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Medical Ethics Oral Presentation

Transcript: The call may have been made with malicious intent, however, there is no way to judge the reliability or veracity of the message Chronic pain and drug abuse Narcotics contract Physician-patient relationship Non-adherence and abandonment Do not ignore the voice message First confront and gather information from Mr. Sutherland Do not mention the call during the first appointment Do not stop giving pain medications Alter Mr. Sutherland's schedule If needed, drug test Mr. Sutherland with his knowledge and engage in additional research, such as MAPS Thank You! Concerns/Questions? Jimmy Sutherland is a 37 y/o who has been coming to the pain clinic for the last 3 years Suffers from debilitating headaches and continuous pain in his lower right leg due to a motorcycle accident Refers to pain as his most faithful friend, however, relies on his narcotics prescription to help him lead a relatively normal life "Jimmy Sutherland is trading his pain pills for junk on the street. Watch out for him. I thought you should know." Has not been in the office for 9 months leading up to the call Has continued to renew his prescription regularly Has not performed suspicious actions such as requesting early renewal or replacement prescriptions or making multiple attempts to fill the same prescription Dr. Tolland has not applied the conditions of the narcotics "contract" How should they respond to this call? By: Heya Batah Monitors patients' adherence to opioid therapy Creates a safe, controlled treatment plan Ensures communication and mutual fidelity between doctor and patient Restricts the patient to one prescribing physician and one dispensing pharmacy Impacts health outcomes Ethical Issue What is a Narcotics Contract? Case Physician-patient relationship Chronic Pain = pain that has typically lasted for 6 months or longer People who experience both are defined as a highly stigmatized and undeserved population Increased risk of being labeled a 'drug addict' Physiologic, psychological, and emotional implications Behavior may be misinterpreted as addiction Opiate pain medication Medical Ethics: Oral Presentation Chronic Pain and Drug Abuse Conclusion Loss of fidelity Power Imbalance Professionalism and non-maleficence Not designed to address illegal activity Keeping the patient's best interest in mind Non-adherence Do not abandon the patient 62 ECG bpm

Medical Literature Oral Presentation

Transcript: Clinical Case 2yo child presents to your outpatient clinic with his parents. He has had 1 day of fussiness, decreased PO intake and pulling of his L ear. Clinical questions P-children with AOM I- course of antibiotics C- vs watchful waiting O- decreased OMTF or RAOM PubMed search Mesh otitis media limits: last 1 yr child (0-18yrs) english human Evidence Treatment recommendations: Jan 2010-watchful waiting for most children (1, 2, 6, 7) Fall 2011- delayed antibiotics for first documented AOM (3, 4) Jan 2011- documented benefit associated with antimicrobial treatment compared with placebo (8) most antibiotics have comparable success (5) EBM resources DARE Cochrane Grade-A ACP PIER Grade-B PubMed Clinical Queries Grade-A Innovative research tools (my new best friends) My NCBI DARE Cochrane MESH References 1. Coker, T.R., et al., Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA, 2010. 304(19): p. 2161-9. 2. Grossman, Z., et al., Implementing the delayed antibiotic therapy approach significantly reduced antibiotics consumption in Israeli children with first documented Acute otitis media. Pediatr Infect Dis J, 2010. 29(7): p. 595-9. 3. Grubb, M.S. and D.C. Spaugh, Treatment failure, recurrence, and antibiotic prescription rates for different acute otitis media treatment methods. Clin Pediatr (Phila), 2010. 49(10): p. 970-5. 4. Hoberman, A., et al., Treatment of acute otitis media in children under 2 years of age. N Engl J Med, 2011. 364(2): p. 105-15. 5. Klein, J.O., Is acute otitis media a treatable disease? N Engl J Med, 2011. 364(2): p. 168-9. 6. Kozyrskyj, A., et al., Short-course antibiotics for acute otitis media. Cochrane Database Syst Rev, 2010(9): p. CD001095. 7. Stevanovic, T., et al., Acute otitis media: to follow-up or treat? Int J Pediatr Otorhinolaryngol, 2010. 74(8): p. 930-3. 8. Tahtinen, P.A., et al., A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med, 2011. 364(2): p. 116-26. 9. Vergison, A., et al., Otitis media and its consequences: beyond the earache. Lancet Infect Dis, 2010. 10(3): p. 195-203.

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