When a patient is harmed by a doctor’s cessation of treatment – commonly called “patient abandonment’, or “medical abandonment” – a malpractice case may result.
A patient will often visit a doctor at a fairly distressing time, often at the height of the patient’s vulnerability.
As a result, a doctor may harm a patient merely by declining to provide treatment or by ceasing the provision of care before it is medically reasonable to do so. Continue reading
Is my doctor’s guideline for my treatment right for me? – Melissa J. Armstrong, MD | March 11, 2017
Health care guidelines are produced in ever-increasing numbers. The National Guideline Clearinghouse, a U.S.-based public website compiling summaries of “clinical practice” (health care) guidelines, has over 1,000 entries and is updated weekly. The National Institute for Health and Care Excellence in the U.K. has over 180 clinical guidelines.
Health care guidelines impact policy decisions and care for individuals. Recent research, though, suggests that the public has only a vague understanding of what guidelines are and how they are developed.
Current high-quality clinical practice guidelines, though, are anchored in a thorough review of available medical evidence.
A group of prominent pain and addiction specialists are pushing back against the federal opioid crackdown by asking CMS to withdraw a notice that would make it extremely difficult for Medicare patients to get painkiller prescriptions above a certain strength.
More than 80 physicians, including four who helped create the 2016 CDC guidelines on opioid prescribing, wrote to acting Medicare director Cynthia Tudor about the notice, which would require pharmacists to refuse prescriptions over 90 milligrams of morphine or its equivalent unless the patient first went through a complex, time-consuming review.
While the CDC guidelines caution that high doses create an overdose risk, they also state that physicians should have ultimate discretion on prescribing, and warn that it is not advisable for patients to be tapered off high doses of opioids involuntarily. Continue reading
LOST IN CHAOS: The State of Chronic Pain in 2016 – Presented by the Pain Action Alliance to Implement a National Strategy (PAINS)
In June 2011, the Institute of Medicine published Relieving Pain in America (RPA or Relieving Pain) and established as its highest priority development of a national population health plan to be completed by the end of 2012
In March 2016, the Department of Health and Human Services (HHS) published the National Pain Strategy (NPS). The NPS advanced all the recommendations made by the IOM committee and the notion that underpinned Relieving Pain, i.e., a “cultural transformation in the way pain is perceived, judged and treated” is needed.
Furthermore, the National Pain Strategy provided a plan to transition from a biomedical pain care model, i.e., one based on prescription medications, interventional procedures and surgeries, to a comprehensive bio-psychosocial chronic disease management model. Continue reading
Like the CDC, FDA, DEA and CMS, the National Committee for Quality Assurance (NCQA) is targeting high doses of opioid pain medication, as well as patients who see multiple prescribers and use multiple pharmacies.
NCQA is a little known non-profit organization that plays a big role in determining the standard of care expected of healthcare providers. It manages accreditation programs for physicians, medical groups and health insurance plans by measuring and ranking their performance against a set of standards known as the Healthcare Effectiveness Data and Information Set (HEDIS).
To post a comment – please! – click here
(a detailed registration is required).
Comments will be accepted until March 22.
Strict limits on opioid prescribing risks ‘inhumane treatment’ of pain patients – By @StefanKertesz – Feb 2017
Lately I’ve been seeing dire warnings on Twitter:
- Its important to have some sense before we make CDC suggestions enforceable, punitive, and not patient centric. https://t.co/G512mieHAf
- No trials have tested impact of involuntary, nonexpertly-managed Opioid discontinuations. Risk of harm is high https://t.co/G512mieHAf
- The road to hell is paved with good intentions. Making CDC #opioid guideline mandatory is ill-advised https://t.co/G512mieHAf
- Let’s hit pause before @CMSGov makes @CDCgov #opioid Guideline mandatory https://t.co/G512mieHAf
Stefan Kertesz, MD, is one of our most powerful advocates because he is an addiction specialist who speaks up for the right of both pain patients and addicts to receive treatment that is scientifically valid and individualized to the patient. Continue reading
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatmentwith
- superficial heat (moderate-quality evidence),
- acupuncture, or
- spinal manipulation (low-quality evidence). Continue reading
New clinical guideline issued for treating low back pain – Medical News Today – 2/14/17
The American College of Physicians (ACP) have published their clinical practice guideline for treating nonradicular low back pain in the journal Annals of Internal Medicine. Nonradicular pain refers to pain that does not irradiate from, and is not caused by, damage to the spinal nerve root.
The condition accounts for a large proportion of all doctor visits in the U.S., and almost 25 percent of the entire adult population in the U.S. has experienced at least one day of low back pain in the past 3 months. Continue reading
“The lack of pain treatment medicine is both perplexing and inexcusable.
Pain causes terrible suffering yet the medications to treat it are cheap, safe, effective and generally straightforward to administer.”
Access to pain treatment as a human right | BMC Med. 2010
Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Continue reading
Treating chronic pain: Regulation ignores the larger issues |Shirie Leng, MD | Meds | December 23, 2014
In 2009, the FDA asked for recommendations on restricting prescribing which were met with opposition from drug companies and physicians’ lobbying groups.
They are talking about pain patient advocacy organizations here, insinuating that they have nefarious motives, and that suffering patients are just lobbyists for pharmaceuticals or doctors (whichever is the punching bag in the particular article).
It’s a conundrum for pain patients because we happen to need what the pharmaceutical industry wants to sell, even while our goals and motives are not just different, but oppositional: Continue reading