Drop-In Clinics May Help with Patient Care-But Close Oversight is Necessary

In terms of treating acute problems, I think these clinics should be looked at very carefully on a continuing basis to determine accuracy of diagnoses and treatment outcomes relative to seeing an otolaryngologist. Oversight is also very important, he added.

Although nurse practitioners and physician’s assistants are experienced in many problems seen in a family practice setting, few of them have specific training in otolaryngology disorders. The problem is that, depending on the experience of the nurse or the nurse practitioner with ENT disorders, it can potentially lead to misdiagnoses and further problems down the line, said Dr. Bhattacharyya.

It would be helpful if the drop-in clinic practitioners have some supervised otolaryngology experience, added Dr. Bhattacharyya. We have seen people who have had sudden hearing loss who were seen in a clinic and were told it was fluid in the middle ear, but ended up having an inner ear hearing loss which probably should have been treated more urgently. In cases like this, seeing an otolaryngologist who would have typically prescribed steroids may have been better for the patient, he added. The problem is that these somewhat acute, but potentially threatening diagnoses are small, they are a needle in a haystack, but if [the drop-in clinic practitioners] have no experience with that diagnosis, it’s going to be hard for them to make it.

Hands-On Experience and Physician Supervision Recommended

Dr. Bhattacharyya said that if the clinics are going to be handling otolaryngology problems, especially if it’s on an acute basis, I would really think they need to be rotating with an otolaryngologist to perhaps get some hands-on experience; I think that would be a good addition to their training before they start manning one of these clinics.

Another issue, said Dr. Bhattacharyya, is that otolaryngology overlaps with many other medical disciplines, so sometimes even for a seasoned otolaryngologist, there is a problem distinguishing between overlapping conditions, and again if there is a limited experience, there could be a number of misdiagnoses.

A complete head and neck exam is necessary for most of these patients who come in with otolaryngology problems, said Dr. Bhattacharyya, and many nurse practitioners do not have that training.

My suggestion, especially in the pilot phase, is that there should be some significant physician supervision when these clinics get rolled out, then I think they need to do a good follow-up on their treatments and diagnoses, to make sure there is good accuracy, he added.