The nursing profession has never lacked its challenges, but two major issues have increasingly affected the quality of work environments for nurses: short-staffing and extended working hours. What negative effects are resulting from these problems?

Short-staffing of hospitals has become a top concern for nurses. The U.S. Bureau of Labor Statistics estimates that, by 2022, there will be a need for more than 1 million registered nurses due to occupational growth and replacement hiring. What is viewed as the most dangerous concern for short-staffing? A lack of sufficient patient care. In hospitals suffering nurse shortages, nurses often do not have time to provide the necessary care for patients or their families, as they are rushed to assist a patient and then move on to the next one. Such feelings can lead to moral distress, in which nurses become physically and emotionally drained when they repeatedly cannot provide the care they feel is necessary.

In order to address problems that arose due to short-staffed hospitals, some nurses are required to work longer shifts involving extended hours and overtime. This solution creates an inherent problem: nurse fatigue. With an increase in fatigue affecting nurses, there is a corollary risk of increased medical errors involving patients, as fatigue can lead to mistakes or oversights related to patient care. The typical number of hours a nurse should work in a week is at most 40 hours, working no more than 12 hours in a day. Nurses who work beyond that start to experience cognitive decline, resulting in a higher probability of mistakes being made that can adversely affect patients.

In October 2019, the Illinois Department of Financial and Professional Regulation announced a new requirement for prescribers renewing their Controlled Substances Registration in 2020: the completion of 3 hours of continuing education on safe opioid prescribing practices. The requirement applies to individuals that are prescribers under the Controlled Substances Act, which includes such licenses for dentists, optometrists, physicians, and veterinarians.

The change does not come as much of a surprise given the continuing spotlight on opioid addictions and overdoses turning into a nationwide epidemic. While most lawsuits have been filed against opioid manufacturers relating to their misleading marketing of these drugs, there is no doubt that prescribers of opioids, most specifically physician prescribers, have been viewed as playing a crucial role in this problem. The Centers for Disease Control and Prevention reported that in 2017 more than 70,000 people died from drug overdoses and of those deaths, nearly 68% involved a prescription or illicit opioid.

In a study conducted by Johns Hopkins Bloomberg School of Public Health examining about 350,000 prescriptions written for patients operated on by nearly 20,000 surgeons from 2011 to 2016 – the latest year for which data was available – researchers found that many doctors wrote prescriptions for doses of opioid tablets after surgeries, including operations that resulted in relatively little pain for patients. The highest-prescribing 5% of surgeons performing these less painful procedures prescribed 40 to 70 pills on average.

Patients have the right to keep their health records private and to know if their information is shared with others. Generally, a healthcare provider may only release an individual’s information with written consent, unless the information is critical for any treatment the patient will receive or if necessary to protect the public at large. In today’s technological world, the majority of patient data is stored in hospital or clinic systems and software. While certainly an efficient manner of securing information, technologies’ ever-changing state may also leave the information exposed to certain vulnerabilities, such as hacking.

Then how does one keep patient information secured from ever-present threats? Unfortunately, there is no single security measure that can be implemented as a sufficient defense. Rather, one must implement multiple defenses that serve as protective mechanisms to slow down any potential attack and make data access more difficult.

Typical defensive measures include firewall and antivirus solution protections, spam filters to block malicious emails and proper security awareness for staff to avoid phishing tactics, data encryption for all portable devices, and intrusion detection systems that monitor irregular network activity. Holders of confidential patient information are also advised to have extensive backup systems in place to ensure patient information is never lost.

Illinois is one of 33 states that has legalized medical marijuana. While such legalization has expanded the ways to address patient pain, it has left physicians in the tricky position of determining whether to prescribe a substance that, while legal at the state level, still faces a federal ban. The question physicians face now is whether their license may be put in jeopardy, even if cannabis is approved for medical use. The answer, of course, is “it depends.”

The risk to physicians is generally minimal, thanks especially to a declaration by the Justice Department in 2013 stating that attorneys would not pursue actions against physicians who recommend medical marijuana in states that have made such use legal. However, this has not stopped state agencies from threatening loss of license to those physicians who do not play by the appropriate rules.

Physicians who neglect to conduct required examinations and report the necessary medical histories when prescribing medical marijuana run the risk of having their actions investigated. Physicians are typically required to maintain accurate medical records, check pharmacy databases to ensure patients are not obtaining certification from other providers, and complete the minimum amount of medical education on the benefits and risks of medical cannabis. What is viewed as the most important requirement for physicians to follow? To maintain an ongoing doctor/patient relationship. A physician should never provide a recommendation for medical marijuana to a previously unseen patient without ensuring the appropriate relationship is established. Such action could result in the physician being taken advantage of by a patient who has already received certifications from multiple providers.

