Frequency of Direct Funduscopy Upon Initial Encounters for Patients with Headaches, Altered Mental Status, and Visual Changes: A Pilot Study.

Objective: To determine the performance of direct funduscopy (DF) as part of the initial clinical assessment among different faculty physicians and residents from internal medicine, emergency medicine, and neurology (N). Methods: Retrospective study of 163 randomly reviewed charts of patients (>18 years) presenting either to the ED, inpatient units, or outpatient clinics from January 2001 to July 2013, with corresponding ICD-9 codes for headaches, altered mental status, and visual changes. Results: Although the Neurology Service was the one who performed most DF upon initial evaluation, DF is infrequently done throughout services independent of inpatient or outpatient location. Two thirds of the patients (66%) presenting with visual symptoms had evaluation done by Ophthalmology, which in some instances contributed to the final diagnosis. Conclusion: A more robust teaching of DF should be included among the basic clinical competencies during Medical School and Neurology Residency training.