What's your gut reaction to this article? Be honest...

[drusso]

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Inside the Battle for the Future of Addiction Medicine - KFF Health News

The experiences of one doctor in Louisiana reveal the tensions around trying to get people to engage in addiction treatment, even if they’re not ready to stop using drugs.

kffhealthnews.org

"But some doctors prefer traditional approaches that range from zero tolerance for patients using illegal drugs to setting stiff consequences for those who don’t meet their doctors’ expectations. For example, a patient who tests positive for street drugs while getting outpatient care would be discharged and told to go to residential rehab. Proponents of this method fear loosening restrictions could be a slippery slope that ultimately harms patients. They say continuing to prescribe painkillers, for example, to people using illicit substances long-term could normalize drug use and hamper the goal of getting people off illegal drugs."

 

[Agast]

She sounds like an extraordinary person. But unless she is immortal, those patients were always going to end in suffering, because she cannot be there for them forever. A clinic that takes on this approach and addresses the liability would make more sense.

 

[Ducttape]

gut feeling - she is doing addiction medicine.

addiction specialists are best at determining appropriateness of continuing high doses of buprenorphine with misbehaving patients


i am doing pain medicine.

its a different paradigm with different goals and expectations.

 

[drusso]

gut feeling - she is doing addiction medicine.

addiction specialists are best at determining appropriateness of continuing high doses of buprenorphine with misbehaving patients


i am doing pain medicine.

its a different paradigm with different goals and expectations.

There can only be one standard of care. If you are moonlighting in the ED, you are held to the standard of a board-certified emergency medicine physician. Ditto for addiction medicine.

Paging Dr. @lobelsteve

 

[Ducttape]

simplistic and purposefully inflammatory.

different specialties can have different "standards of care".

specifically, i am not an addiction specialist so i cant impinge whether what she did is appropriate.



the implication is that you believe that she is completely wrong in her practice.

 

[drusso]

simplistic and purposefully inflammatory.

different specialties can have different "standards of care".

specifically, i am not an addiction specialist so i cant impinge whether what she did is appropriate.



the implication is that you believe that she is completely wrong in her practice.

Can cardiology and pulmonology have different standards of care? The answer is, "No."

 

[geauxg8rs]

Can cardiology and pulmonology have different standards of care? The answer is, "No."

The soc would be different for a cardiologist who doesn’t do any intervention vs one who does and that would be different from one who is eps trained further.

 

[specepic]

It sounds like she cont'd to RX even if pts broke rules, You have to have guard rails and stick to them. also it sounds like she was employed rather than PP. Her employer probably felt she was a liability risk (and they were probably right)

 

[Ducttape]

Can cardiology and pulmonology have different standards of care? The answer is, "No."

Disagree. Depends on patient, diagnosis, purpose of treatment.

Simplisticly speaking, A cardiologist may recommend cardiac cath for shortness of breath. A pulmonologist will recommend PFTs.

A neurologist will prescribe gabapentin for seizure disorder. A pain doctor may prescribe gabapentin for radicular pain. Different doses

An addiction specialist will discuss buprenorphine but not pure opioids for addiction. A pain doctor will recommend non opioids for chronic pain. A palliative pain doctor will prescribe opioids for end of life care.

 

[drusso]

Disagree. Depends on patient, diagnosis, purpose of treatment.

Simplisticly speaking, A cardiologist may recommend cardiac cath for shortness of breath. A pulmonologist will recommend PFTs.

A neurologist will prescribe gabapentin for seizure disorder. A pain doctor may prescribe gabapentin for radicular pain. Different doses

An addiction specialist will discuss buprenorphine but not pure opioids for addiction. A pain doctor will recommend non opioids for chronic pain. A palliative pain doctor will prescribe opioids for end of life care.

Find me one example of a state's medical practice act that acknowledges more than one standard of care—not different tactics that produce the same or equivalent results—but stratifies standards for medical licensure by specialty. Imagine if you could choose different correct answers on the USMLE based on what specialty you were intending to pursue. "Oh, I'm going into psych, so that answer is C, but wait, I'm doing IM and then cards, so the answer is B."

 

[clubdeac]

Find me one example of a state's medical practice act that acknowledges more than one standard of care—not different tactics that produce the same or equivalent results—but stratifies standards for medical licensure by specialty. Imagine if you could choose different correct answers on the USMLE based on what specialty you were intending to pursue. "Oh, I'm going into psych, so that answer is C, but wait, I'm doing IM and then cards, so the answer is B."

Drusso this is more of a philosophical argument. The problem is you’re assuming there is objective truth. This will be seen as inflammatory but the far left does not believe in absolute objective truth hence the end of USMLE scores, SAT/ACT scores, and grades and the introduction of DEI, affirmative action and participation medals

 

[SSdoc33]

Drusso this more of a philosophical argument. The problem is you’re assuming there is objective truth. This will be seen as inflammatory but the far left does not believe in absolute objective truth hence the end of USMLE scores, SAT/ACT scores, and grades and the introduction of DEI, affirmative action and participation medals

your comment is not inflammatory, it is just stupid.

this has nothing to do with politics

 

[clubdeac]

your comment is not inflammatory, it is just stupid.

this has nothing to do with politics

Don’t get offended.

