CURRENT EVENTS AND ITEMS OF MEDICAL-LEGAL INTEREST
MY OPINION:
1. Hospital Emergency Departments are closing in the Los Angeles County area in alarming numbers. This is placing an enormous burden on Los Angeles County General -University of California Hospital. The reason generally given is that the financial burden is too great for the smaller hospitals to bear.
One of the reasons for this is that physicians are not as available to see emergency or urgent care conditions in their private patients as they formerly and traditionally have been. Thus, their patients go to the available emergency departments in the remaining hospitals. Patients who call their personal physicians as early (or late) as 5:01 p.m. are greeted by a recording that says: "The office is now closed. If this is an emergency, hang up and call 911. If this is not an emergency, please call back during regular office hours."
A major problem with that situation is that when a patient does not feel well, it is urgent to the patient as it well may be. So off the patient goes to the emergency department.
Of course, there are other possible causes for this burden on the emergency rooms. But perhaps the physicians, themselves, may be playing more of an etiological role than they believe. N.B. I used to keep my office phone line open 24/7. I even made house calls.
2. Abusive, rude physicians are getting more attention now. A common cause for disciplinary actions against hospital staff physicians arises from the unacceptable and sometimes arrogant attitudes of younger physicians who are not tolerant of the older physicians who they feel are not as well trained as they, the younger physicians are. That may be true in some cases. Tolerance pays off. Older, more seasoned physicians have a lot of inherent knowledge that goes a long way in treating patients - sometimes even more helpful than the latest medications, and with fewer aide effects. Obviously there are exceptions.
3. Pain. PAIN. Chronic intractable pain is still a scourge upon us. Such patients need help. Don't be afraid to treat chronic intractable patients with adequate pain medication. The essentials in treating such patients without running into trouble with licensing boards is as follows:
a) Verify the pain as truly intractable, confirmed by consultants in the field or area involved in the pain.
b) Medical boards don't approve of treating an addict purely for his/her addiction unless you are properly certified to do so. The primary, dominant reason for prescribing pain medication should be for a true, confirmed medical condition.
c) DOCUMENT everything as completely as is reasonable, and even more so. Fully document past history, present history, a physical examination that will support your findings, laboratory work, copies of previous treating doctors' records, copies of all consultants reports, and full documentation of the patient's progress while under treatment.
d) Added safety procedure is to document a full informed consent for treatment that may cause addiction, or if the patient is already addicted and comes to you from another physician, that you are treating the patient for proven, chronic intractable pain from a true medical condition.
e) Try to ascertain that the patient is not being concurrently given medication for chronic intractable pain by another physician. Don't get caught in the trap of being a concurrent supplier.
PLEASE REMEMBER THAT THE ABOVE ARE ITEMS FOR GENERAL DISCUSSION. THEY ARE NOT TO BE TAKEN AS LEGAL ADVICE, NOR THAT AN ATTORNEY-CLIENT RELATIONSHIP HAS BEEN ESTABLISHED. . LEGAL ADVICE IS GIVEN ONLY IF A WRITTEN, AND SIGNED, RETAINER AGREEMENT IS COMPLETED.
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