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Tuesday, February 13, 2007

Rx’s for Doctors

Internists: Good News on Cancer described the recent reductions in cancer rates, especially because of colorectal screening. As you know, patients approaching age 50 have several options for colorectal screening.

Advice for internists who use paper charts:
Have the receptionist identify each morning which of the day’s patients are nearing age 50. Have them place a PostIt note with a picture of a colon or pair of buttocks onto the front of the chart. That will give you a memorable, cheap, and confidential reminder to discuss options for colorectal screening with that patient, and you’ll start the discussion with a smile.

Oncologists: Now A Model Patient describes a cancer patient’s non-compliance with an outpatient oral chemotherapy order. It draws on this month’s article in the British Medical Journal by Dr. Saul Weingart et al. They found that two-thirds of the cancer centers in the U.S. write chemotherapy orders without writing the patient’s body surface area.

Advice for oncologists: If you hand-write oral chemo orders, make a special pre-printed form that has a space explicitly for the body surface area. That will prompt you to record it, giving the pharmacist a convenient way to verify that he or she is not dispensing an overdose.

Weingart’s survey found that “few” cancer centers get patients’ written informed consent for off-protocol oral chemotherapy drugs. This may well expose you to a risk of a lawsuit, and foregoes an opportunity to learn and honor the patient’s wishes.

Advice for oncologists: Have patients sign a consent form for off-protocol prescriptions.

Family Medicine physicians: Lucio Satar’s parents didn’t immunize him against the flu, and Lucio developed pneumonia, with complications, and died.

Please suggest to the families you see in the next few weeks that they get vaccinated.

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