Posted in Access to healthcare, Doctor-Patient Relations, Government Regulations, Medical conditions and illness, outcomes, Pain, Patient Safety, Patient-centered Care, Policy Issues, primary care, Protocols, Uncategorized

The Pendulum Has Swung Too Far

“…an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause—it is seen. The others unfold in succession—they are not seen: it is well for us, if they are foreseen…The one takes account of the visible effect; the other takes account both of the effects which are seen, and also of those which it is necessary to foresee. Now this difference is enormous, for it almost always happens that when the immediate consequence is favourable, the ultimate consequences are fatal, and the converse.” ~ Frederic Bastiat


Treating Pain in Primary Care

“If there is ever a case for patient-centered care, it is probably the chronic pain patient, especially the older chronic pain patient,” Vega suggests.

He recalled the case of a 72-year-old retiree with chronic degenerative disease of the spine. “She also had stage IV chronic kidney disease, hypertension, and diabetes, all fairly stable and well-controlled. It would be a huge mistake to put her on chronic anti-inflammatory drugs; acetaminophen doesn’t do enough, and she has trouble accessing physical therapy,” he explained. “What really sets her free is tramadol once a day, which she takes in the morning. And then she uses acetaminophen the rest of the day. When I last wrote her the usual prescription, the pharmacy denied it, saying she didn’t have a chronic condition and was at risk for overdose. They didn’t notify me and she went 10 days without therapy. She finally called me, asking why I had withheld her medicine, and I didn’t know what she was talking about.”

Source: The Pendulum Has Swung Too Far

Posted in American Presidents, Education, Evidence-based Medicine, Free Society, Government Regulations, Medical conditions and illness, outcomes measurement, Pain, Patient Choice, Patient Safety, Policy Issues, Prevention, Quality, Rule of Law, State Medical Boards, Unsettled Science

Opioid Policy: The Devil and the Deep Blue Sea | Medpage Today

Great insight and perspective by Heath McAnally, MD, MSPH, regarding the sometimes reactive, albeit good intentioned, response of gov’t and private entities to the opioid crisis.  Worth the read for sure.

Pendulum swings in medicine aren’t new, but damping the oscillation rarely bears such urgency. To paraphrase the original document, we call on our leaders to:

  • Recognize that opioid tapering requires evidence-based careful selection, patient-centered methods, realistic goals, and close monitoring for adverse events.

  • Include the expertise of pain management subspecialists at every level of decision-making about future opioid policies and guidelines.

  • Put a halt to policies forcing opioid tapering/cessation outside the contexts of diversion or unequivocal, documented harm: benefit ratio imbalance

Dr. McAnally is a board-certified anesthesiologist, pain physician, and addictionologist practicing in Alaska (the military sent him there and he decided to stay). If he wasn’t trying to guide people in improving their own lives, teaching medical students to do the same, or writing about it, he’d probably be outdoors right now slogging up a mountain with a good friend or two.

Source: Opioid Policy: The Devil and the Deep Blue Sea | Medpage Today