Real physicians discuss recent healthcare headlines.
E-record rules are burning out doctors and killing patients
https://nypost.com/2019/03/28/e-record-rules-are-burning-out-docs-and-killing-patients/
While I think we will all agree that we spend too much time on computers, whether it’s at home or work, the author should have stopped at that without trying to make too many political points. Being spurred to adopt new technologies is probably a good idea. But it’s true that going too fast can create many unforeseen problems. No pressure and nothing ever changes. But there is a middle ground of looking for the best technologies that help more than they hurt. Whether we go to single payor or not is its own kettle of fish.
– Mark Plaster, MD, JD
The digitization of medical records has not become a system of dependable information, but a disconnected patchwork that has handcuffed health providers to more hours spent on a computer than the time they spend with their patients. There is no industry that deserves an increase in efficiency through digital liberation more than medicine, however the lack of intuitivity, inability to access critical/time-sensitive information, endless scrolls of data, the ridiculous maze of pull down menus, pop-up alarms, and an endless number of clicks, all we have now done is swap one set of problems for another…increased cognitive burden leading to physician burnout and patient safety issues leading to patient morbidity and mortality.
– Salim R. Rezaie, MD
Doctor delivers bad news by video
https://www.bbc.com/news/world-us-canada-47510038
I was in the room when my dad was told he was going to die by a living breathing doctor. It didn’t go any better. There is no way, digital or live to tell someone bad news. I don’t disagree that being there to hold someone’s hand when bad news is delivered can sometimes be better. But bad news is bad news no matter how it is delivered.
– Mark Plaster, MD, JD
When the medical profession loses respect from patients, “innovations” like this are one of the reasons why. If you’re too busy to take time out of your schedule to give one of your patients a *death sentence*, you’re an a-hole.
– William Sullivan, DO, JD
CDC guidelines don’t offer any shortcuts to safer opioid prescribing
https://www.nejm.org/doi/full/10.1056/NEJMp1904190
The use of opioids for both acute and chronic pain is not a black and white issue. Simply, setting inflexible recommended dosages and duration thresholds is not the answer for a heterogenous population of patients and can lead to patient harms. Pandora’s box of opioid prescribing has been opened, and a global issue, but swinging the pendulum the other way and cutting off opioids is also not the answer, nor what the guidelines are suggesting. We should all maximize non-opioid treatment and while starting fewer patients on opioid treatment is a start and will reduce the numbers of patients on opioids in the long run, for patients who are currently on opioids, an individualized taper should be implemented with a multimodal approach to lower the risk of overdose and experiencing increased pain. Guidelines should not dictate our care but help guide our care of patients, but they should also not be misinterpreted at the cost of our patients.
– Salim R. Rezaie, MD
As one who now spends a great deal of time treating patients with opioid use disorder I frequently hear the horror stories of patients who became addicted on opioids that their physician prescribed, but then were suddenly discharged from the practice when they demonstrated evidence of OUD. The main take home of this is the fact that the patient now has a problem that will takes months if not years to correct. It is a far more nuanced problem that most clinicians think it is. And it is finally time to bring it out in the open and treat it like we would anyone other health problem.
– Mark Plaster, MD, JD
Let’s see, now. The Joint Commission – working for the CMS – called pain a “fifth vital sign” and graded hospitals in part on how well hospitals treated patient’s pain. HCAHPS scores are required by CMS and grade medical providers on whether they “did everything possible to treat a patient’s pain.” Millions of patients are prescribed opioid pain medications each year and, according to the CDC, there were 218,000 opioid related deaths in 18 years. Now the CDC picked the 90 MME number as a benchmark for “safety” in prescribing opioids and at the same time has caused many patients who were productive members of society on higher doses of medications to decompensate and experience more pain. Mark’s right that the issue is nuanced, but this random solution isn’t the answer. I can only imagine the next round of unintended consequences that occur with the next set of “guidelines” that are issued to fix the current “guidelines.”
– William Sullivan, DO, JD
Alexa is now HIPAA compliant paving way for secure health apps
https://www.hipaajournal.com/hipaa-compliant-alexa-skills/
All I can say is “What took you so long?”
– Mark Plaster, MD, JD
Just because we can do things doesn’t mean we should do things. What could go wrong by giving all of your health information to Amazon and letting everything be accessed by a speaker in your living room? It isn’t like a visitor to your house could ask Alexa about your medical history while or Alexa would send information to some random person…
– William Sullivan, DO, JD