Cindy Grande MD, an expert advisor to an important new pain guideline, started her ascent towards reasonable care strategies for pain long before she even began residency in family practice; and navigating the cutting edge is a distinction she achieved before completing residency. Her achievements excel beyond what many family physicians achieve in their entire careers, [...]

This week I interviewed Andrew Friedman, MD a member of the expert committee who authored the latest revision of the AMDG Guideline, that addresses the management of pain, particularly the evidence related to the use of opioids. Dr. Friedman is a Physical Medicine and Rehabilitation Specialist at Virginia Mason Medical Center in Seattle. We discussed how [...]

Raising the Quality of Care while Introducing Efficiency. Creating the workflow of champions keeps begging the question as to what is your goal? What are you driving at in your practice, your clinic. Consider the concept of overconsumption as a defect. It might sound a bit harsh, but with 16,000 people per year having lethal [...]

Physicians managing chronic pain with opioids often meet tiresome resistance communicating risk related information to patients, who insist that the information simply doesn t apply to them. Sorting through patients each day, our belief that we are improving their quality of life, can be directly challenged by emerging patient behaviors or other risk indicators. In this episode we discuss details of transitioning care that are useful for the entire clinic to understand.

Bringing your clinic into the fold with respect to developing policies can help you identify the biggest problems you are trying to solve, and anticipate problems or objections to implementing reasonable and effective policies.

Defining standard work that keeps patients safe and care reasonable, can lift an organization to a higher level of reliability and objectivity, but only when these actions are universally executed without bias. Dose limit adherence, abuse surveillance, and alcohol screening are a few high yield focus areas to develop workflow around.

Providing care decisions and interactions that are reasonable, is what we expect of organizations providing healthcare, and the individuals within it. When faced with challenging and unreasonable circumstances, we need expert skill to respond and guide the care towards reasonable. Being experts at returning to reason requires thats where we started in the first place. This week we discuss a foundation for reasonable care, and strategies for bringing it back when things are not going as expected. Calm, assertive, reasonable.

Having a basic system to define reasonable care with prescribing high risk controlled medications in your clinic can increase patient safety, system efficiency, and reduce the frustration that occurs in the subset of patients struggling to self-manage.