Electronic health records (EHRs) make information related to patient-centered records available instantly and securely, containing patient medical history, diagnoses, medications, and treatment plans that greatly assist with overall diagnosis and treatment. However, missing, incomplete, or ineligible documents may hurt patient care and be used as evidence if a patient claims negligent treatment. In order to best protect yourself, here is advice on how to ensure properly maintained EHRs:

Understand How the Data is Tracked

Each time someone at the practice or hospital goes into a patient record, data tracks who signed into the EHR, the physical location of the computer, and the exact update made to the EHR. This means that any possible delay in patient treatment that a physician seeks to rectify by having the EHR reflect assistance in a timelier manner can be pulled in the digital “audit trail” to demonstrate patient record manipulation.

What Should Be Documented

EHRs should be kept up-to-date to ensure you can demonstrate appropriate, timely patient care was provided. Since the EHR is used as a communication tool amongst all practitioners involved in the patient’s care, you want to document patient medical records in the manner that you would want documented if assuming management of the care of a patient you did not know. Do not forget to include a diagnostic rationale, especially in circumstances where the medical record could suggest another course of action that was overlooked.

Health professionals will likely have to deal with difficult patients throughout their careers. They are the ones patients look to when experiencing high levels of stress or anxiety over the health issues facing their day to day lives. Such interactions can test the limits of health care professionals who have a duty to remain respectful and composed, so as to not compromise the integrity of their relationship with the patient. Then how should one deal with disrespectful patients?

The most obvious answer: remain calm. A patient acting disrespectfully is generally acting on feelings out of anxiety or a perceived lack of attention rather than attacking you personally. In such situations, it is important to keep control and address the patient in a way that can cool down the situation. Having a response ready for such moments can help diffuse the tension and set boundaries with the patient. For example, if a patient begins using explicit language toward a doctor or nurse, a simple response of, “let’s keep it professional,” can allow the health care professional to call out unacceptable behavior while moving on to the necessary task at hand. When facing unacceptable patient behavior, it helps to remain firm, refusing to engage in arguments or unnecessary apologies. Keep the interaction professional, and if necessary, pursue a follow-up conversation within a day of the interaction to foster a sense of open communication.

Another tactic is to always approach difficult patients with a level of empathy. Remember, you are dealing with patients during the most sensitive, anxiety-inducing moments of their lives. Making patients feel as if you are really trying to understand them and that you genuinely care can go a long way in helping an otherwise disrespectful patient calm down. If you feel the reason for ‘acting out’ extends beyond the stress that comes with health issues, you can suggest that the patient find a social worker or someone to talk to about their difficulties. Be sure that in taking such an approach, you handle the suggestion sensitively to make sure the patient does not feel abandoned.

Medical adherence is the act of taking medication as prescribed by a physician, which involves taking the proper dose, at the correct time, and for the recommended length of time. In order to achieve the full benefit of medications, patients need to adhere to prescribed treatment regimens. Patient non-adherence can result in adverse consequences to a patient’s health and result in additional medical costs and physician visits.

Why would a patient willingly not adhere to a medication treatment meant to provide help? It should not come as a surprise that the rising cost of prescription medications is a barrier for many patients. According to a Truven Health Analytics-NPR Health poll, 67% of patients do not take their medications because they cannot afford them. However, most physicians are surprised to learn that high costs account for only a small amount of patient adherence. Most patient non-adherence is intentional-based, resulting from such factors as a lack of understanding medication instructions or the reasons for taking certain medications, or confusion surrounding dosing schedules.

What impact does this have on a physician? A patient’s inability to follow a prescribed medication treatment should not create liability exposure for physicians. Unfortunately, that is not always the case. If a patient suffers harm due to their non-adherence to medication treatment, a physician’s efforts in ensuring adherence may be looked into by the Illinois Medical Board. Given that physicians are believed to have a better understanding of the ramifications of a patient’s failure to pursue treatment, physicians are under a greater burden to ensure adherence.

Artificial Intelligence has come into everyone’s life in one way or another over the past decade. One of the fastest growing areas using this new technology is the healthcare industry. There have been many advancements over the years and new ways of using it coming out every day. These advancements have even come into light with physicians using data they receive from wearables like smartwatches.

