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Drug Wars in the Exam Room

As physicians, we have all been faced with patients inappropriately looking for prescriptions for controlled substances. Some are looking to abuse them and some to divert them for profit. It is often hard to distinguish when a patient truly needs these medications or when they are just “drug-seeking.” More experienced doctors have a better sense of which patients are which. Drug-seeking patients often play on our emotions because they know we generally care about patients and may have difficulty turning down a request for opioids from someone in supposed pain. For years, patients have used many ruses to access these medications. Many of them “doctor shop,” use several pharmacies, or frequent various emergency rooms, making it difficult to track their prescriptions. And it’s much harder for a doctor to turn down a request from a new patient in acute pain than from one the doctor knows well and doubts. Having so many controlled substances available and sold on the streets has led to an increase in prescription drug dependency. These patients have a hard time breaking these addictions and often can only stop with help from special rehab programs. It has led to a further resurgence of IV heroin addiction and opioid deaths in many areas. As the states have tightened controlled substance prescriptions, they have become less available for diversion and are now a gateway drug to heroin—which is cheaper than prescribed medications. I am seeing teens in my practice addicted to IV heroin, a habit that started by raiding parents’ or relatives’ medicine cabinets. It has never been more imperative for doctors to step up and do...
Electronic Communication With Patients

Electronic Communication With Patients

Throughout healthcare, there has been a recent push for electronic communications to be used more frequently as a means to improve quality of care. Examples include emailing test results to patients or managing conditions without requiring time-consuming and costly office visits. “Despite the push, few physicians use electronic communications,” says Tara F. Bishop, MD. A 2008 study showed that less than 7% of physicians regularly communicated with their patients electronically. In Health Affairs, Dr. Bishop and colleagues had a study published to investigate how different practices used electronic communication and the associated benefits and barriers. They interviewed leaders of medical groups that used electronic communications extensively but varied in their approach. Five of the six groups were large; four had more than 500 physicians, and another had 115 doctors. Participants used electronic communication programs to communicate test results, allow patients to request medication refills and appointments, and ask questions of their doctors.   Perceptions & Hurdles According to the results, electronic communication was widely perceived to be a safe, effective, and efficient means of communication. Leaders of medical groups reported that it improved patient satisfaction and saved time for patients. “The advantages were obvious and sometimes outweighed the disadvantages,” says Dr. Bishop. “We were told that patients favored this model. Leaders and frontline providers said the system helped them provide high-quality care.” “Unless the practice takes steps to reduce a physician’s daily workload, communicating with patients is extra work that makes some feel that their day is never ending.” Despite its advantages, electronic communication also increased the volume of physician work. “Many physicians said that while electronic communication may...
Unhealthy Heart Behaviors: Getting Ahead of the Curve

Unhealthy Heart Behaviors: Getting Ahead of the Curve

The American Heart Association (AHA) has set a 2020 goal of improving the heart health of all Americans by 20% while reducing deaths from cardiovascular disease (CVD) and stroke by 20%. The AHA’s 2020 goals were designed strategically to help all individuals prevent declines in their current health behaviors and take a step toward better heart health by progressing toward ideal healthy lifestyle behaviors. “To achieve these goals, prevention is the top priority,” says Bonnie Spring, PhD. “Major strides have been made toward reducing risks for CVD and stroke, but the significant economic toll linked to these health challenges necessitates a new approach.” According to recent estimates, direct annual CVD-related costs are projected to triple, rising from $272 billion in 2010 to $818 billion in 2030. A Call to Action In 2013, the AHA released a science advisory, published in Circulation, emphasizing the importance of greater efforts to preserve cardiovascular health from childhood and to treat health risk behaviors into older ages. The call-to-action statement addresses three novel approaches to attain the AHA’s 2020 goals: 1. Preserving positive cardiovascular health by promoting healthy lifestyle behaviors. 2. Treating unhealthful behaviors in addition to risk biomarkers. 3. Combining individual-level and population-based health promotion strategies that steer the public toward the next level of improved cardiovascular health. “Clinicians need to treat unhealthy behaviors as aggressively as they treat high blood pressure (BP), cholesterol, and other CVD risk factors,” says Dr. Spring, who was lead author of the AHA statement. “It’s a paradigm shift from only treating biomarkers to also helping people change unhealthy behaviors.” Clinicians already treat physical risk factors, but people...
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