Tag Archives: doctors

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

Doctors Should Stop Using The Language Of War

Doctors Should Stop Speaking The Language Of War – Forbes – by Robert Pearl, M.D., a practicing physician and business school professor

Our American culture glorifies war, and war cries are pervasive in our healthcare. We speak of “battling a disease” with a “high caliber” “arsenal” of treatments,  and hear the familiar exhortations “don’t let your disease win” and “don’t surrender to your disease”.

We declare war on cancer, on poverty, on drugs – none of which are even “winnable” –  so I have reservations about calling myself a “pain warrior”.

As soon as the microphone opened for Q&A at a conference I recently attended in New York City, a physician in the audience began his question with, “As a front-line physician.” Another asked from the perspective of someone “in the trenches.” And a third wondered how to provide medical care when we are getting “bombarded by mandates.”
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Chronic Pain After Mastectomy

Chronic Pain After Mastectomy: A Common and Challenging Pain Syndrome | May 09, 2016 | by Chris Iliades, MD

For many women, the pain of breast cancer does not end after surgery, and chronic pain after mastectomy—termed postmastectomy pain syndrome (PMPS)—can be mentally and physically debilitating.

Studies have shown that between 20% and 30% of women develop symptoms of PMPS after surgery. This number varies in the literature,” says Susan K. Boolbol, MD, chief of breast surgery at Mount Sinai Beth Israel,

Etiology of PMPS

PMPS was first described in the late 1970s.

As with other neuropathic pain syndromes, the condition starts with tissue damage, inflammation, and nerve damage.  Continue reading