Companies like Microsoft and Apple have entire teams dedicated to healthcare. The teams create software that give customers and physicians the ability to see all types of data, from a person’s heart rate to glucose levels, throughout the day. While these wearables generate a lot of information, physicians are in the precarious position of having to decide if, how, and when to use this data. Sometimes more info is not always better: studies have shown some wearables customers use the devices for the sole purpose of improving their health, and this creates an issue if the physician is not sure how to use the information to benefit the patients.

While wearables will continue to be an exciting field for medical advancement, it can also be a concern for doctors. Most of these wearables are not FDA approved, or worse there are concerns about the confidentiality of patient information (Violations of State and Federal Confidentiality Statutes). Doctors not only have to worry about how to use the information, but they also have to worry about the legal risk of their use.

Artificial Intelligence (AI) has come into everyone’s life in one way or another over the past decade. One of the most significant growth areas using this new technology is the healthcare industry. There have been many advancements over the years, and new ways of using it come up every day. These advancements even arrive on the surgical side of a physician’s practice. 

Robots empowered with AI have been used to assist surgeons in performing intricate surgeries. These robots limit the amount of human error, which can cause adverse outcomes for the patient. Since robots can be used to get into smaller areas than a surgeon’s hands are able, robots also make the surgery less invasive. Techniques like these allow for faster post-operative recovery and higher patient satisfaction. While robots, at least in the near future, are not going to take over and replace a surgeon’s knowledge and judgment, they will continue to expand the field.

One hurdle to the growth of AI in surgery is patient and physician trust in machines and AI. As it becomes more and more commonplace to see certain operations being assisted by a computer, there will come the point where the type of surgery may be too much for the patient/surgeon to trust the machine.

Over the past decade, artificial intelligence (“AI”) has entered everyone’s life in one way or another. The healthcare industry is one of the most significant growth areas for this technology. There have been many advancements over the years, and new ways of using it arrive every day. The advancements, in large part, enter the medicine side of a physician’s practice.

One area of advancement with AI in medicine is diagnostics. Computers have been able to use data from around the world to diagnose patients so the treating physician can find the root of the problem as quickly as possible.

Therapy has also made advancements due to AI. Some including patients gaining the ability to use electronic therapy dogs or even software that allows a cost-effective way to speak about their problems.

Patient-centric care is what our healthcare system has moved towards, but when is that too far? What happens when patients start to tell doctors how they want their treatment plan to look? As patients gain more and more access to information, they may become a more informed “customer”; this can be both good and bad. Patients can have a better understanding of what their issue is, but, their informal knowledge does not replace a medical/osteopathic degree.

One of the ways patients are starting to have more control over the system is through patient satisfaction surveys. Patients now have the ability to “rate” the care they received. While the idea behind this patient satisfaction surveys helps the hospitals see potential areas of concern, the survey itself can also cause problems. When administrations spend too much time looking at this type of data, it can create problems that don’t actually exist. Just like looking up a Google review, one must take the information with skepticism. Most people who are happy (or at least satisfied) with their experience do not take the time to fill out the surveys. Rather, the surveys are completed by patients upset about something (whether right or wrong). This type of survey can cause issues for physicians.

While most hospitals and administrations have started to guard against misuse of patient satisfaction surveys, sometimes they don’t mitigate the impact on doctors. If the hospital tells doctors how to treat patients by way of strict review of the patient satisfaction surveys, doctors may feel like they lost their independent judgment. That loss of judgment can result in the overprescribing of opioids or running a test that isn't needed. This could ultimately cause a problem with the Illinois Department of Financial and Professional Regulation, and your license. If a problem does arise, Williams & Nickl is here to help you get through that process and back on the right track. Our firm focuses on professional license defense to ensure the Medical Board does not violate your rights, and you have a chance to move on from your issue.

Patient-centric care is what our healthcare system has moved towards, but when is that too far? What happens when patients start to tell physicians how their treatment plan should look? As patients gain more and more access to information, they may become a more informed “customer”; this can be both good and bad. Patients can have a better understanding of what their issue is, but as the saying goes ‘your Google search does not replace a medical/osteopathic degree’.

Patients often use Google before they see their physician. Patients want to understand what is going on before they see a doctor or to determine whether they will even make an appointment to see one at all. There are several problems with this approach, the most important of which is a patient believing their symptoms fit a hundred different diseases. This belief can cause an overreaction, and entering a physician's office very anxious and stressed. When this happens, the patients may start to ask for unneeded tests, procedures, and medication. Physicians are then put into a difficult position: should they try to calm the patient and assure them or give in and run multiple tests to prove that WebMD did not actually diagnose them with the diseases. In some cases, the patient could actually be correct in their assumptions and not be overreacting, so physicians must use their judgment on the best course of action for that particular patient.

