Pain & Addiction: Common Threads

On November 1st, I’ll be presenting on the messy intersection between opioid addiction, chronic pain syndromes and other mental disorders. Please click here or on the image below for a full-sized PDF of the conference announcement.

You can register for the event here.

I’m still messing with my slides, however, my presentation will be a “new and (very much) improved” version of material that I’ve delivered to other audiences (for example, here and here)

Many thanks to Taylor Gilard, Susan Gordon, the University of Minnesota’s School of Nursing and Allina Health for involving me in the event.

Think Like a Health Plan

In one of my lives (I have a few), I serve as the medical director for a commercial health plan. My duties involve developing policies and reviewing claims. It’s the greatest job on earth if you love evidence-based medicine (which I do!). And it connects perfectly to another life: teaching EBM at the University of Minnesota, which I’ve been doing since 2004.

I’m pleased to return to St. Joseph’s Hospital, my former employer and postgraduate alma mater, on August 20th to discuss health insurance with the family residents.

This post contains my key teaching points and didactic materials.

Suggested Thought Process

  1. Is the health care service a covered benefit? (cf. benefit plan)
  2. Does the carrier have a policy concerning the health care service?
  3. In the absence of a specific policy, is the health care service medically necessary?
  4. Does the member (patient) and/or evidence meet criteria?

Benefit Plan

At a very high level, benefits are determined by the member’s benefit plan. Eligible services are subject to the plan’s terms, as often summarized in medical policies. Excluded services are not eligible for coverage and cannot be funded by the plan (doing so would violate a contact with the plan’s owner).

Medical Policies

Medical Necessity

Group Exercise

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Opioid Investigations & Enforcement

I’m honored to be serving as a panelist at Fredrikson & Byron’s upcoming “Opioid Investigations and Enforcements Breakfast Seminar” on May 22nd.

Opioids are a common and sometimes uncomfortable area where law and medicine intersect. For years, I’ve been extolling the virtues of the Federation of State Medical Boards’Model Policy” as a means for mitigating risk. It also serves as an excellent framework for approaching opioid-related incidents and investigations.

Fredrikson & Byron is hosting an opioid-related event

The Model Policy first appeared in 1998 and is now in its fourth edition (2017). Section 3 provides detailed guidance on patient selection, informed consent, medication agreements, drug testing, and so forth.

Adhering to the Model Policy ensures patient safety but also provides a safe harbor against enforcement actions. For example, the Minnesota Board of Medical Practice typically includes this condition in opioid-related discipline:

Respondent shall read the Federation of State Medical Boards’ “Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain”

Adhering to the Model Policy is a good way to avoid being investigated. And acknowledging the Model Policy and demonstrating compliance with it are an effective means to respond to questions about care.

Many thanks to Kevin Riach and Joe Dixon, shareholders at Fredrikson & Byron, for including me in this event. And I hope to see you there!

Sunday Sermon

Well, not exactly. They didn’t let me get anywhere near the pulpit!

I did, however, speak at Gustavus Adolphus Lutheran Church for its weekly Table Talk series (the title is a nod to Luther). Last week, I presented on addiction. Today, I held forth on Rational Emotive Behavior Therapy (REBT), which is a way to reduce emotional disturbances by thinking more clearly.

My “text” for last week was Romans 7:15. I also wandered through DSM-5 and Doug Sellman’s “Top 10” on my way to Gerald May’s brilliant conceptualization. I didn’t have a text today, however, “renew your mind” would have been apt.

Many thanks to Dr. Arland Hultgren  (see, also, Amazon) for inviting me to visit such a wonderful parish. And also Rev. Tim Nelson for connecting us.

P.S. I’m a PK (pastor’s kid) and so far have avoided seminary myself. But I wound up in the “belief business” anyway. §

Think Like a Doctor

My longtime collaborator, Jim Beattie, and I will be taking our roadshow to Cleveland, Ohio, for the Midwest Chapter of the Medical Library Association’s Annual Conference. Our four-hour workshop (sounds long, goes fast) provides a practical introduction to evidence-based medicine (EBM). The material is adapted from courses that we teach at University of Minnesota and prior MLA conference presentations. This blog post serves as our “course website.”

PowerPoint Presentations
Think Like a Doctor: Course Introduction
Think Like a Doctor: Diagnosis
Think Like a Doctor: Therapy

Other Course Materials
Competency-Based Medical Education (resource)
Abstract Attack (resource)
PubMed Citations for Small Groups

Family Medicine Clerkship Assets
Unanswered Clinical Questions (article)
Should We Google It? (article)
Evidence Uptake by Synthesized Resources (article)
12 Step EBM Project
CAT Template
PLS Template
Clinical Bottom Line tip sheet
Strengths & Weaknesses of Evidence tip sheet

EBM Resources
Centre for Evidence-Based Medicine (organization)
Levels of Evidence (LOE) Taxonomy (2011) (resource)
Strength of Recommendation Taxonomy (SORT) (resource)
POO, DOO and You (article)
A POEM a week for the BMJ (article)
The Rational Clinical Examination (article series)
The Rational Clinical Examination (book)
Users’ Guides to the Medical Literature (book)
Evidence-Based Physical Diagnosis, 4th ed. (book)
Evidence-Based Medicine, 5th ed. (book)
Diagnostic Calculator (resource)
Biostatistics Calculator (resource)

Predicting Suicide & Violence

I recently delivered a webinar on suicide and violence for the Minnesota Center for Chemical and Mental Health. You can view the presentation here.

I’m a huge fan of using validated scales and measures to guide clinical decisions. I described the use of the following tools in the webinar:

I also referenced an important meta-analysis by Joseph C. Franklin, Ph.D., et al., and an associated press release by the American Psychological Association.

Finally, here’s a shameless plug for some translational pieces on suicide and violence that I wrote for Today’s Hospitalist (where I’m a long-time contributing editor).