Friday, December 15, 2017

OCMA Blog

Cooperative of American Physicians, Inc. and Orange County Medical Association Offer 3-part CME Seminar for Physicians

Part One: "Treating Pain in Today's World: Avoiding the New Pitfalls"


LOS ANGELES, CA (April 15, 2014) - The Cooperative of American Physicians, Inc. (CAP) and the Orange County Medical Association (OCMA) are joint sponsors of "Treating Pain in Today's World: Avoiding the New Pitfalls," the first topic in a three-part continuing medical education (CME) series on opioid education.  This topic will be presented on Monday, May 5, 2014 at 6 p.m. at the Orange County Medical Association Conference Center in Irvine, CA.

Chronic pain is a major concern and affects approximately 100 million people in the U.S., according to the Institute of Medicine of the National Academies, and one of the most common reasons for patients to seek medical care.  Physicians are in a key position to balance the benefits and risks of opioid therapy.  They often struggle with the need to assist patients who require management of chronic pain while confronting the risks associated with prescribing opioids.

"CAP's sponsorship of the opioid education series is part of our ongoing commitment to support programs that teach physicians how to reduce their liability risks and improve patient safety, so they can focus on what they do best - providing excellent care," said James L. Weidner, Chief Executive Officer of CAP.

The featured speaker is Standiford Helm II, MD, Medical Director at the The Helm Center for Pain Management and Immediate Past-President of OCMA.

After attending "Treating Pain in Today's World: Avoiding the New Pitfalls," physician participants should be able to:
 

  • Understand the law and new regulations that govern the use of opioids to control pain
  • Understand the multi-discipline methods for controlling pain
  • Describe appropriate assessment, monitoring and documentation strategies to support opioid prescribing
  • Learn how to evaluate the benefits of prescriptive opioids against the potential risks
  • Utilize PDMP/CURES as a tool to discover questionable prescription opioid activity

To register and for more information, please visit: https://treatingpain.eventbrite.com.  OCMA and CAP members may attend this seminar for free.  Registration is required.


Prescription Drug Abuse – What to Look For

By Ann Whitehead, JD, RN
Vice President of Risk Management & Patient Safety Cooperative of American Physicians, Inc.

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic. A staggering statistic from the National Drug Abuse Institute reveals prescription drugs are the second most abused drug, behind marijuana, by seniors in high school. The CDC finds overdoses from prescription painkillers resulted in more deaths in 2010 than heroin and cocaine combined.1

Prescription drug abuse affects all age, race, gender, and socioeconomic classes. Here are two examples: the patient on an antidepressant prescribed by his psychiatrist was also taking a narcotic prescribed by an orthopedist. In a drug-induced haze, the man threw himself down a flight of stairs, breaking his neck; or the 83-year-old patient who recently came to the office for morphine who later tested positive for cocaine. Both patients create liability and treatment issues for their physicians. 

Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription opioid painkillers. The U.S. Drug Enforcement Administration (DEA) and the California Department of Justice are aggressively prosecuting individuals who prescribe opioids illegally and those who operate “pill mills.” Physicians face challenges when trying to spot the patient who may be abusing prescription drugs or possibly improperly sharing them with others. The following are some suspicious behaviors that may raise the red flag. 

The patient may:

• Refuse to grant permission to obtain old records or communicate with previous physicians.
• Demonstrate reluctance to undergo comprehensive histories, physical examinations, or diagnostic testing, especially urine drug screenings.
• Request specific drugs (often because of the higher resale value of brand names).
• Profess multiple allergies to recommended medications.
• Resist certain treatment options.
• Threaten doctors or display anger during visits.
• Consistently target appointments at the end of the day or during off hours.
• Repeatedly lose prescriptions.
• Request escalation in dosages.
• Demonstrate noncompliance with prescription instructions.

A helpful tool for physicians is the “Opioid Overdose Toolkit: Information for Prescribers” recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).2 This guide offers tips on safe prescribing and preventing opioid overdose including: assessment, state drug monitoring programs, medication selection, prescription writing tips, use of naloxone, and deciding when to stop opioid.

Lastly, if you get a call from the DEA or local law enforcement, contact the CAP Hotline for assistance.

For more information about CAP, or to request additional information or risk management publications, please contact us at: MD@CAPphysicians.com, or call 800-356-5672. You can also visit our website at: www.CAPphysicians.com.


1 Centers for Disease Control and Prevention (CDC). CDC grand rounds: Prescription drug overdoses – A U.S. epidemic. MMWR Morb Mortal Wkly Rep.2012; 61(1):10-13.
2 Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Toolkit” Information for Prescribers. HHS Publication No. (SMA) 13-4742. Rockville, MD: Substance Abuse and Mental Health Administration, 2013.


How Should You Deal With Negative Online Reviews?

"Had to wait 1 1/2 hours."
"The staff was horrible, rude and unprofessional."
'The doctor misdiagnosed my problem."

In the past, a physician's reputation and practice were built by word of mouth. Today, word of mouth is no longer limited to people talking face-to-face. Websites, such as Yelp.com, AngiesList.com, HealthGrades.com, RateMDs.com and Vitals.com, allow anyone with access to a computer to share his or her opinion about a physician with the public at large.

Physicians tend to focus on the negative comments, but not all comments are negative. A recently published study in the Journal of Internal Medicine found that an overwhelming number (88 percent) of online reviews for physicians were positive. The following is an excerpt of the study:

We identified 33 physician-rating websites, which contained 190 reviews for 81 physicians. Most reviews were positive (88%). Six percent were negative, and six percent were neutral. Generalists and subspecialists did not significantly differ in number or nature of reviews. We identified several narrative reviews that appeared to be written by the physicians themselves.

The CAP Hotline has received an increasing number of calls from physicians asking how to respond to negative comments. So what can a physician do in response to a negative online opinion? Some physicians fear that negative comments may harm their reputation and want to seek legal remedies to battle unsubstantiated online libel and defamation. This may not always be the best solution to the problem. Lawsuits are time consuming, expensive, and may not produce the outcome desired by the physician. Courts may view negative statements made online at review websites as opinion, not fact.

Physicians should accept that rating websites are here to stay, at least for the foreseeable future. An occasional unfavorable review must be seen as a cost of doing business in the age of social media. If a physician desires to respond to a negative comment, much caution and thought should be put into the method and type of response. Some websites, like Yelp.com, have sections in its "Support Center" for business owners which discuss how to respond to comments.

Whether to respond is a personal choice and should be given careful consideration. A response may be made publicly or in private to the individual. All responses should be kept simple, polite, honest, professional, and compassionate. If the criticism is true, it should also describe what changes are being made to prevent this from occurring in the future. You may end your reply by showing that you care by stating: "Thank you. We appreciate all feedback."

What other steps can be taken to address patient opinions?

  • Go online and see what is being said about your practice.
  • Assign a staff member to regularly monitor these sites.
  • Update incorrect demographic information.
  • Personalize your comments with a clear professional photo.
If a comment is not appropriate, consider taking another approach. CAP provides free Patient Satisfaction Surveys to its members. In today's environment, a satisfied patient is an important part of a successful practice and it is better for the feedback to come directly to you and not to the Internet.

If you are a CAP member, we encourage you to take advantage of this free opportunity, by calling 800-252-7706 to request a packet of 100 surveys.

If you are not yet a member of CAP but are interested in learning more about the myriad benefits of membership, including superior medical professional liability coverage, contact Membership Development at 800-356-5672 or request an online quote at www.CAPphysicians.com/join.

Ann Whitehead is a Senior Risk Management & Patient Safety Specialist for the Cooperative of American Physicians, Inc.

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