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Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
Clinical Questions at the Point of Care

Clinical Questions at the Point of Care

Since the 1980s, studies have shown that clinicians frequently raise questions during patient encounters in all healthcare settings. These studies have suggested that although questions arise frequently, they often go unanswered. “Unanswered questions should be seen as an opportunity to improve outcomes by filling gaps in medical knowledge,” says Guilherme Del Fiol, MD, PhD. He adds that understanding clinicians’ questions is essential to guiding the design of interventions that aim to provide the right information at the right time. According to Dr. Del Fiol, there are challenges associated with maintaining current knowledge in medicine. “Several factors can come into play,” he says. “Science is continuing to expand medical knowledge, but this can make it increasingly complex to appropriately deliver healthcare. In addition, the aging population continues to grow, a phenomenon that further complicates how easily clinicians can address more difficult questions at the point of care.” No systematic reviews have been available on the clinical questions raised by clinicians in the context of patient care and decision making. A Systematic Review on Clinical Questions Dr. Del Fiol and colleagues recently conducted a systematic review of the literature on clinicians’ questions. Published in JAMA Internal Medicine, the research focused on the need for general medical knowledge that could be obtained from books, journals, specialists, and online resources. The systematic review took into account the frequency by which clinicians raised clinical questions, how often these questions were pursued and how often answers were successfully found, and the types of questions that were typically asked. They also sought to determine overriding themes and the potential effects of information seeking on clinicians’ decision...
Optimizing Migraine Care

Optimizing Migraine Care

The American Headache Society (AHS) recently joined the Choosing Wisely initiative of the American Board of Internal Medicine in an effort to draw attention to tests and procedures that are associated with low-value care in headache medicine. An AHS committee of headache specialists produced a list of five such tests and treatments, and their methods and rationale were published in Headache. “We wanted the list to address common but often unnecessary or potentially risky tests and treatments for headache that in many cases do not represent evidence-based strategies,” explains Elizabeth W. Loder, MD, MPH, FAHS, who was lead author of the study. Imaging According to the AHS, neuroimaging studies should not be performed in patients with stable headaches who meet criteria for migraine. In addition, CT scans should not be used in non-emergency situations as a diagnostic tool for headache patients when MRI is available. “MRIs can diagnose more underlying conditions that may cause headache that can otherwise be missed with CT,” says Dr. Loder. In addition, MRIs do not expose patients to radiation like CT scans. The recommendations note that MRI is of better value and safer than CT for migraineurs in all but a few emergency situations. Treatments The AHS also recommends against prescribing opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders. “The effectiveness of opioids is not in question,” Dr. Loder explains, “but these agents pose serious long-term risks and should be reserved for select patients. Effective long-term treatments will, in most cases, be necessary to manage this chronic disorder.” In addition, the risk of dependency and abuse associated with opioid or butalbital-containing...
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