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The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole. No boring lectures here, just high value content and a healthy dose of humor. Fantastic podcast for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine. Topics include heart disease, obesity, diabetes, cardiac imaging, migraines, fibromyalgia, hypertension, cholesterol, osteoporosis, insomnia, testosterone, functional medicine, dementia, and more!
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Now displaying: September, 2016

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole.

thecurbsiders@gmail.com

Sep 26, 2016

Learn to treat non cancer pain in the elderly. Managing persistent pain in the elderly can be...painful. On this episode Matt and Paul interview Dr. Marissa Galicia-Castillo, a Professor of Geriatrics from Eastern Virginia Medical School board certified in Internal Medicine, Geriatrics, Hospice/Palliative Medicine. Are we being too stingy with opioid prescriptions? How do you assess and treat pain in patients with advanced dementia? We’ve got your answers.

Clinical Pearls:

  1. Persistent pain in the elderly is underrecognized and undertreated
  2. Nonpharmacologic therapy is still first line (get off the couch!)
  3. Scheduled acetaminophen is a valid first line
  4. Consider low dose oxycodone IR as a second line (assuming NSAIDS contraindicated)
  5. Diversion of medication by family members is a concern and may cause treatment failure
  6. Opiates can be a great tool. Don’t be afraid to use them with careful patient selection.
  7. Follow quality of life and functional status as your end points for pain control.
  8. Pain in cognitively impaired may present as behavior problems. Treat the pain and treat the behavior.

Disclosures:

Dr. Galicia-Castillo reports no relevant financial disclosures.

Learning objectives:

By the end of this podcast listeners will be able to:

  1. Recognize that pain in the elderly is often underrecognized and undertreated.
  2. Recognize the signs and symptoms of pain in patients with cognitive impairment.
  3. Utilize opiates safely and effectively for the management of noncancer pain in the elderly
  4. Formulate a basic therapeutic approach to noncancer pain utilizing nonpharmacologic and pharmacologic therapy 

Links from the show:

  1. Dr. Galicia-Castillo’s article on use of opioids for persistent noncancer pain in older adults

http://www.ccjm.org/current-issue/issue-single-view/opioids-for-persistent-pain-in-older-adults/a136ddc8a922abd74237073a1ab89d4f.html

  1. CDC guidelines on prescribing opioids for chronic pain (#8 discusses criteria for naloxone prescribing)

https://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-a.pdf

  1. World Health Organization Pain Ladder

http://www.geriatricpain.org/Content/Management/Interventions/Documents/WHO%20ladder.pdf

  1. Observational study of Naloxone administration along with opiate prescriptions (NEJM Journal Watch 2016).

http://www.jwatch.org/na41676/2016/07/19/should-naloxone-be-prescribed-patients-taking-opioids

  1. Effect size seen with opiates and tramadol were small in this review, but adverse event rates were high. This is why a trial with monitoring of functional  status is recommended.

http://www.ncbi.nlm.nih.gov/pubmed/21472151

  1. A RCT looking at Tramadol for knee osteoarthritis with underwhelming results.

http://www.ncbi.nlm.nih.gov/pubmed/20215961

  1. EULAR 2016 guidelines for treatment of fibromyalgia

http://ard.bmj.com/content/early/2016/07/04/annrheumdis-2016-209724.abstract

  1. Dr. Clauw’s YouTube Video

Chronic Pain: Is it all in their head?

  1. Dr. Clauw’s University of Michigan website for patient self education on fibromyalgia

Fibroguide.com

 

Sep 12, 2016

Summary:

Fifty four percent of physicians report at least one symptom of burnout. On this episode Dr. Philip Kroth an Internist and Chief of Clinical Informatics from the University of New Mexico schools us on how electronic health records (EHR) relate to burnout and tips to promote physician wellness. Miss this episode and you might get burned...out. I refuse to apologize for that pun. Enjoy!

 

Clinical Pearls:

*Check out the article by Shanafelt below to view breakdown of burnout by specialty.

*24/7 access to EHRs is a double-edged sword. You have to protect your own time.

*Turn off email alerts.

*Limit your screen time when off the clock. Kids are only allowed 1 hour per day!

*Take the EHR training and become a MASTER.

*Keep in mind these four domains related to burnout and try to mitigate your risk.

  1. Health information technology and documentation burden
  2. Stress versus control and support. You need to balance the “seesaw”
  3. Health policy and regulation (e.g. ACOs, MACRA)
  4. Physician culture of endurance (e.g. giving yourself an IV when sick instead of going home)

Disclosures:

None reported.

Links from the Show:

1. Article by Shanafelt finding burnout in 54 percent of physicians.

Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014 Shanafelt, Tait D. et al. Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 - 1613

2. Turnover of primary care doctors cost about $250,000 in 1991!

Buchbinder, SB et al. Estimates of Costs of Primary Care Physician Turnover. Am J Manag Care. 1999 Nov;5(11):1431-8.

3. Maslach Burnout Inventory

http://www.mindgarden.com/117-maslach-burnout-inventory

4. Volkswagen stops sending emails in the evening.

http://www.bbc.com/news/technology-16314901

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