The BG Health Care Thread: Decreasing the Surplus Population

[Meresgi]

If it's the same pharmacy your old doctor probably didn't cancel the prescription.

Not same location but yeah was using Walgreens back in NM. I would have figured since it was "controlled substance" and blah blah they'd be way more up on something like that. CA doesn't even check my ID when I pick it up though like NM used to, which is double hilarious to me since some NM peeps at my old gym were going off on how hard it would be to get T in CA and i'd end up having to back alley it up through Mexico.

[Outlaw]

In a novel experiment, brain-like human tissue implanted in rat brains influenced the rodents' behavior

https://www.nbcnews.com/health/healt...vior-rcna51531

We have all seen this movie..

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[Zealot]

Do it with sharks.

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[Spicyryan]

Do it with sharks.

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[Outlaw]

CVS, Walgreens Pharmacies cutting hours.

https://www.cbsnews.com/news/pharmac...walgreens-cut/

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[6souls]

Walgreens cut available hours for staff at my location as punishment for not selling enough credit cards.

[archibaldcrane]

https://twitter.com/mattyglesias/sta...U0X2BoV5A&s=19

[kuronosan]

Load of bullshit. That has nothing to do with NP increases, and if anything they're the ones doing it and I'm the one fixing it.

Providers like Tyche know what they're doing. It's actually more dangerous for nurse practitioners to practice outside of their scope and doctors that prescribe opioids and benzodiazepines actually know what they're doing and either try to fix the regimen or stabilize it so the patient doesn't die.

[Byrthnoth]

Ah, a classic yglesias... finds a semi-data-justified take that he walks away from after he gets the RTs.

[Salodin]

I mean...the data at least warrants a more thorough investigation. Y'all trying to tell me a doctor would never overprescribe something? Lol

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[kuronosan]

I mean...the data at least warrants a more thorough investigation. Y'all trying to tell me a doctor would never overprescribe something? Lol

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The difference between your average physician and your average nurse practitioner in terms of scope, knowledge base, and skill set is about as wide as a high school football running back and Tom Brady.

Sure, they can throw the ball. It doesn't make them a quarterback, and even NFL passers end up like Russell Wilson once in a while.

Also the data is correlation at best and precisely the reason people don't understand the difference in practice. There's no desperation from physicians to practice dangerous drugs that could harm patients just to keep patients. On average we're LESS likely to prescribe them because of the dangers.

Unfortunately we all have patients who were started on them by other providers and then have to hear their doctor tell them they shouldn't be on it "even though it's really really helping".

Edit: this syllogism alone is mind-boggling

[archibaldcrane]

Load of bullshit. That has nothing to do with NP increases

What is your theory as to why this study is seeing a rise in GPs prescribing opioids and opioid/benzo combos?

[Tyche]

What is your theory as to why this study is seeing a rise in GPs prescribing opioids and opioid/benzo combos?

Caveat, I didn't read the study. But I'll tell you my theory.

With the increase of NPs and providers overall, patients have wider access. This also leads to some revolving doors of providers. One provider may start a patient on a benzo. That provider moves to a different practice, new provider comes in and does an intake eval, and starts another medication. Patient tells new provider "hey, I've been on this 'insert whatever controlled' for years. Provider checks the state reporting system for controlled substances to verify they have been on it, and then they just continue it.

Providers change, inappropriate med reconciliations are done, meds get stacked until someone comes in and goes "ok, what the fuck is going on with these meds". Provider wants to start making medication adjustments, patient gets pissed, goes to find a new provider. That happens a lot. And to be perfectly honest, a lot of providers just don't want to deal with the extreme difficulty of weaning patients off these medications. It's fucking hard to get 87 year old granny of a mg of Xanax twice daily.


