Tampilkan postingan dengan label narcotic. Tampilkan semua postingan
Tampilkan postingan dengan label narcotic. Tampilkan semua postingan

Narcotic addicts can sue doctors and pharmacies for enabling them

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In a 3-2 decision, the Supreme Court of West Virginia ruled that narcotic addicts may sue pharmacies and physicians for facilitating their addictions.

A suit was brought on behalf of 29 pain center patients who had been treated with narcotics for various injuries and became addicted. One article quoted the Chief Justices explanation: "A plaintiff’s wrongful or immoral conduct does not prohibit them from seeking damages as the result of the actions of others."

The court recognized that most of the plaintiffs "admitted their abuse of controlled substances occurred before they sought help "at the pain clinic.

Another story said, "The justices paved the way for people to claim damages for allegedly causing or contributing to their addictions of controlled substances—even if they broke the law by doctor shopping."

In a dissenting opinion, one justice wrote that the decision “requires hardworking West Virginians to immerse themselves in the sordid details of the parties’ enterprise in an attempt to determine who is the least culpable—a drug addict or his dealer.”

In response to the ruling, the West Virginia Medical Association issued a statement: "It may cause some physicians to curb or stop treating pain altogether for fear of retribution should treatment lead to patient addiction and/or criminal behavior. It may create additional barriers for patients seeking treatment for legitimate chronic pain due to reduced access to physicians. It would allow criminals to potentially profit for their wrongful conduct by taking doctors and pharmacists to court."

A post on the American Pharmacists Association website explained that pharmacists were included in the ruling "because they were aware of the pill mill activities of the medical providers. The plaintiffs said these pharmacies refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances, and filled synergistic controlled substances."

One newspaper summarized the public reaction to the ruling in an editorial stating, "Those who are illegally abusing prescription narcotics should be prosecuted to the fullest extent of the law. The same goes for medical professionals who are found guilty of committing a criminal act. But telling a drug addict or someone who is illegally abusing prescription narcotics that it is OK to go to court and file what could very well be a frivolous lawsuit is both baffling and shameful. This ruling by the Supreme Court justices is a clear back eye for West Virginia. And it does nothing to help West Virginia’s rampant drug problem."

As I wrote last year, I think the prescription drug abuse epidemic all stems from a 15-year campaign that declared pain is the fifth vital sign—a concept which is both untrue and as we have come to learn, harmful.

I agree with the WVMA. If I were practicing in West Virginia, I would be very reluctant to prescribe narcotic pain medication to any patient.

What do you think?
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Which is better—an electronic or a paper progress note

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It depends on whom you ask.

A new study says internal medicine house staff generally feel that the quality of progress notes is unchanged or better since the implementation of an electronic medical record, but the attendings feel that progress note quality is unchanged or worse.

Over 400 interns, residents, and attending internists at four university hospitals were surveyed. The paper appears online in the Journal of Hospital Medicine.

Specifically, 50% of residents felt that the quality of notes was unchanged and 39% thought the quality was better or much better. Conversely, 39% of the attendings felt the note quality was unchanged, and another 39% felt that it was worse or much worse.

From the paper: Half of interns and residents rated their own progress notes as “very good” or “excellent.” A total of 44% percent of interns and 24% of residents rated their peers’ notes as “very good” or “excellent,” whereas only 15% of attending physicians rated housestaff notes as “very good” or “excellent.”

When the 9-item Physician Documentation Quality Instrument was used to evaluate notes, attending perceptions of housestaff notes were significantly lower than housestaff perceptions of their own notes, p < 0.001. One of the PDQI items asked for a rating of how succinct resident notes were. That feature was rated lowest by attendings and residents alike. I can think of a lot of words to describe electronic progress notes, but "succinct" isnt one of them.

In all, 16% of interns, 22% of residents, and 55% of attendings reported that copy forward [copy and paste] had a “somewhat negative” or “very negative” impact on critical thinking, p < 0.001. Auto population of fields in notes was judged similarly.

The authors felt that these differences could be explained because Attendings may expect notes to reflect synthesis and analysis, whereas trainees may be satisfied with the data gathering that an EHR facilitates. I agree.

Can all this be remedied?

Dr. Daniel Sexton, a Duke University internist, authored a three page guide [link is safe] on how to write effective progress notes. Here are just a few excerpts:

DO NOT TRANSCRIBE LAB DATA INTO THE PROGRESS NOTES UNLESS YOU INTEND TO COMMENT UPON IT. [All caps by Dr. Sexton]

It is often good and useful to explain your thinking in the chart.

Do not mindlessly repeat yourself in daily notes. [That goes for "copy and paste" too (my extension of this recommendation)]

LENGTH OF NOTES DOES NOT RELATE TO RELEVANCE OF NOTES. [All caps by Dr. Sexton]

I have written about the pitfalls of electronic medical records several times. In my blogs search field to your upper right, insert "electronic medical record" or "EMR" and click "Search This Blog" to see my other posts.

Its early in the academic year. Start writing better notes now. And please dont copy and paste.


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