Tag Archives: doctors

Doctors are Firing Complex/Difficult Patients

Missing appointments? Skipping doses? You might get fired by your doctor – By Max Blau @maxblau – May 15, 2017

A new survey of primary care doctors reveals an interesting statistic:

9 out of 10 practices have told a patient not to come back. 
The doctors have fired their patients.

The research, published in JAMA Internal Medicine on Monday, found that firing patients doesn’t happen often, but it’s making some health experts nervous that doctors will expunge difficult patients from their rolls as insurers move toward reimbursing them more for benchmarked health outcomes than actual services provided.  Continue reading

Physicians ceded control of health care

Physicians ceded control of health care. It’s time to take it back | PHYSICIAN

This is such a truthful look at what’s happened to the practice of medicine that the author had to remain anonymous to protect themselves against punishment from the administrative powers that have taken over.

In the not-to-distant past, American health care was the gold standard.

It offered job satisfaction and autonomy, was financially rewarding and was considered by many to be the most honorable profession. But as we all know, over the last two decades, increasing health care costs and demands and increasing competition for insurance contracts have changed the face of medicine.
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Understanding the patient’s context

How Well Do You Know Your Patient? – By Jennifer P. Schneider, MD, PhD and Bennet Davis, MD – Mar 2017

Can you describe a day in your patient’s life?

As treating chronic pain with opioids comes under greater and greater scrutiny, one of the lessons that has become more evident to prescribers is that initial assessment and follow-up are no longer a matter of just gathering facts about the characteristics of the pain and its level.

We cannot provide safe and effective care unless we understand the patient’s context.   Continue reading

Advice for Dealing With Difficult Patients

A Psychologist’s Advice for Dealing With Difficult Patients – March 2017

During his talk, Dr Mariano sought to address a common situation encountered by pain physicians in their every day practice: should they reinstate opioid treatment in patients successfully taken off these medications?

The answer is: it depends on the patient,

  • on whether they have a history of substance misuse,
  • on their functioning, and
  • whether they are actively involved in their own pain rehabilitation.

“This is the primary directive of opiate prescribing.

Yes, the primary directive of opioid prescribing is that it depends on the patient. That’s exactly why standard dose restrictions for opioids are not medically sound.
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The Best Hospitals Are Managed by Doctors

Why The Best Hospitals Are Managed by Doctors December 27, 2016

Healthcare has become extraordinarily complex — the balance of quality against cost, and of technology against humanity, are placing ever-increasing demands on clinicians.  

These challenges require extraordinary leaders.

Doctors were once viewed as ill-prepared for leadership roles because their selection and training led them to become “heroic lone healers.”  But this is changing.  The emphasis on patient-centered care and efficiency in the delivery of clinical outcomes means that physicians are now being prepared for leadership.   Continue reading

“Addiction Medicine” IS now Recognized Medical Specialty

ABMS accepts “Addiction Medicine “ – 3/14/2016 – update/correction to a previous post

The American Board of Medical Specialties (ABMS) officially recognized Addiction Medicine as a subspecialty at its October 2015 Board Meeting in Dallas, Texas.

The American Board of Preventive Medicine (ABPM), a Member Board of ABMS, sponsored the application for the subspecialty to allow physicians certified by any of the 24 ABMS Member Boards to apply for the new certificate

However, a previous article (and blog post) shows exactly how flimsy the requirements are to become an “Addiction Medicine” specialist.

With little training in anything but the 12-step model, such specialists are supremely unqualified to deal with the complexities and social consequences of addiction.  Continue reading

“Addiction Medicine” NOT a Recognized Medical Specialty

“Addiction Medicine” is not recognized by the American Board of Medical Specialties (ABMS)–It is a “self-designated-practice specialty” (SDPS) and indicates neither knowledge nor expertise. – Disrupted Physician – 6/14/2015

This article shows exactly how flimsy the requirements are to become an “Addiction Medicine” specialist.

With little training in anything by the 12-step model, such specialists are supremely unqualified to deal with the complexities and social consequences of addiction.

The increasingly rapid growth and complexity of medical knowledge in twentieth century American medicine resulted in the creation of specialties and subspecialties.   Continue reading

A Better Opioid/Pain Contract

Breaking the pain contract: A better controlled-substance agreement for patients on chronic opioid therapy | Cleveland Clinic Journal of Medicine. 2016 November

ABSTRACT: “Pain contracts” for patients receiving long-term opioid therapy, though well-intentioned, often stigmatize the patient and erode trust between patient and physician. This article discusses how to improve these agreements to promote adherence, safety, trust, and shared decision-making.

Regulatory bodies and professional societies have encouraged or mandated written pain treatment agreements for over a decade as a way to establish informed consent, improve adherence, and mitigate risk.

Unfortunately, the content of these agreements varies, their efficacy is uncertain, and some are stigmatizing or coercive and jeopardize trust.

See The Tyranny of Pain Management Contracts   Continue reading

Assessing Pain Is Vital

Yes, Assessing Pain Is Vital – Pain Medicine News – June 20, 2016 by Lynn R. Webster, MD

I wrote in a blog last year that efforts to roll back pain as the fifth vital sign are likely to gain traction, despite inaccuracies and flawed thinking.

That is precisely what has happened.

A recent Medpage Today article titled “Opioid Crisis: Scrap Pain as 5th Vital Sign?” lays out similar flawed arguments touted by Physicians for Responsible Opioid Prescribing (PROP)

What are these flawed arguments?   Continue reading

Response to Surgeon General’s Opioid Pledge

Pain Academy’s Response to Surgeon General’s Opioid Pledge: “Come to terms with chronic pain” – National Pain Report – September 30, 2016 by Ed Coghlan

Since the CDC Guideline on Opioid Prescribing was released what has rankled many in the pain community—doctors, patients and advocacy organizations alike – was the lack of options to opioid prescribing.

The Academy of Integrative Pain Management added its voice this week in criticizing the Surgeon General’s Opioid Pledge.  It coincides with an op-ed published in USA Today from AIPM’s immediate past president, Dr. Robert Bonakdar.

In the USA TODAY, Dr. Bonakdar wrote, while over-prescribing of opioids and lack of insurance coverage for non-pharmacological treatments are problems, what the Surgeon General really needs to address is more fundamental – in the US, we have difficulty dealing with chronic pain.   Continue reading