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4462. Patient Dignity (Formerly: Patient Modesty): Volume 94

-physician relationship (as opposed to the archaic, paternalistic term of the doctor-patient relationship). I am not sure exactly which volume I have brought this up in, but I argue that this is a more correct term as the patient is the primary member of importance in the relationship and thus put first. The term physician is also a more accurate term describing a person that is licensed to diagnose, treat, and prescribe. Three articles focus on the importance of shared decision making in individual (...) electronic devices should be carried by personnel carrying out patient care. 8. There are more but these come to mind first. Please feel free to add. JR At , said... PT Because people want those that care for their health and even their lives to consider them as human beings. They can't accept that patients are just objects to be processed at the convenience of the bureaucracy. Consider how people treat their family and friends when they are sick. These people can't imagine that anyone, with rare

2019 Bioethics Discussion Blog

4464. 5 steps clinicians can take to get back to their patients

at the base of this problem and follows with a prescription to get any medical office back on track. The heart of the matter of patient care Why are medical providers feeling they struggle more than ever with administrative duties? Park points to two main issues. “The first is mandates set by the Affordable Care Act to move to electronic health records,” she says. “In itself, this was always going to be a challenge. But many offices continue to struggle because they never had the proper contractor support

2019 KevinMD blog

4465. The commodification of health care is destroying the doctor-patient relationship

and could prescribe whatever drug or test they felt necessary based on years of experience. While there was a strong doctor-patient relationship in those bygone days, it was not necessarily an equal partnership. Patriarchal doctors expected their advice to be followed and patients generally complied because they trusted their doctors. Patients today have lower expectations of their doctors, having never experienced a strong bond forged through generations of caregiving. Unless they need a prescription (...) . Limits must be set on astronomical copays and deductibles that drive patients away from their doctors. Eliminating the time-consuming and expensive middlemen of bureaucracy would not only help reduce costs but also would give back precious doctor-patient time — time that could be used for health caring. In theory, technology should free up time and allow doctors to spend more with their patients. Electronic medical records have fallen far short of this ideal, though, increasing provider frustration

2019 KevinMD blog

4466. The problem with abbreviations in the medical record

The problem with abbreviations in the medical record The problem with abbreviations in the medical record The problem with abbreviations in the medical record | | January 28, 2019 23 Shares Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way. Take, for instance, the patient whose outside chart was reviewed when she showed up in our office for a follow-up appointment after an emergency (...) .” The medical documentation community has battled against abbreviations for many years, primarily because of the risk of an abbreviation being used by one person to mean one thing, and interpreted by someone else to mean something different altogether. Many years ago, when we used the electronic health record more as a word processing document, I remember seeing numerous occasions where a patient with MR (mitral regurgitation) was suddenly “transformed” into a patient with mental retardation. And vice versa

2019 KevinMD blog

4467. The old days of medicine are gone

and golf memberships at a mere fire sale. Gone are the days when physicians would be called “doctors” instead of “providers” and with it the respect that was once ascribed to the title. Gone are the days when a patient would ask: “But what does the doctor say?” instead of asking: “Will the insurance pay?” Gone are the days when a physician can direct the care of the patient or prescribe a medication or service(s), they deemed necessary. Even their prescription pads have lost most of their value as once (...) any prescription reaches the pharmacy it will mostly join the lot of those that will not be covered by insurers. Gone are the days where health insurance had a certain value. Instead, the ever limiting and continuously more expensive and less valuable commodity has become the new descriptive of having but a false security crutch called health care coverage. Gone are the days when physicians could perform thorough examinations on their patients. Instead, they have become thorough typists, chaotic

2019 KevinMD blog

4468. Why doesn’t the allied health field play a larger role in the care of patients?

as part of a physician’s practice, and there’s a possibility they share the same electronic medical record (EMR). But that’s the exception, not the rule. Wouldn’t it make complete sense for everyone to be on the same page and work together and be paid a reasonable amount? Part of the problem with the allied health field is there is a gaping hole inconsistency regarding accreditation and regulation. Some fields call for full licensure, some only a certification. In terms of certification, some require (...) are connected to any state licensure. One does not even need to obtain a certification to market themselves as a “health coach.” While there’s a lot of variance in the accreditation process of those in the allied health field, there’s no question the importance these professions play in the role of the health of an individual and the overall care plan prescribed by the primary care physician. Rob Arnold is an exercise physiologist. Image credit: … … 89 Shares Tagged as: Subscribe to KevinMD and never miss

2019 KevinMD blog

4469. Preserving Patient Dignity (Formerly: Patient Modesty):Volume 106

someone remind medical providers to treat them w/ dignity and respect--isn't that part of what this country built on? We also want it brought to attention about the use of drugs such as versed and fentanyl which in many cases are used for convenience of the medical staff rather than for the need of the patient. Another area is how easily medical records are manipulated especially since they are electronic boilerplate creations. Most people never read those records so they have no idea how many (...) have 100+ volumes in probably seven instead of 14 years. BJTNT At , Anonymous said... Hello, The following is a sad commentary on a previously unquestionably, noble profession. This doctor has had 32 yrs of experience. Friday, November 1, 2019 Montgomery County Doctor Agrees to Pay $1.4 Million to Resolve Allegations of Improper Opioid Prescribing After Pleading Guilty to Related Criminal Charges https://www.justice.gov/usao-edpa/pr/montgomery-county-doctor-agrees-pay-14-million-resolve-allegations

