NEW YORK (Reuters Health)—The 2019 edition of the American College of Physicians (ACP) ethics manual provides a six-step approach to resolving ethical dilemmas and adds or expands sections that address emerging issues in 21st century medicine.1 “The Manual provides succinct guidance on issues that affect the patient-physician relationship, and also issues that have to do…
Ethics Forum: Is a Conflict-of-Interest Slide Enough?
We have all been to numerous lectures, grand rounds and other continuing medical education activities where the speaker, prepared and poised at the podium, begins his lecture with a title slide. Soon after, we see the ubiquitous conflicts of interest slide, which lists the invited speaker’s research funding, his consulting activities and his board memberships—all…
Ethics Forum: When & How to Intervene with the Impaired Colleague
You are seeing a hospital consult late in the afternoon on a Saturday. The patient has suspected, new-onset lupus with inflammatory arthritis, renal failure with nephrotic range proteinuria and a malar rash. You plan to start the patient on high-dose IV steroids, and you decide to speak to the nephrologist on call first. When he…
Compliance Means More than Just Paperwork
Effective management of healthcare compliance requires an office compliance plan that stays current with changing government regulations, payer requirements, office operations and technology. Many still wonder, why is a compliance program needed—if something isn’t broken, don’t fix it, right? This is not always the case; compliance is an essential part of practice operations, but providing…
Ethics Forum: What to Do with the Inherited Opioid Patient?
A 67-year-old man with a recent onset of diffuse muscular pain and stiffness and an erythrocyte sedimentation rate of 55 is referred to you by his family practitioner. He has a history of non-insulin-dependent diabetes mellitus, but no history of headaches or swollen joints. He has chronic back pain, has had two surgeries and was…
Ethics Forum: Righting the Wrong Diagnosis
A 54-year-old woman is establishing care in your clinic after retirement of her previous rheumatologist. Your review of her records suggests that she was diagnosed with systemic lupus erythematosus seven years ago on the basis of symptoms of body pain and fatigue, and serologic evidence of positive ANA 1:40 (speckled) and borderline anti-SSB antibody. She…
Patients Lose When Insurance Company Forces Drug Switch
This past June, a 64-year-old man with a history of psoriatic arthritis and severe arthritis appeared at our clinic for his regular follow-up with concerns about a letter from his insurance company. The letter stated the company wouldn’t pay for the patient’s secukinumab (i.e., Cosentyx) prescription anymore and suggested he take ixekizumab (i.e., Taltz) instead,…
Patient Satisfaction Scores—Do They Matter?
You see a patient for the first time to establish care for Sjögren’s disease. She complains of dry eyes, dry mouth and diffuse arthralgias. You do not appreciate any synovitis on physical exam. Of note, you are the fourth rheumatologist she has seen during the past year. Toward the end of the clinic visit, she…
Ethics Forum: What to Do When an Autoimmune Patient Needs a Transplant?
Despite our best efforts and modern interventions, we still have patients in the intensive care unit with organ failure. Although renal failure can be mitigated by dialysis, patients with cardiac or respiratory failure secondary to active autoimmune disease raise difficult clinical and ethical issues. Two recent cases, both with organ failure, led us to examine…
Balancing Opioid Addiction Risk with Pain Management Needs
SAN DIEGO—During a session at the ACR/ARHP 2017 Annual Meeting Nov. 3–8, three representatives from the federal government described several of the government’s varied national strategies and agencies that are tackling pain. All of these strategies are affected by the current national epidemic of opioid overdoses and the need for safer analgesic prescribing. But the…
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