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Electronic Prescription

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4261. Difficult Patient vs Difficult Doctor

a study that found that patients that were labeled noncompliant had underlying issues and NOT mental illness or just being difficult. Of patients that were not taking medication, the issue was that the patients could not afford the cost of the medications prescribed. The paper encouraged physicians to see if this was the issue and seek cheaper alternatives for the plan of care. (Source: ) This has been around for a long time and I have seen nurses commonly share this on social media. I have also heard

2018 Bioethics Discussion Blog

4263. Petition to retire the surviving sepsis campaign guidelines

. Guidelines should summarize evidence and provide recommendations to clinicians. Unfortunately, the SSC doesn’t seem to trust clinicians to exercise judgement. The guidelines infantilize clinicians by prescribing a rigid set of bundles which mandate specific interventions within fixed time frames (example above)(10). These recommendations are mostly arbitrary and unsupported by evidence (11,12). Nonetheless, they have been adopted by the Centers for Medicare & Medicaid Services as a core measure (SEP-1 (...) for Medicare and Medicaid Services quality measure SEP-1: The early management bundle for severe sepsis/septic shock. Emergency Medicine Clinics of North America 2017; 35: 219-231. Marik PE. Surviving sepsis: going beyond the guidelines. Annals of Intensive Care 2011; 1: 17. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Medicine. Electronic publication ahead of print, PMID 29675566. Kanwar M, Brar N, Khatib R, Fakih MG. Misdiagnosis of community-acquired

2018 First10EM

4264. How doctors can distinguish themselves in a data-driven world

. Other doctors and I now have electronic medical records in the majority of hospitals and medical offices; there are claims data warehouses, and there is a host of other forms of data. Along with this big data, we have ever-evolving ways to analyze and visualize data which enable more precise measurement, the ability to compare, and the opportunity to predict future events and outcomes. According to a McKinsey report, health care analytics has the potential to create $300 billion in value. New health (...) data like laboratory results and prescriptions. Data may also include a plethora of unstructured information that come from consumer intake tools or medical records. Doctors who have a thorough knowledge of clinical and operational medicine understand how diseases and health care services are classified and those who can take their clinical knowledge and explain it with data elements are poised to be critical translators for analytics teams. For example, in my role, I often work with analytics

2018 KevinMD blog

4265. Why “happy” doctors commit suicide

anxiolytics and was suffering from rebound anxiety and insomnia — sleeping just a few hours per night and trying to operate and treat patients each day. Then his psychiatrist retired and passed him on to a new one. Eight days before he died, his psychiatrist prescribed two new drugs that worsened his insomnia, increased his anxiety, and led to paranoia. He was told he would need medication for the rest of his life. Devastated, Ben feared he would never have a normal life. He told his sister it was “game (...) for occupationally induced mental health wounds, they become even more desperate. If physicians do seek help, they risk being disciplined. Doctors rightfully fear lack of confidentiality when receiving mental health care as private conversations with therapists could be turned over to medical boards and illegally accessed by their supervisors via electronic medical records at their institutions. So physicians drive out of town, pay cash, and use fake names in paper charts to hide from state boards, hospitals

2018 KevinMD blog

4266. 5 lessons I learned about medicine from yoga

requirements of the electronic medical record is documenting at lunch, not attending yoga. Workload and compression of time dictate the day’s schedule. Additionally, by nature of where and when the courses were offered, the yoga itself was reduced to its barest elements. It was by nature, made reductive. It’s as if we thought that by bringing in the “asana” physical postures and “pranayama” breathing techniques, we were bringing yoga. But it was never just about the postures and the breath. yoga makes (...) enter an exam room to remind ourselves of our intention,and — for those few moments — work with an awareness of who we choose to be. We may remind ourselves that it is the energy we choose to bring into each encounter that has the power to change the lives of others. Often far more than any medication we can prescribe. Everything we desire, of ourselves and of our colleagues is available to us. We just have to unlock the practice. Rana Awdish is a pulmonary physician. Image credit: … … 338 Shares

2018 KevinMD blog

4268. Arts workshops as a space for pain communication

they spoke about their pain. Working collaboratively with sound was a particularly good metaphor for pain communication. Participants brought sounds that stood in for their pain and these were often unpleasant to the point of triggering pain in others. This had to be managed sensitively, but by layering sounds together, ‘treating’ them electronically and mixing them, they became collectively pleasant and easier to hear. Sound also provoked reflection about what it meant to listen to pain, how to respond (...) clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section is not appropriate here either - that is not the point of BiM. Finally, all the comments that are made reflect the views of the person who made them and are not endorsed by BiM or members of the BiM research group. Copyright © 2019 · on · · Send to Email Address Your Name Your Email Address Post

