Increasing help for physician impairment

This issue also covers new drugs for depression, conference coverage about gastroenterology, and escalating generic drug prices.


Physician impairment can be difficult to talk about, and to assess. This June, ACP took steps toward both goals by publishing a position paper, “Physician Impairment and Rehabilitation: Reintegration Into Medical Practice While Ensuring Patient Safety,” detailing a framework for the profession's response, including a distinction between functional impairment and potentially impairing illness and best practices for physician health programs. Our story reviews ACP's recommendations and offers advice on recognizing impairment, getting help, and promoting physician well-being. prevent-recognize-impairment.htm

Your patients may have asked you recently about esketamine, a new nasal treatment for depression, which was approved by the FDA earlier this year. Another treatment, brexanolone, was also approved specifically for postpartum depression. But while both new drugs offer some hope, their practical usefulness is limited, and they are certainly not a cure-all, according to psychiatrists and other experts. An internist's best bet for managing depression remains routine screening, then cognitive behavioral therapy or second-generation antidepressants for first-line treatment, they said.

Our conference coverage this issue is from Digestive Disease Week, which was held in San Diego in May. A story discusses the connection between the gut and the brain and how behavioral assessments and treatments might help relieve symptoms of irritable bowel syndrome. Learn how to talk to patients about this possibility without making them think their problems are “all in their heads.” Then, read about the rise of eosinophilic esophagitis, a previously rare disorder that now has rates approaching those of inflammatory bowel disease. Changes in the esophageal biome might be a prime contributor, according to one expert.

The price of prescription drugs has long been deemed a culprit of escalating health care costs, but one potential mitigating factor—generics—has become less reliable. Physicians and patients report increases in once-affordable drugs, such as colchicine for gout or nitroglycerine for heart conditions, that can be dramatic enough to negatively affect adherence. Our story details possible causes behind these unpredictable increases and offers physicians tips and tricks to alleviate them. Chief among them is to help patients become informed consumers and encourage them to let you know if a copay is suddenly beyond their reach.

Nutritional assistance programs are another way of helping patients, but the best way to operate them remains a subject of dispute. A recent study in Health Affairs tried to bring some clarity to the issue by comparing different types and frequencies of food vouchers and their effect on patients' fruit and vegetable intake. Read our Q&A to find out the results.

How does your practice manage physician impairment? Do your patients report problems with the price of generic drugs? Let us know at acpinternist@acponline.org.

Sincerely,

Jennifer Kearney-Strouse
Executive Editor