Misdiagnosis of acute eye diseases by primary health care providers: incidence and implications

To the Editor: The article by Statham and colleagues raises important issues about the accuracy of diagnosis by primary eye care providers, with all professionals in the study recording a diagnostic accuracy rate of less than 50%.1 From the general practice perspective, the authors raise a number of important contributors — lack of equipment, ophthalmological expertise and time.

Additional factors, such as undergraduate and postgraduate exposure, and targeted training in the diagnosis of sight-threatening acute eye conditions, are also crucial considerations. From a postgraduate point of view, the Royal Australian College of General Practitioners offers a comprehensive continuing professional development program to support broad-based GP training, including in eye disease.2 The Master of Medicine (GP) offered by the University of Queensland also includes a dedicated subject on primary eye care, with particular emphasis on sight-threatening presentations.3 The Division of General Practice in which one of the sites in the report by Statham and colleagues1 sits is currently working with that hospital’s Department of Ophthalmology to institute an education/continuing professional development reform program to better target hospital eye referrals from primary care (Shelley Kleinhans, Health Systems Improvement Program Manager, GPpartners [Brisbane North] Division of General Practice, personal communication).

It is very important to describe accurately the dimension of missed diagnosis within primary care — the ensuing challenge is to address it by harnessing the significant momentum within the primary care community for quality improvement.