2018 Body in Mind blog

4269. 5 fears physicians face today

operating models being featured at national conferences will force them to work even longer days, putting further strain on their family and personal lives. Physicians work hard, often having to spend with each patient. And during those precious few minutes, doctors now find themselves looking more at the computer screen than at the patient, needing to document every symptom and treatment in real-time just so insurers will pay them. “The electronic health record was supposed to make my life easier (...) here to doctors who worry about being inappropriately scapegoated for health care’s high costs and rampant failures. This is a common fear because (a) there’s plenty of blame to go around and (b) so many health care failures can be traced back to the doctor’s office. However, just because doctors are on “the front lines” doesn’t mean they deserve the blame. For example, it’s true that doctors write prescriptions for pricey meds and order expensive radiological scans, but they have no influence over

2018 KevinMD blog

4270. The answer to your prior authorization problem is simpler than you think

with the process end up writing for less-effective prescriptions because they know the preferred drug will require a prior authorization. This is forcing providers to face a frustrating decision every day: prescribe the best medication and risk delays in care by submitting a PA that may be denied or require step therapy? Or avoid the PA from the start and write for a less-effective, though pre-approved prescription? Regardless of the decision, this is a problem that has yet to be resolved despite (...) a PA, perhaps through (read-only) access to the provider’s electronic medical records (EMR) system. Doing so creates a touchless system for providers that decreases downtime in the prescription-filling process and ultimately gets patients the best prescriptions, faster. Could this solution have other implications? The Tufts Center for the Study of Drug Development the cost of bringing a new drug to pharmacy shelves at $2.7 billion. But that cost only increases when PAs enter the picture. Physicians

2018 KevinMD blog

4271. When should insurance companies be held responsible for medical malpractice?

their jobs: Her physician issued a prescription for the life-saving anti-seizure drug, and the pharmacist tried to dispense the medication. It was Yarushka’s insurance company — not the physician or the pharmacist — that was the monkey wrench, arbitrarily denying coverage for her medication without any reasonable justification. Medical malpractice is defined as negligence by act or omission in cases where the prescribed treatment fell below the accepted standard of practice and caused injury or death (...) MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication. But in July of 2009, she turned 19, and when, shortly after her birthday, her family went to pick up the medicine the pharmacist told them they’d either have to shell out $399.99 to purchase Topomax out-of-pocket or obtain a so-called “prior authorization” in order to have the prescription filled. Prior authorizations, or PAs as they are often referred

2018 KevinMD blog

4272. CURES is not a fix for the opioid crisis

a five day supply. The patient is receiving hospice care. CURES cannot be accessed in a timely manner and the prescription does not exceed a five day supply. CURES cannot be accessed because of technology limitations. Trying to access CURES would result in an inability for the patient to receive the prescription in a timely manner and does not exceed a five-day supply. Other states are closer than California at having an interface with common electronic health records. Meanwhile, despite considerable (...) the script. Did we need this law to affect all physicians? We have prescribing data. Would looking at those outliers (and excluding oncologists) have been a more sensible approach? Additional training for those who prescribe above a predetermined threshold would make sense. Embedding decision support and socializing guidelines for use makes sense. Having total morphine equivalent visible in the header is already implemented. SureScripts data that easily allows visualization of prescriptions from other

2018 KevinMD blog

4273. The MultiDimensional Symptom Index: A New Tool for Rapid Phenotyping of People in Pain

. Ongoing work is underway to better understand further properties of the MSI. I hope clinicians will find value in it especially as we move increasingly towards electronic data capture where the burden of scoring a tool is no longer an issue. The MSI is not currently openly available, but those who wish to review it are free to contact me at . Dave Walton Dave Walton is an Associate Professor with the School of Physical Therapy at Western University (Ontario Canada) where he teaches and is Director (...) Digital Strategy, Sydney Subscribe! All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that! We aim to facilitate and disseminate good clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section

2018 Body in Mind blog

4274. Health care has too many moving parts

multiple medical conditions, all of which seemed quite well managed. He relayed a recent frustrating experience in which he had to see a new eye doctor because the ophthalmologist who had been caring for his eyes for several decades had passed away. He had told the new doctor of some worsening vision, and they told him he had dry macular degeneration and a minor cataract, and that he just needed new glasses. He was given his prescription, which he took to a nearby optician, but when he finally received (...) the glasses several weeks later they made things worse, not better. It took several visits back to the eye doctor before they finally realized that they had fitted his eyeglasses frame with his wife’s prescription, not his. So many moving parts. Once a week in our practice, we have a dedicated bit of time set aside where the supervising attendings get to meet one-on-one with the interns and residents who are doing their ambulatory rotations. It’s their time to go over issues related to patient care

