Study reveals lack of self-awareness among doctors when prescribing opioids

From Science Daily:

As health providers struggle to curb the epidemic of opioid abuse, researchers have found that 65 percent of emergency department (ED) physicians surveyed underestimated how often they prescribed the highly addictive pain killers to patients

How to Tell Whether a Psychiatric Emergency is Due to Disease or Psychological Illness

From ACEP Now (hat tip: Dr. Menadue):

The emergency department serves as both the lifeline and the gateway to psychiatric care for millions of patients suffering from acute behavioral or mental health emergencies. As ED providers, in addition to assessing the risk of suicide and homicide, one of our most important responsibilities is to determine whether the patient’s behavioral emergency is the result of an organic disease process, as opposed to a psychological one; there is no standard process for this.

On the one hand, these psychiatric patients are high-risk medical patients. They not only have a higher incidence of chronic medical conditions, but they’re at greater risk of injury, including serious head injury, than the general population. The rate of missed medical diagnoses in the emergency department ranges from 8 to 48 percent, with the highest missed diagnosis rate among first presentations. Any and all acute medical emergencies need to be identified. The admitting psychiatric team certainly shouldn’t be burdened with a missed medical emergency.

On the other hand, psychiatric patients can stress the emergency department, with the average length of stay ranging from 15 to 30 hours, depending on the whether they require medical clearance and whether they are admitted.1,2 Lack of agreement between the emergency department and the psychiatric department can lead to the adoption of arbitrary exclusionary criteria, which delay admissions even further. In one study, the total costs were $17,240 per patient requiring medical screening.3 So, having these patients who are at high risk for acute medical problems that need to be dealt with before their disposition while at the same time wanting to move them through the system efficiently poses significant challenges. An appropriate and accurate medical clearance process is imperative for decreasing length of stay in the emergency department and the cost of care as well as for identifying medical issues that may be causing or exacerbating the patients’ presentation.

She went to the ER for a rape exam. Her nurse didn’t know how to do one.

From the Tribune:

Nearly 4,500 patients were seen in emergency rooms in the state for alleged, suspected or confirmed sexual abuse or rape in 2016, the most recent year the Illinois Department of Public Health has data available. And not every victim goes to a hospital. Last year, Illinois Criminal Justice Information Authority data recorded almost 10,000 people who received services from state-funded rape crisis centers.