I don't know Kuros stance on this, but I don't think GPs should prescribe benzos for regular use. If the patient wants 5 or 6 tablets for upcoming travel or a nightly benzo for insomnia, that's perfectly fine. But if the patient is having panic attacks or anxiety so extreme that they need benzos daily...refer out to psychiatry. Most specialists will go through a proper med rec with these patients. I'm not sure they get that as often with FNPs and GPs that are seeing 40 patients a day.

[kuronosan]

Caveat, I didn't read the study. But I'll tell you my theory.

With the increase of NPs and providers overall, patients have wider access. This also leads to some revolving doors of providers. One provider may start a patient on a benzo. That provider moves to a different practice, new provider comes in and does an intake eval, and starts another medication. Patient tells new provider "hey, I've been on this 'insert whatever controlled' for years. Provider checks the state reporting system for controlled substances to verify they have been on it, and then they just continue it.

Providers change, inappropriate med reconciliations are done, meds get stacked until someone comes in and goes "ok, what the fuck is going on with these meds". Provider wants to start making medication adjustments, patient gets pissed, goes to find a new provider. That happens a lot. And to be perfectly honest, a lot of providers just don't want to deal with the extreme difficulty of weaning patients off these medications. It's fucking hard to get 87 year old granny of a mg of Xanax twice daily.


I don't know Kuros stance on this, but I don't think GPs should prescribe benzos for regular use. If the patient wants 5 or 6 tablets for upcoming travel or a nightly benzo for insomnia, that's perfectly fine. But if the patient is having panic attacks or anxiety so extreme that they need benzos daily...refer out to psychiatry. Most specialists will go through a proper med rec with these patients. I'm not sure they get that as often with FNPs and GPs that are seeing 40 patients a day.

I agree with everything this says.

My running theory is that with increase in coverage, so does access to these medications. In reality, these prescriptions are federally tracked per patient because they're controlled substances, which means you would know if multiple providers prescribed to the same patient in a certain window of time, and while that would give you an idea for how many prescriptions were sent it doesn't give you the context on why or who started it at what time.

And while it is dangerous to combine opioids with benzos it certainly isn't so high a risk you should never do it. It's higher risk to have a patient come in who is on them and just stop them cold because then they could die or overdose on a Zanzibar laced with fentanyl.

I completely disagree with the notion that you should see NP prescriptions increase and GP prescriptions decrease. That's not how this works.

Often I tell patients no to benzos, especially when on opioids, but then I inherit patients on them and what do I do? Let them have a seizure? I tell them no, they go to a doctor or NP who tells them yes, the cycle continues. So I'm not competing for business, I'm trying to protect the patient by minimizing the number of prescribers handling these meds.

I hate when general practitioners prescribe benzos because 9/10 I have to clean it up.

[archibaldcrane]

https://twitter.com/kylegriffin1/sta...3TF42EBGA&s=19

[archibaldcrane]

Obamacare was good actually.

We should just continue the process of socializing HC costs and increasing access to care.

https://twitter.com/mcbridetd/status...HHVUrSHhw&s=19

[kuronosan]

The uninsured rate doesn't mean much. I have at least a dozen patients on marketplace plans who have their medicines change constantly "to control costs" even though medications have varying levels of efficacy despite similar mechanisms of action.

The end result is wasted time, more frequent appointments for monitoring, more cost to the patient out of pocket, and less actual affordability, which is only correlated to access and not an actual function of it in practical settings.

[Andalusian girls]

while cost-mandated medication shifts during treatment are deeply suboptimal the claim Obamacare coverage costs the patient more than being uninsured seems patently absurd, but if you have some scholarly evidence for it i'd like to peruse

[kuronosan]

while cost-mandated medication shifts during treatment are deeply suboptimal the claim Obamacare coverage costs the patient more than being uninsured seems patently absurd, but if you have some scholarly evidence for it i'd like to peruse

I'm happy to dive into it but am on call right now. All I can offer is anecdotal stuff from patients and dealings with insurance companies.

[Andalusian girls]

whenever time allows mon cher