2018 KevinMD blog

4275. Richard Smith: Surely time to let the private sector take over dental care completely

unlike a visit to a general practitioner—albeit less than the true cost. The dentist tapped my lower left wisdom tooth, took an X-ray, and pronounced it “crumbing away.” It needed to come out, which has to be done by a specialist. He said he would refer me, warning that it would probably take a month to receive an appointment and another month for it to happen. He also gave me a prescription for antibiotics in case I began to develop an abscess. I haven’t used the prescription, but a few days after (...) -ray, explained everything well, including possible adverse effects, and advised an extraction under local anaesthetic, exactly what I was expecting. He said that as the operation would be done under local anaesthetic it could probably be one soon, in not much more than two weeks. In passing he explained that dentistry unlike the rest of the hospital hadn’t switched to electronic records because their their heavy workload. So I went upstairs to make an appointment, which I had to do at a desk

2017 The BMJ Blog

4276. Jeffrey Aronson: When I use a word . . . Language that counts

write) and an uncountable process (e.g. medication or prescription, acts of medicating or prescribing). However, plurals of non-count nouns are often used, as in the examples given in the Table, and eventually they may become count nouns with new meanings. Here are some bête noires: methodologies (generally use “methods”); safeties (use “harms”); surgeries (use “operations”, when it doesn’t mean doctors’ places of work); symptomatologies or symptomologies (use “symptoms”); toxicities (use , since (...) ’.” ( The Philosophy of Grammar , George Allen & Unwin Ltd, 1924) Some nouns have it both ways, depending on meaning. Chocolates in a box are countable—two chocolates, a few chocolates, many chocolates (but who’s counting?). Chocolate in a bar is not countable—much chocolate, little chocolate, less chocolate. Morbidity (sickness) is not countable, but comorbidities means diseases. This duality arises, for example, when a noun can mean both a countable object (a medication that you give or a prescription that you

2017 The BMJ Blog

4277. Richard Lehman’s journal review—31 July 2017

evidence is often confusing. , based on electronic medical records, most people who were recorded as having had an adverse reaction to statins continued to receive prescriptions for a statin, including over 80% who were given a different statin and then had a further reaction to it. Over a mean of four years, people who continued their statins did slightly better than those who did not, judged by a composite outcome of myocardial infarction, stroke, or death. But the quality of the data is questionable (...) think I’ve ever finished a “course” of them. As soon as I’ve felt myself get better, I’ve stopped. I suspect most doctors are the same, and yet every pack we prescribe sternly warns the patient to complete the whole lot. I am glad to see the science of this unpicked . Although it has 10 authors, it reads like the product of a single person who can order thoughts well and convey them with clarity. I particularly like the division between “professional pathogens,” which contrive active harm

2017 The BMJ Blog

4278. Primary Care Corner with Geoffrey Modest MD: Benzos may not increase mortality risk

to propensity scoring, the benzodiazepine group had more smokers, hypertensives, atherosclerotic disease, hyperlipidemia, COPD/asthma, neuropathic pain, cancer, a lot more anxiety and depression, and were much more likely to be on beta blockers, steroids, opioids (35% vs 24%!!), anticonvulsants, SSRIs (22 vs 12%), and other hypnotics. All of these characteristics were well-balanced after propensity score matching — Short acting benzodiazepines were more frequently prescribed, 75% of the filled prescriptions (...) on a benzodiazepine during a medical visit within the prior 14 days vs 1,252,988 non-initiators, from 2004-2013 — all patients were required to fill at least one prescription for any medication both in the 90 days and 91- 180 days before the index date (ie, they were plugged into medical care and filling prescriptions), and high dimensional propensity scoring was done (see below). — Mean age 46, 85% men, mean Charlson comorbidities score 0.5 (ie, low), 5% smokers, 4% obesity/overweight, 28% hypertension, 1% heart

2017 Evidence-Based Medicine blog

4279. Difficult Patient vs Difficult Doctor

a study that found that patients that were labeled noncompliant had underlying issues and NOT mental illness or just being difficult. Of patients that were not taking medication, the issue was that the patients could not afford the cost of the medications prescribed. The paper encouraged physicians to see if this was the issue and seek cheaper alternatives for the plan of care. (Source: ) This has been around for a long time and I have seen nurses commonly share this on social media. I have also heard

2018 Bioethics Discussion Blog

4280. 10 ways this primary care physician will work smarter in 2018

about scanning the New England Journal of Medicine on my iPad every Wednesday night. I’m usually on call that night, so it will be easy to remember this resolution. 3. In my northern clinic, where routine prescriptions are filled by the providers, I will save myself up to an hour a week by refilling routine, non-controlled medications for a whole year and relying on the other existing systems for making sure patients don’t get “lost to followup.” I learned this from Christine Sinsky’s work many (...) years ago, but because my southern clinic has standing orders for routine prescription renewals, I haven’t had to worry about it so much. 4. In both clinics, I will invest a little more time polishing my EMR templates in order to speed up and beef up my documentation. I will also continue to ponder how I can insert a visit snapshot near the top of each progress note so I can get the gist of it without scrolling down to the bottom when rereading it at the next, follow up visit. 5. I will more

2018 KevinMD blog

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