"We deserve better than this."

July 18, 2016

The Republican National Convention starts today, and I find myself in a difficult position. I feel compelled to make some statements about the state of our Union; at the same time appropriately constrained by a need to remain nonpartisan in the role I am honored to fill as the president of the New Hampshire Medical Society. My son tells me I am a bleeding heart liberal. I accept that categorization, as opposed as I am to name calling and labeling. I am not, however, a flaming liberal; the difference being that a flaming liberal puts a lot of provocative bumper stickers on his/her car. I mention the above only to indicate the great restraint I am now exercising. 

A Cure for Physician Burnout

July 13, 2016

I was able to get away last week to spend some time in Maine with family and friends. Beautiful weather in a beautiful state, and of course my favorite people. Now perhaps the part of the trip that stands out more prominently in my memory is the fact that the striped bass have finally arrived in our part of the Gulf of Maine (Casco Bay).

A thank you to the new EVP

July 6, 2016

The Executive Council met last week, including members of the search committee that identified Jim Potter as our new Executive Vice President.

An excellent Council meeting

June 15, 2016

The Medical Society had an excellent meeting this past Wednesday.  Before the council meeting we reviewed our annual budget audit with the finance committee (we are in good shape), followed by an excellent discussion, led by Seddon Savage, MD, about making training for MAT (medication-assisted therapy) for those suffering from opioid addiction more easily accessible for NH physicians.

Board of Medicine Rejects Governor's Opioid Rule Proposal

Special NHMS Alert: Board of Medicine Rejects Governor’s 13-Page Proposal - Sets Temporary Opioid Prescribing Rules*

Empowering Successful Partnerships

It is not uncommon for weekdays to blur with weekends when working shifts in the emergency department (ED).  However, one of the key distinguishing features is that there are fewer resources available on weekends. This can be an encumbrance when attempting to provide patients with continuity of care for their medical issues. Strikingly, there is nothing remotely comparable for those evaluated in the emergency department when treated for addiction and mental health related concerns. Addiction stands alone to a greater extent, as it is the most challenging of circumstances to offer any reasonable resources with any regularity.  There routinely are few to no options available, any day of the week, in the majority of EDs in the state.  It is that dismal.

I am just here for a refill!

We are still all in it together, at least as best as I can tell from recent experiences.  In the past few weeks I have had several deja vu encounters, occurring in separate emergency departments in different states.  Most recently, I was coming on shift and taking sign out from a colleague who informed me of a challenging discussion. A patient was insistent that he was to get his narcotic prescription refilled, that the original prescriber was not reachable, offering no means for the patient to get in touch, and of course, to just go to the emergency department (ED). Despite the patient acknowledging that he had not taken the medication as prescribed and that the sixty tablet prescription was to last another week or so, but was already metabolized, he remained steadfast, that he must get a refill immediately.  The patient was not in extreme pain nor compromised to any concern whereby refilling the prescription most definitely was not a consideration. 

Pharmaceutical price gouging continues to force the toll on the most vulnerable.

Despite more social media coverage and public outrage regarding the rapid and egregious rise in pricing for many of the most commonly prescribed and generic medications, there is no immediate solution on the horizon.  Providers and patients are usually the last to become aware of the details.  “No wonder, Dr.

The End Game

“He was perfectly fine this morning, and a bit tired this afternoon, which made sense.  I went in to check if everything was okay and found him lying in bed having trouble breathing clutching his chest.  That’s when I called 911.  Of course I want everything done that can possibly keep him alive.” These were the words and wishes of the patient’s family member.   This was a man in his tenth decade of life, unable to speak for himself, facing momentary demise, with no clarity of how involved or intense the resuscitation process should be.  A man barely alert, in pain, with few chronic medical problems, in his mid-nineties, supine in an emergency department resuscitation bed.  There was no way to determine what he really wanted for himself under such circumstances, leaving the timely decision up to family and friends, who reportedly had not discussed such possibilities in the past nor made reference to what he might have wanted based on his character in general.  End-of-life care decis

The usual suspects, who are they really?

While walking into the emergency department (ED) for a Friday night shift, I heard the patch on the EMS radio reporting a patient found down, unresponsive, not breathing and cyanotic on the sidewalk.  An initial dose of naloxone had restored the patient’s respiratory drive, but ongoing resuscitation was in progress, with a five minute ETA.  For me, the prehospital EMS providers and my department colleagues, it was yet another shift treating a patient with an acute life threatening opioid overdose.  Over the next five hours of the same shift, there were three more opioid overdoses, each as severe as the first. All required supportive care and were eventually discharged from the ED. Fortunately, none died, unlike others in the days and weeks before.  Three of the four patients had a history of being prescribed, or using illicitly, methadone and/or buprenorphine, with no recent or related history of abusing prescription narcotics.

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