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“Doctor Shopping” After Orthopedic Trauma

“Doctor Shopping” After Orthopedic Trauma

Recent reports have shown that the negative consequences of narcotic use are increasing, and diversion of these drugs for non-medical use is growing, with Americans consuming about 80% of the global opioid supply and 99% of the global hydrocodone supply. There has been an alarming rise in unintentional overdose deaths in the United States over the past decade due largely from increases in prescriptions of narcotics. It has been estimated that up to 20% of prescription drug abusers receive their narcotics from one physician prescriber, but a growing percentage obtain these medications by seeking multiple providers, a phenomenon dubbed “doctor shopping.” Few studies, however, have looked at narcotic use in patients who have experienced orthopedic trauma. While some investigations have focused their attention on positive toxicology screenings at the time of admission after orthopedic trauma, there is limited research exploring the impact of postoperative doctor shopping and the role of orthopedic surgeons in this phenomenon. “It has been suspected that many orthopedic trauma patients may be at a higher risk for pre-injury narcotic use and doctor shopping,” says Hassan R. Mir, MD, MBA, FACS. Exploring the Problem Dr. Mir, Brent J. Morris, MD, and colleagues sought to identify the prevalence of patients who have had orthopedic traumas and were seeking multiple providers for narcotics after surgery in a study published in the Journal of Bone and Joint Surgery. For the analysis, the researchers reviewed prescription records for 151 adults who were admitted to an orthopedic unit over a 1-year period and assessed data on narcotic prescriptions obtained 3 months before and within 6 months after each orthopedic procedure. Patients...
Predicting Home Discharge After Surgery

Predicting Home Discharge After Surgery

Most surgical patients want to know whether or not they will need to prepare for care at a rehabilitation facility. “If prolonged postoperative care will be required, it’s helpful for patients to anticipate this so they can make arrangements in advance for their needs after surgery,” says Joseph A. Hyder, MD, PhD. A New Risk Calculator Several surgical risk calculators are already used in practice, but many are limited because they include features like laboratory testing, detailed medical data collection, and other variables. Clinicians lack a comprehensive tool that can predict patient-centered outcomes, such as home discharge after surgery and improve shared decision making. To address this issue, Dr. Hyder and colleagues derived and validated a simple, interview-based method to accurately predict postoperative discharge tohome in a study published in the Journal of the American College of Surgeons. The researchers used outcomes data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program, which involved more than 88,000 patients who underwent general and vascular surgery at over 400 hospitals in 2011. Using these data, they created a statistical prediction model called the “Home Calculator,” which addressed five patient risk factors: ♦ Age. ♦ Whether a patient needs assistance with activities of daily living. ♦ American Society of Anesthesiologists Performance Status. ♦ Whether the surgery was elective. ♦ A patient’s location prior to hospitalization. According to findings, the Home Calculator had excellent prediction results for home discharge across multiple specialties, including general, vascular, gynecologic, urologic, orthopedic, and thoracic surgery. Prediction results of the Home Calculator were similar to other gold standard models for predicting morbidity and mortality. “We...
Transformative Leadership Begins with Self-Development

Transformative Leadership Begins with Self-Development

If healthcare leaders want to transform our healthcare system so it is truly patient-centered and cost-effective and if we are serious about creating a culture of health in which we are preventing diseases long before they result in sickness, the place to start is with ourselves. All healthcare leaders—no matter whether you practice in a small office or a large hospital—because more often than not, physicians set the tone. But what you may not realize is that your mental and emotional state has a significant effect on the people around you. In his book Primal Leadership: Unleashing the Power of Emotional Intelligence, psychologist Daniel Goleman revealed: “The actions of the leader account for up to 70 percent of employees’ perception of the climate of their organization.”[1] Leading Means Showing the Way Unhappy, dysfunctional leaders cannot create high-functioning, compassionate practice environments, and a stressed out, unhealthy organization cannot take care of the health of others. So as physicians, we need to ensure that the effect we have on others is positive and beneficial. As leaders: ♦ If, when facing a problem, we display thoughtful intelligence rather than anger or frustration, we will inspire that behavior in others and promote creative solutions. ♦ If we are trustworthy and nurture a culture of trust, our colleagues will feel safe enough to communicate honestly, therein creating an environment in which real change is possible. ♦ If our words and actions demonstrate a deep commitment to cost effective, patient care, others will follow our lead, resulting in an improved practice environment. ♦ If we hold ourselves accountable for the vision and if we foster...
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