Crash Cart: Teens Aren’t Getting STI Prescriptions Filled

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Arizona is first to recognize all out-of-state occupational licenses

https://cronkitenews.azpbs.org/2019/04/10/license-bill/

Arizona will be the first state to recognize out-of-state occupational licenses. What a concept…sarcasm intended. Someone trained and licensed in another state doesn’t forget that training when they cross a state border. I trained in North Carolina and came back to Texas for my staff position.  This move required me to take a 50-question multiple choice question test on state laws, at a cost of $60 dollars, and then wait for the state to confirm that I passed. Arizona passing this law, will allow anyone to move to the state and start practicing immediately without going through expensive, time-consuming and redundant processes…a model that other states should follow.
– Salim R. Rezaie, MD


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Think about the concept of licensing in 50 different states. On one hand I get the idea that the federal government needs to take a back seat to state specific issues. But on the other hand, having 50 separate medical licensing requirements makes it look like some states have a lesser standard for practice than others. It’s been a long time since we got rid of the whole “locality rule” in medical malpractice cases. Drivers in one state can drive in other states. Ditto gun owners. Physicians with a license in any state can practice at any VA facility in the country. The only reason that there isn’t the same widespread acceptance for professional licenses is the money grab that the states get for licensing fees.
William Sullivan, DO, JD

If this becomes a trend it could be great for telemedicine, particularly in cities near state boarders; but there need to be protections so oxy mills from low-reg states can’t just prescribe on Twitter of course.
–Seth Trueger, MD, MPH, FACEP

This is good politics, but probably won’t do much for doctors. I guess the idea is, once you prove to the AZ state medical board and your credentialing hospital that 1) you moved to AZ and 2) you have a valid out-of-state license and 3) you are licensed in good standing, with no “pending complaints, allegations or investigations relating to unprofessional conduct” … well that sounds like it’s about 3/4 of the way toward a new state license anyway. State licensing for things like law make some sense – but Salim’s right – medicine doesn’t change just because you cross state lines; this is an artifact that’s holding back mobility and telemedicine and needs to go.
Nicholas Genes, MD, PhD


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It’s the first step to a national medical license and opens up a lot of mobility.  That is good for EPs.  And better for telemedicine.
– Mark Plaster, MD, JD

Man left cotton swab in ear for years, suffered from seizures and skull infection

https://www.today.com/health/cotton-swab-stuck-ear-led-man-suffer-seizures-skull-infection-t150611

A grown man with a cotton swab in his ear for years says something about the intelligence of the patient or the frustration with access to care in a national health system.  Since a cotton swab in the ear would make you virtually deaf in that ear it’s hard to think that a normal man would ignore it unless his alternatives were even worse.
– Mark Plaster, MD, JD

This guy had intermittent ear pain and hearing loss for 5 years and the best that the primary care provider could do was keep prescribing antibiotics? SMH. The morals of the story are not to put anything in your ear beside your elbow and … more importantly … bad things don’t get better. I think five years of the same symptoms qualifies as the “don’t get better” part of that maxim.
William Sullivan, DO, JD


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Just over half of teen girls that receive STI diagnosis get prescriptions filled

https://www.upi.com/Health_News/2019/05/28/Just-over-half-of-teen-girls-diagnosed-with-STIs-in-ERs-fill-prescriptions/9191559060681/

Of course not all prescriptions are filled; it’s a hassle, there are time and money costs. Any time that single doses are appropriate in the ED it makes it easier, like a single dose penicillin shot for strep throat. Frankly I’d rather get a shot in the butt than have to go to the pharmacy and pick up a prescription, let alone pay the co-pay and take a medication multiple times a day for a week…
–Seth Trueger, MD, MPH, FACEP

This rubs me the wrong way. If you’ve been diagnosed with a STI, you don’t fill the prescription, and you continue having sex, you are knowingly transmitting a disease to others. That is a crime. https://www.cdc.gov/hiv/policies/law/states/exposure.html Yes, it would be nice to make sure patients can afford their medications, but the onus of assuring successful treatment can’t fall solely on hospitals and emergency physicians. Giving a Rocephin “love dart” may solve part of the problem, but patients need to take some responsibility for their health as well.
William Sullivan, DO, JD

If you think that a patient isn’t going to fill a script for an STI isn’t that a good reason for an IM injection?  That’s a public health issue.  Besides, when you see a 13-year-old with an STI you have more problems than the need for a bus pass.
– Mark Plaster, MD, JD

This is not the first study to show that prescriptions frequently don’t get filled.  The more important question is why?  The answer is probably multifactorial including out-of-pocket costs and lack of education. With the ridiculous costs of medications, I try to ensure patients can afford what we are prescribing them and stress the importance of complications from not getting these medications filled.  Spend an extra two minutes and make sure your patient understands why this is important and if they can afford it.
– Salim R. Rezaie, MD

All good points. I’d just like to add that 1) it’s kind of nutty we don’t have pharmacies in our EDs and 2) it’s also nutty that our health systems aren’t automatically tracking unfilled prescriptions. I mean, our social workers can give needy patients the antibiotics or other crucial meds they should take before departure, but in most cases, we essentially ask our patients to schlep to a second location and roll the dice to see how expensive things really are – and if it’s too much, come back and we’ll see what we can do.

And if they don’t fill the Rx or come back, well, I’m sure the DOH and ACO and PCP would all like to know about it, but not badly enough to pay Surescripts for the data feed, and not enough to assign a case manager to follow-up with the patient.
Nicholas Genes, MD, PhD

Six human radiologists can’t outperform Google’s lung cancer detection AI

https://venturebeat.com/2019/05/20/googles-lung-cancer-detection-ai-outperforms-6-human-radiologists/

When the information input is objective, such as in an X-ray, it would seem that AI will always become superior.  It was only a matter of time and program development.  Human advantage comes when the information input is not objective such as a patient history.  That needs interpretation by a real, living, breathing, doubting, human being to analyze correctly.
– Mark Plaster, MD, JD

Anything that can cut down on wait times for a report and can improve patient outcomes deserves more investigation. Like Mark said, we’re a long way off from physicians being replaced by AI. I’m just not sure I want Google knowing not only what my e-mail communications look like, but also what the inside of my body looks like.
William Sullivan, DO, JD

AI is coming. How it is implemented is key. Makes sense to me that AI that doesn’t do all the work, but highlights areas of concern for radiologists to focus on, and there’s some data to support this. Analogous to primary care models with PAs/NPs seeing many patients with the supervision and support of a physician, particularly for more complex cases.
–Seth Trueger, MD, MPH, FACEP

 

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