Sometimes poor medical judgment results when doctors are pressured by patients, and this can cause multiple issues including overprescribing opioids or running tests that aren’t needed. Any of these scenarios could cause the physician a problem with the Illinois Department of Financial and Professional Regulation, and their license. If a problem does arise, Williams & Nickl is here to help you get through that process and back on the right track. Our firm focuses on professional license defense to ensure the Medical Board does not violate your rights, and you have a chance to move on from your issue.

Patient-centric care is what our healthcare system has moved towards, but when is that too far? What happens when patients start to tell physicians how they want their treatment plan to look? As patients gain more and more access to information, they will be a more informed "customer"; this can be both good and bad. Patients can have a better understanding of what their issue is, but, as the common saying goes, your Google search does not replace a medical/osteopathic degree.

One way a patient can start to dictate how they are treated is by requesting specific medication. Pharmaceutical manufacturers plaster TV, print and internet sites with drug advertising with the urgent request “Ask your doctor about it!” Drug companies would argue that informative ads empower the consumer patient to obtain the medication they want, but physicians would counter that the consumer is not educated enough to make such a decision. Studies have shown that patients are more likely to get their medication of choice when they request it. This is true not only for the drug brand but also the drug type. Speculation occurs, as it is unclear whether the physician simply wants to pacify the inquisitive patient or if they truly believe the medication is the most appropriate treatment.

While listening to your patients and adhering to their requests can be harmless, patients dictating their medications can cause a lot of issues, including the overprescribing of opioids. This could ultimately cause a problem with the Illinois Department of Financial and Professional Regulation, and your license. Many have stated that the best practices are to work with your patient to make the decision together. Let your patient know how you came to your decision and do not be afraid to say NO, especially when it comes to controlled substances. If a problem does arise, Williams & Nickl is here to help you get through that process and back on the right track. Our firm focuses on professional license defense to ensure the Medical Board does not trample your rights, and you have a chance to move on from your past issue.

Authors and physicians Drs. Adam Cifu and Vinayak Prasad wrote a blockbuster book in 2015 that is making news lately. The abrupt change in medical gospel, sometimes being rewritten every week, is a true disaster for patients who try to keep up with the ‘latest and greatest’ in medicine. The authors use the term ‘medical reversal’ to describe sudden flip-flops in standards of care. Medical reversals cause angst among not just the patients, but the doctors that now must face the fact that their advice and practice was potentially harmful or maybe not even helpful in any way.

Examples of therapies and medical strategies that turned out to be wrong include estrogen-replacement therapy after menopause, use of coronary stents to open narrowed coronary arteries, lobotomy, Vioxx, vertebroplasty, arthroscopic knee surgery to repair degenerative meniscal tears, and more.

The authors try to find out why modern medicine reverses itself and to make suggestions on how to make it stop. State of the art health care can be harmful or unhelpful. Why do a surgical repair of the meniscus in a knee when physical therapy is just as effective? The causes are very common – an inadequate scientific study or a flawed study due to financial bias. And if the treatment makes a lot of common sense, it is more likely to be useless, which is very counter-intuitive.

Depending on where a physician works, there could be great relationships with nurses, or it could be very difficult. Although there is no blame or fault, some places have physicians and nurses working hand-in-hand and some experience stressful relationships between the providers. No matter, the vast majority of physicians and nurses want to have a strong working relationship with each other. In order to facilitate those relationships, there are some do’s and don’ts:

Communication is the first thing on which every provider can improve. You should let others know your expectations but also understanding the other side’s. Many times, a simple explanation can clear up what could have been a significant issue. Involving the nurses as much as possible and keeping them aware of what the physician is doing truly helps the relationship. Doing so will guide everyone to work together and limit the potential for antagonism and alienation.

The second goal is to improve one’s ability to understand. A common scenario is the one-upmanship game inherent in complaining/bragging as to who works the most hours or who has had the roughest shift. The easiest way to stop this is to practice ‘understanding.’ Knowing that both of practitioners have hard jobs and that sometimes working in the hospital of office isn’t fun for anyone can help calm relationships between the professions. Both positions have different roles in patient care, both are supposed to work as a team, and understanding these roles will help reduce tension.

In January of 2020, Illinois became the latest state to legalize recreational cannabis. The question for physicians is now ‘may I use cannabis without fear of being fired from my job?’ The quick answer is, of course, it depends. The longer answer is: it depends on where you work and when you’re using it.

