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TSBME Executive Director addresses TMDA/TGS
regarding Pain
Donald Patrick, MD, JD, Executive Director of the Texas
State Board of Medical Examiners, was among the speakers addressing the Texas
Medical Directors Association/Texas Geriatric Society's annual meeting on
September 6, 2002. The topic was "Regulatory Considerations in Effective
Pain Management." Dr. Patrick began by stating that opioids are recognized
as being the most effective treatment for chronic pain. The TSBME has
published guidelines regarding appropriate prescribing of pain medications, with
this being updated most recently in 2000.
However, Dr. Patrick stated that physicians should not
"make the mistake of treating without a diagnosis, even in geriatric patients."
Documentation of a complete history and physical examination are requisites,
with this being done legibly. Dictated notes are preferred,
but one should avoid template dictations. Such documentation should
illustrate how treatment improves function or quality of life.
Finally, Dr. Patrick indicated that the TSBME has
corrected a number of efficiency issues. He reminded that TSBME represents
the public and is responsible to the public. Physicians may be considered
"customers". The investigative section is now fully staffed with caseloads
now current. All investigations are done under the supervision of an
attorney. He stated that TSBME investigative attorneys should be
considered in the same category as district attorneys and plaintiff attorneys
[italics added]. He ended his talk with a description of whom he
considers to be the "problem doctors," those being prescribers who use a "cornucopia of meds with
minimal followup and no tracking of refills."
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