 

[Ducttape]

Find me one example of a state's medical practice act that acknowledges more than one standard of care—not different tactics that produce the same or equivalent results—but stratifies standards for medical licensure by specialty. Imagine if you could choose different correct answers on the USMLE based on what specialty you were intending to pursue. "Oh, I'm going into psych, so that answer is C, but wait, I'm doing IM and then cards, so the answer is B.

Tell me whether state medical boards insist that meds be only prescribed for FDA approved indications only.

Tell me, if there is only one standard of care for everyone, why does each medical society establish their own guidelines for their own specialty.

In full exposure, you had no interest at all in anyone's opinion. You posted the thread as rage bait so that you could get on your high horse.

Congrats to you. Hope you enjoy your rarified air.

 

[drusso]

Drusso this more of a philosophical argument. The problem is you’re assuming there is objective truth. This will be seen as inflammatory but the far left does not believe in absolute objective truth hence the end of USMLE scores, SAT/ACT scores, and grades and the introduction of DEI, affirmative action and participation medals

You're right. Post-modern moral relativism ruined the West. Medicine works because of markets, norms, training pipelines, and professional discipline not despite them.

Suicide of the West: How the Rebirth of Tribalism, Populism, Nationalism, and Identity Politics is Destroying American Democracy: Goldberg, Jonah: 9781101904930: Amazon.com: Books

Suicide of the West: How the Rebirth of Tribalism, Populism, Nationalism, and Identity Politics is Destroying American Democracy [Goldberg, Jonah] on Amazon.com. *FREE* shipping on qualifying offers. Suicide of the West: How the Rebirth of Tribalism, Populism, Nationalism, and Identity Politics...

www.amazon.com

 

[SSdoc33]

You're right. Post-modern moral relativism ruined the West. Medicine works because of markets, norms, training pipelines, and professional discipline not despite them.

Suicide of the West: How the Rebirth of Tribalism, Populism, Nationalism, and Identity Politics is Destroying American Democracy: Goldberg, Jonah: 9781101904930: Amazon.com: Books

Suicide of the West: How the Rebirth of Tribalism, Populism, Nationalism, and Identity Politics is Destroying American Democracy [Goldberg, Jonah] on Amazon.com. *FREE* shipping on qualifying offers. Suicide of the West: How the Rebirth of Tribalism, Populism, Nationalism, and Identity Politics...

www.amazon.com

i see that johan goldberg cited these things in the present tense (is destroying) rather than your assertions in the past tense (ruined the west).

perhaps we should examine why you need to come to random online strangers for validation of your world view?

 

[VA Hopeful Dr]

Find me one example of a state's medical practice act that acknowledges more than one standard of care—not different tactics that produce the same or equivalent results—but stratifies standards for medical licensure by specialty. Imagine if you could choose different correct answers on the USMLE based on what specialty you were intending to pursue. "Oh, I'm going into psych, so that answer is C, but wait, I'm doing IM and then cards, so the answer is B."

I could be mistaken but I believe there are some states where the experts in malpractice cases must be in the same speciality as the defendant.

 

[interjectionreflection]

Can cardiology and pulmonology have different standards of care? The answer is, "No."

I I think it's fair to look at more than just a disease process or specialty. It's a multifaceted decision just like chronic pain treatment can vary from one physician to another. Treatment of CHF may be different for a cardiologist versus palliative care when the goals of care different.

 

[hallowmann]

I could be mistaken but I believe there are some states where the experts in malpractice cases must be in the same speciality as the defendant.

I think this is true, but most require that the practice setting be the same (e.g. an FM doc in the ED is measured on the practice setting - so could have an EM trained expert witness).

Regardless, I think claiming that "standard of care" is singular is dubious at its core. Standard of care is a concept, it's broad, frequently changing, and depends heavily on who you are asking, where they are, and what resources they have at their disposal. There is not one "standard of care", there are groups of things within the standard of care and there are things that are decidedly outside of it. What is standard of care in one location with one set of resources may not be standard of care in another.

As an example, if you have two societies that define guidelines for Hypertension treatment/targets, both of those guidelines despite being different may be within the standard of care, but things outside of them may not be.

EDIT: As for the actual article, there is nothing in it that suggest she is deviating from the standard of care. She is describing a harm reduction approach to Addiction Medicine, which at times is unconventional by older medicine standards and often weighs issues of risk, patient harm, patient benefit, and liability. Without knowing the specifics of cases, which are not described in this article, it's impossible to know if she is truly deviating from the standard of care set by Addiction Medicine societies and physicians.