First, employers can stop you from possessing and using cannabis at work. They still have the ability to discipline you for the possession of cannabis on company property and will be able to test you for the drug under reasonable suspicion. The problem is that cannabis can remain in your system for weeks, and there is no current test to determine if you are impaired.

Second, Illinois has a nondiscrimination law that bars employers from discriminating against employees for legal activities done outside of work hours. We assume that because cannabis is legal that employers cannot prevent you from using it outside of work, but if some is impaired when reporting to work, how would an employer test for it?

On March 20, 2020 Governor Pritzker issued Executive Order 2020-10 (“Order”) which required all residents of Illinois to shelter in place. The Order was extended through April 30, 2020. The Order exempted all healthcare workers for the obvious reason that healthcare is a critical concern in the current global pandemic. The Illinois Department of Financial and Professional Regulation (“IDFPR”) has recently posted on its website bulletins related to the healthcare industry, a number of which are entitled “Guidance.” The bulletins concern the temporary relicensing of retired and out-of-state healthcare non-licensed practitioners. None of these bulletins deal with ethical issues in providing healthcare services in a COVID-19 environment.

Specifically, there does not seem to be real guidance for the #1 question Williams and Nickl receives from clients: Must a doctor, PA or nurse remain working in a hospital or clinical setting in which they objectively believe the practice environment is a danger to themselves or their families? The answer is NO!

Even though politicians and science experts resort more and more to the “war” analogy, an Illinois healthcare worker cannot be charged with desertion. As an Illinois healthcare licensee, you are not bound by the Uniform Code of Military Justice to sacrifice your life or the health of your family. But all healthcare professions have an affirmative duty to avoid patient abandonment. In short, no doctor, nurse or PA can quit on the spur of the moment. All healthcare practitioners are required to arrange, in one form or another, for the continuity of patient care. What constitutes reasonable notice and arrangement for continuity of care varies widely by individual circumstances.

As of March 30, 2020, the DEA will allow oral prescriptions of schedule II controlled substances when:

• they are needed for the proper treatment of a patient;

• there are no appropriate treatment options; and,

• when submitting an electronic or paper prescription to the pharmacy prior to dispensing the substance is not possible.

Physicians and other prescribers can make the determination to phone in the emergency schedule II script after reviewing the circumstances for each patient, and that review must include the above criteria. Clearly, not every controlled II prescription will be prescribed by phone.

Pharmacists must be aware of qualifications that apply before you can dispense that phone script. First, oral prescriptions are limited to only the adequate amount the patient needs right away. Schedule II prescriptions that go past this period are still subject to the requirement for paper or electronic submission. Second, pharmacists must put the script into writing ASAP, and must cover all of the required fields besides the prescriber’s signature. 

During the COVID-19 pandemic, patients in rural areas face difficulties already present in obtaining care, including poverty, inconsistent virus information, and lack of transportation. Pharmacies serving these populations are working extra-hard to ensure the best care in their communities.

One way community pharmacies can help is with mobile clinic options. A mobile clinic can provide clinical and education services to those with transportation challenges. In addition to offering a telephone service to patients who cannot come to the pharmacy, mobile clinics can be at the disposal of area health agencies as the pandemic expands. While it may seem that patient outreach services can and will be affected by COVID-19 just as other non-health related business, pharmacies are able to adjust as more info about the virus comes online. Some pharmacies have adopted best practices including working with county health departments, senior centers, and school districts to assist the community with support, medication and needed supplies.

Requests for delivery have risen dramatically, for obvious reasons, and some pharmacies have developed a way to coordinate deliveries with patients that limits in-person contact. It is important to remember that pharmacists must be available for follow-up care to those patients. Some pharmacies are pushing state Medicaid programs to issue waiver requests for reimbursements on home delivery, which is critical due to the small margins that community pharmacies already endure.

During the COVID-19 pandemic, pharmacists and pharmacy technicians have been included in legislation creating a tax holiday for health professionals and first responders who continue to serve. The “Helping Emergency Responders Overcome Emergency Situations” (HEROES) Act of 2020 did not originally include pharmacists as beneficiaries, but they have since been added.

The original bill only applied to physicians, nurses, physician assistants, nurse practitioners, hospital and medical facility support staff, emergency medical technicians, paramedics, firefighters, corrections officers, and law enforcement officers. The hope is that the legislation will be added to the next congressional COVID-19 legislative package so pharmacists have peace of mind.

What does the federal tax holiday mean? It would suspend federal tax withholding for four months and give the government the authority to extend withholding for an additional three months. It applies to all income up to $150,000 annually.