Study of diagnostic accord between general practitioners and an ophthalmologist.
OBJECTIVE
To identify diagnostic accord and disagreement between general practitioners and an ophthalmologist and thereby determine how undergraduate and non-specialist postgraduate ophthalmic training could be improved.


METHODS
Comparison of diagnosis of presenting conditions by general practitioners and one ophthalmologist in patients consulting general practitioners for ophthalmic problems during March 1989 to February 1990.


METHODS
12 general practices in west Nottingham.


METHODS
1474 patients presenting to the study general practitioners with new ophthalmic conditions or new episodes of recurrent conditions.


METHODS
Diagnoses of general practitioners and ophthalmologist.


RESULTS
1121 (76%) of patients with eye problems agreed to see the ophthalmologist and most were seen within three days. Sufficient data for comparison were available on 1103 patients. Diagnostic agreement was found in 638 cases (58%), but potentially serious misdiagnosis was found in only 15 cases; management in three of these cases would have ensured later identification. Most commonly confused conditions were infective and allergic conjunctivitis, blepharitis, and dry eyes. General practitioners assessed visual acuity in only 114 cases yet eight of the 15 patients seriously misdiagnosed had reduced acuity, an important diagnostic sign.


CONCLUSIONS
Most ophthalmic disease seen in general practice does not require specialised equipment for diagnosis. Most cases of misdiagnosis have no serious consequences for the patient. Undergraduate and postgraduate training in ophthalmology should ensure that common conditions can be easily differentiated and more serious conditions identified and referred.
Sheldrick
J H
JH
Department of General Practice, University of Nottingham.
Vernon
S A
SA
Wilson
A
A
D002983:Clinical Competence; D003951:Diagnostic Errors; D004739:England; D005128:Eye Diseases / Q000175:diagnosis*; D005194:Family Practice; D006801:Humans; D015588:Observer Variation; D009885:Ophthalmology; D012680:Sensitivity and Specificity