Use of the EMS system for seriously ill children: A survery of primary care physicians

Purpose Many seriously ill patients with cancer do not discuss prognosis or advance directives (ADs), which may lead to inappropriate and/or unwanted aggressive care at the end of life. Ten years ago, patients with cancer said they would not like to discuss ADs with their oncologist but would be willing to discuss them with an admitting physician. We assessed whether this point of view still held. Patients and Methods Semi-structured interviews were conducted with 75 consecutively admitted patients with cancer in the cancer inpatient service. Results Of those enrolled, 41% (31 of 75) had an AD. Nearly all (87%, 65 of 75) thought it acceptable to discuss ADs with the admitting physician with whom they had no prior relationship, and 95% (62 of 65) thought that discussing AD issues was very or somewhat important. Only 7% (5 of 75) had discussed ADs with their oncologist, and only 23% (16 of 70) would like to discuss ADs with their oncologist. When specifically asked which physician they would choose, 48% (36 of 75) of patients would prefer their oncologist, and 35% (26 of 75) would prefer their primary care physician. Conclusion Fewer than half of seriously ill patients with cancer admitted to an oncology service have an AD. Only 23% (16 of 70) would like to discuss their ADs with their oncologist but nearly all supported a policy of discussing ADs with their admitting physician. However, fully 48% (36 of 75) actually preferred to discuss advance directives with their oncologist if AD discussion was necessary. We must educate patients on why communicating their ADs is beneficial and train primary care physicians, house staff, hospitalists, and oncologists to initiate these difficult discussions.

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Use of ems for seriously ill children in the office: A survey of primary care physicians

Prehospital Emergency Care ◽

10.1080/10903129908958915 ◽

1999 ◽

Vol 3 (2) ◽

pp. 102-106 ◽

Cited By ~ 6

Author(s):

Colleen O. Davis ◽

Lance Rodewald

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Seriously Ill

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Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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