2019 Bioethics Discussion Blog

4470. Inaction is driving our collective burnout

border, in community health centers, in prisons, on Native American reservations, in the hallways and exam rooms of some of the most esteemed academic medical centers in our country. I listened to these stories as part of my work with Primary Care Progress, a national nonprofit working to strengthen primary care teams and clinicians. As I spoke with several health care providers about the realities of their work, I expected to hear the usual concerns: the rise of the electronic medical record (...) prescription costs. Our health care providers don’t get to turn a blind eye to symptoms of America’s divisions and inactions. They also don’t get to decide who deserves treatment. The victim or the shooter. The immigrant or native born. The nationalist or the progressive. For clinicians, they’re all patients. But health care professionals do suffer the consequences of inaction. William Osler famously remarked, “Listen to your patients; they’re telling you their diagnosis.” We also need to listen to our

2019 KevinMD blog

4471. Patients and physicians need to talk more and tweet less

Patients and physicians need to talk more and tweet less Patients and physicians need to talk more and tweet less Patients and physicians need to talk more and tweet less | | January 8, 2019 50 Shares Long ago, and far away, I encountered a patient that changed the way I practice. I was with a medical student while examining a middle-aged woman who presented with a dramatic eruption that was probably DRESS syndrome (DRESS syndrome was not yet described). I prescribed prednisone and asked her (...) that even if the doctors were outstanding, an argument with a receptionist, a canceled appointment, or insurance glitch were responsible for a miserable experience. The reviewer warns patients to go elsewhere. Wouldn’t it be more effective to let the practice know to directly to address the issues? Destructive. Over nearly four decades of practice have I ever misdiagnosed a skin cancer? Prescribed a drug that did not work or yielded an adverse reaction? Have I ever not acquiesced to every patient

2019 KevinMD blog

4472. Patient Dignity (Formerly: Patient Modesty): Volume 94

-physician relationship (as opposed to the archaic, paternalistic term of the doctor-patient relationship). I am not sure exactly which volume I have brought this up in, but I argue that this is a more correct term as the patient is the primary member of importance in the relationship and thus put first. The term physician is also a more accurate term describing a person that is licensed to diagnose, treat, and prescribe. Three articles focus on the importance of shared decision making in individual (...) electronic devices should be carried by personnel carrying out patient care. 8. There are more but these come to mind first. Please feel free to add. JR At , said... PT Because people want those that care for their health and even their lives to consider them as human beings. They can't accept that patients are just objects to be processed at the convenience of the bureaucracy. Consider how people treat their family and friends when they are sick. These people can't imagine that anyone, with rare

2019 Bioethics Discussion Blog

4474. Erythromycin

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4475. Clarithromycin

offspring neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes (...) prescribing guidelines. If a macrolide is indicated, erythromycin is the preferred choice during pregnancy because there is more documented experience of its use than for other macrolides. Exposure to a macrolide antibiotic at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians

2014 UK Teratology Information Service

4476. Macrolides

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4477. Ionising Radiation

kinetic energy or sufficient charge to displace atomic electrons resulting in molecular ionisation. Key factors which influence the degree of ionising radiation exposure and the subsequent biological effects include the duration of exposure, the distance from the source, the degree of shielding and the type of radiation emitted. Adverse fetal effects following ionising radiation exposure during gestational development can include dose-related deterministic effects which arise as a result of damage (...) of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs

2014 UK Teratology Information Service

4478. Azithromycin

neurodevelopment and cerebral palsy risk following antibiotic use in the management of spontaneous preterm labour or rupture of membranes are conflicting, although an electronic health record study has since reported a higher risk of cerebral palsy and epilepsy amongst children of women treated with macrolides during pregnancy compared to those of women receiving penicillin. The RCOG advises against routine use of antibiotics for women in premature labour without ruptured membranes, but that antibiotic (...) treatment should not be withheld at any stage in pregnancy if a pregnant woman is showing signs of infection. A single study has identified an association between asthma and in utero exposure to macrolides, but found the same for other antibiotic classes studied and did not take into account other reasons for asthma being more common in these children. Where possible, the results of culture and sensitivity tests should be available before making a treatment choice in accordance with local prescribing

2014 UK Teratology Information Service

4479. Cyanoacrylates

such as the manufacture of plastics, electronics and scientific instruments. Exposure may therefore occur in both domestic and occupational settings including factories and during manicuring, dentistry and surgery. No published reports have been found on the possible adverse effects of cyanoacrylate on human reproductive function or following exposure in human pregnancy or lactation. An evidence-based assessment of the risk to the fetus following either acute or chronic exposure during pregnancy is thus not possible (...) reporting form. Please encourage all women to complete an . Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced

2014 UK Teratology Information Service

4480. SNAP: a population health guide to behavioural risk factors in general practice

): Ask (1) • identify patients with risk factors Assess (2) • level of risk factor and its relevance to the individual in terms of health • readiness to change/motivation Advise (3) • provide written information • provide a lifestyle prescription • brief advice and motivational interviewing Assist (4) • pharmacotherapies • support for self monitoring Arrange (5) • referral to special services • social support groups • phone information/counselling services • follow up with the GP . Figure 1.The 5As 1 (...) . Ask 2. Assess 3.Advise 4. Assist 5. Arrange Amount smoked and readiness to change Information and motivation interviewing NRT Buproprion Quit prescription Quitline Follow up visit BMI and stage of change Diet Physical activity Information Guidelines Physical activity prescription Heartline Dietician Follow up visit Diet history and readiness to change Information Guidelines Heartline Dietician Follow up visit Alcohol intake and readiness to change Information and motivation interviewing

2014 The Royal Australian College of General Practitioners

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