NANOSNET

My staff usually requires a letter of referral before I schedule a patient so that we know it's not just someone being sent for a refraction in error, but one got through and when we called to find out why and by whom the patient was being sent, we were told by a lawyer's office, and the lawyer's office said that it was because he lost vision on a weight loss medication.

When I saw this delightful 48-year-old man who is status post bariatric surgery and has hypertension and sleep apnea, but not diabetes, I asked him what doctor actually sent him to me and he said none did- he went to an optometrist for the decreased vision that's been present for six months and has been slowly progressive and nothing was done, and they did not refer him for another opinion or testign.

But he says that out of the blue a lawyer contacted him because he had visual loss while he was on Wegovy

He has absolutely no idea how the lawyer found out about this, so I have to assume that either the lawyer is illegally screening epic for diagnoses or some other database or that someone in the optometry place somehow contacted the lawyer. I guess a third method might be if the lawyer had access to a database of all patients on semaglutides and similar medications and had a way of cross referencing it for medical visits for blurred vision.

When I saw this man, he was 20/20 in his right eye and 20/80 in his left eye. However, he refracted to 20/25 in the left eye and although 20/80 OU at near, refracted to 20/20 and 20/25 for near.  He had no afferent defect and normal color vision.  His fields just show the minor changes first time field takers sometimes show.  His OCT 

His fundus was normal aside from tilted oblique discs

Has anyone seen this kind of direct lawyer referral without it involving the patient's desire or knowledge?

Disgusting...

It's possible the optometrist is  used to sending cases on to lawyers. Then the lawyer is suspicious as to the reason and sends the patient on to such as a neuroophthalmologist for clarification.

could be- I just found some optometric records from before the Wegovy and it just has  presbyopia-  

Dear All,

The happiest day of my life was when I did not have to see any more Medical Legal Cases.

JLK

When I was doing a lot of medical legal work, this was not unusual. In many cases, the patient was told to definitely not to tell the doctor a lawyer was involved. It didn't bother me because I made sure that there were no very specific diagnosis and make sure the medical records were general. I didn't mind because eventually the lawyer would call me to discuss the case and of course I would tell him I can't do that for free. I would then tell him that if he wants any specific information, he needs to depose me or pay me for talking to him and the dep would eventually come upI would then tell him what he would be paying for the time of my deposition. I would also explain if asked by the patient there is a cost for the lawyer. If he wants any information it's not in the somewhat bland medical record. Obviously this is only if the patient somehow ends up in your office and you end up doing an exam. If called by a lawyer directly. I explained that I would bill him and not discuss the case until paid.

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The difference here is  that this man, who I believe, has no idea how the lawyer found him- he never contacted  any lawyer- and was so happy that I could refract him down.

Hi Larry,

Thank you...just incredible