Stop the Pain - Killers

So much time is spent on the astonishment of the opiate epidemic in the United States.  Where did it start?  How did it get to be so bad?  Who is the most responsible party?  Most importantly, who has the greatest likelihood of making the most timely impact in reducing the overprescribing, abuse and unnecessary deaths from opioids?  After all is said and done, there needs to be greater federal and state mandates to stop the incessant marketing and prescribing of opioids as first line analgesics for chronic pain.  It is clear that current practices and usage are directly correlated with killing the thousands of people using them as painkillers, as well as facilitating recreational use and abuse. That, too, stems from overprescribing, overabundance and greater availability to secondary markets.  Refer to the blog two weeks ago, noting predictable prescribing practices by zip code.

What's in a zip code?

As there are many more states and providers across the country focusing on the epidemic of opioid abuse and addiction concerns, there can be some utility in recognizing patterns that exist within your own zip code. “Each community chooses its opioid.  Within a 60-mile radius of where I have worked, patients have told me that ‘only idiots’ abuse any opioid other than ‘fill in the blank.’  Heroin, oxycodone, meperidine, hydromorphone, fentanyl, dextromethorphan- they all have been abused, but usually only one is abused in any given community. This is primarily due to control of the drug scene by one gang or another.  If opioids do have to be prescribed, limit dosing to three to four days maximum because follow-up for persistent pain is essential.”  ACEP Now, Feb 2015, Vol.34, Number 2, p.

A Painful and Protected Disease Kept Isolated From the Cure



Anytime there is a really sick child or adolescent, regardless of whether or not you are specialty trained in pediatrics, there is a visceral pain and wanting to immediately remedy the condition.  For many of those faced with such circumstances, there is rarely an opportunity to completely eradicate the underlying disease or offending circumstances.  We look to bring more eyes and minds together to stop the disease process, to reduce the suffering and to help the patient, their parents and caregivers. Often entire communities come together to raise support for a child or a family dealing with cancer.  Dozens or more people put their personal needs aside and focus intently on those of a family hoping to stop the cancer that is ravaging their child’s physicality, devouring their emotional existence and impacting their lives forever.   This occurs despite a complete lack of knowledge about the disease.

Scared to Death

As a medical student during a surgical rotation in the 90s at the old Boston City Hospital, I started locking the resident’s call room door whenever I was attempting to catch a cat nap.  This came on the heels of the morning after the chief surgical resident was jumped and beaten while he was sleeping in the call room, by a completely random person wandering the floors of the hospital.  Over the years I have seen patients attack patients, nurses, caseworkers and physicians.  All completely random acts without provocation in the middle of emergency departments, hospital wards and out of the way sundry areas like stairwells or the hospital garage.  The incidence and severity of violence is on the rise in healthcare settings.  Dr. Michael Davidson, the 44-year-old Boston based cardiovascular surgeon who was murdered just weeks ago by a patient’s relative, is one recent tragedy.

Generically Expen$ive

It can be a self-rationalizing moment to reconcile prices at the pumps when filling up these days.  If you are not driving an economy car, it can break the bank.  No need to even go near the social conscientious swirl of how big your carbon footprint is, essentially a personal decision of indiscretion.  If you do a bit of research, a graduate degree in economics is not requisite to understand how prices from the wellhead to the pump are influenced by supply and demand through embargos and OPEC controls.  However, it is not as easily understood regarding the rapid rise in costs for several generic medications over the past few years.  For many this can lead to a personal healthcare and financial crisis that is not based upon personal indiscretions, while the drug companies’ explanations just don’t make sense.

You Don't Have to Be a Player to Be a Coach - You Have to Be Present

The disenchanted practice of medicine is often found to encompass those who have been at it for many years.  Then there are the newbies, not yet out of medical school, encountering the dynamics of clinical rotations, but eyes and ears wide open to get a clearer understanding of how to select a residency training program to best suit their lifelong careers in medicine.  Now, more than ever, the voices of mentors and far less senior clinicians are having greater impact on the future career decisions of medical school grads and early retirement of others.  There is mounting intolerance to corporate directives, second to the short-sighted corporate decisions made on their behalf by administrators.  It is far more challenging and uncertain as to how to plan for the future.  One cannot just go with what one’s heart and inherent talents lead one to, but rather how to hopefully align with the future state of health care.  

It Will Be a Lifesaver for Many

There have been convoluted discussions regarding the utility in providing educational awareness in how to reduce the risk in risky behavior. Needle exchange programs struggled to get off the ground for years.  Proponents supported disease prevention while increasing access to unused syringes without punitive legal ramifications.  Counterpoints have viewed such options as means to increase illicit substance abuse of those already exposed and to entice others in contemplation.  Data and the tincture of time have borne out the need for ongoing support with a multifaceted approach, incorporating strategies and stop gaps, not to derail well warranted public health initiatives.  “To effectively reduce the transmission of HIV and other blood-borne infections, programs must consider a comprehensive approach to working with IDUs. (IV Drug Users). Such an approach incorporates a range of pragmatic strategies that address both drug use and sexual risk behaviors.

NHMS Membership - Two More Please

Our practices are attached to the swinging pendulum of healthcare debt, reimbursement and corporate drivers.  This blog is not intended to highlight the potential trends of ACOs, hospital mergers and acquisitions, or the impact they will have on the quality of physicians’ professional practices and our patients.  After all, so many providers are well aware of the changes on the horizon.  Many more healthcare professionals are intimately aware of business practices and much more willing to partner with or be employed by healthcare organizations than to weather it alone.  This, too, is part of the swinging pendulum that physicians should be mindful of.  There can be some very positive outcomes for all, but it is important to remain at decision tables and as proactive stakeholders.  To do so, it is essential for physicians to grow more robust and cohesive groups in order to be proactive agents of change.

Right Sizing MOC Exams

Over the past decade and a half, there has been considerable attention given to the utility of Maintenance of Certification (MOC) examinations in order to remain board-certified for many specialties.  As a de novo approach, the impetus was to serve as a better means to keep physicians current with the rapidity of changes occurring in any given specialty.  Ongoing scrutiny regarding the correlation between the MOC, as well as other requisite lifelong learning curricula to support the 10-year re-examination cycle, remain under the magnifying glass as to how efficacious they really are. 

Can't always sort wheat from chaff

In follow up to last week’s blog, it may be considered somewhat reflexive to speak to a confounding circumstance in the recognition and treatment of multi-substance abuse and addiction.  Mental illness is intertwined in the management of substance abuse and addiction.  Neither one of these complex conditions are adequately addressed through episodic care, whether it is rendered in an emergency department, a primary care office or from a three-day stay in a psychiatric facility.  Rarely are any of the underpinnings addressed adequately, and quite often the process can be viewed as simply inhumane.

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