
The pediatrician was right 30% of the time.
These were all staff docs.
The point of the article was that we need better methods for evaluating effusion. My take away is the pediatrician is misdiagnosing your kid 2x more often then they get it right when it comes to ear infections.
I’m at a point now where if I ask the patient if the referring doc did an ear exam and they say “yes,” my first thought is “alright, man! Good on you for trying!” And that’s pretty sad.