Medical school prepares physicians to prescribe medications for prevention and treatment of disease, but little to no time is spent teaching something just as important: de-prescribing. In our current system of auto-refills, e-prescriptions, and mindless “checkbox” EMR medication reconciliation, patients may continue taking medications years after their original prescriber intended them to stop. There is no doubt that many Americans are over-medicated, and the problem
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At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual? At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result ...

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The opioid overdose epidemic was the centerpiece of U.S. Secretary of Health and Human Services Tom Price, MD’s West Virginia listening tour recently. While the tour was billed as an opportunity to gain knowledge on the epidemic, his response to his observations illustrates just how difficult it is to change attitudes and beliefs with information alone. In response to Herculean state-based and volunteer efforts to keep people alive -- not to ...

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Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?" Flash forward to today’s online “symptom checkers.” They are quizzes to see if someone has a certain disease and exhortations to see their doctor even if they feel fine. Once drug makers discovered that health fears and even hypochondria sell drugs, there seems ...

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I had an interesting conversation with a patient in the office some time ago. He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than ...

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A small study published this month showed that most Epipens retain their potency for at least 4 years after their expiration date. That’s no guarantee, of course. I’d still recommend as a “best practice” that families replace them as they expire. But it’s reassuring to know that they’ll usually be effective even when expired. And using an expired EpiPen is almost certainly better than using nothing ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. One thing about me that even my closest friends are unaware of is that I am a zombie fighter. Unlike the ones in video games, TV series, or movies, the zombies that I fight in my practice are prescriptions that won’t die. They ...

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“Pigs get fat, but hogs get slaughtered,” the saying goes. And so may it prove to be true for the pharmaceutical industry. Three articles, all published May 3, illustrate the greed and egregious pricing by certain drug companies that are gaining public recognition and scrutiny. As an example, Marathon invested $370,000 to obtain the license for the data on “deflazacort,” a steroid available for about $1,200 a year in the United Kingdom. ...

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Opioids have become so closely associated with chronic pain that it is nearly impossible to talk about one without the other. When we look back just five years ago, when we were still in residency, news stories about chronic pain and opioid overdoses were not commonplace. Now, we find ourselves almost desensitized to each new opioid headline. We are general internists, primary care providers and junior faculty. We practice at ...

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I recently took a three hour online course on something I learned to do when I was a medical student. And I thought it was something I had been doing fairly well for the past 20 years.

New regulations have come down requiring all practitioners to take a CME-certified course on safe and effective management of opiates for acute and chronic pain. This has clearly ...

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