Knowledge Library

The Use of Advanced Practice Providers in a Medical Practice: Update 2020

Physicians work with advanced practice providers (APPs) in a variety of medical settings. Advanced practice providers include physician assistants (PAs), and four classifications of advanced practice registered nurses (APRNs): nurse practitioners (NPs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs). As the healthcare industry is experiencing an ever-increasing aging patient population, fewer physicians, is transitioning to value-based reimbursement, APPs are becoming vital to the success of team-based care. In this article we explore the qualifications of APPs, the benefits of employing APPs, as well as the impact they have on the role of physicians. Advanced...

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Practicing during a pandemic – Coronavirus/COVID-19

Since first emerging as a novel virus in December 2019, the SARS-CoV-2 coronavirus outbreak has quickly enveloped the world and, as of March 11, 2020, it was declared by the World Health Organization to be a true pandemic. Currently, there are over 118,000 cases in 114 countries, with 4,291 fatalities. In the U.S., there are 1,215 cases in 43 states, with 36 associated fatalities- and those numbers are growing rapidly. A few of the issues that challenge the response to the coronavirus outbreak are the variability of symptoms and disease severity of COVID-19 in individuals, a shortage of viral test...

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Smartphones and Texting with Patients

Text messaging or SMS (short message service) has become the virtual default method of direct communication in today’s society. As regular mail and even personal emails are increasingly as difficult to find as needles in virtual haystacks, and there is less and less time for telephone calls, individuals who want timely responses are using text messages to communicate- and this expectation is present in healthcare as well. Consider the following statistics: 95% of text messages are read within 3 minutes of being sent. (Forbes) 98% of text messages are read. (Physician Practice News) 91% of US adults 65+ own a...

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Audio and video recordings: What is permissible?

In an age in which most people have a recording device handy at all times, physicians may wonder what their rights and obligations are with respect to audio and video recordings in their private practices. It is clear that video recording, either by staff or by patients, should generally not be permitted in areas in which patient information may be exposed, but what about within the privacy of the exam room?   California is a “two-party consent” state with respect to audio recordings. This means that in the context of a private conversation, both parties taking part in the conversation must consent to having the conversation recorded.    Alaska, Idaho,...

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Capacity v. Competency and Why it Matters

Evaluating medical decision-making capacity can be challenging when treating patients who exhibit cognitive deficits. Understanding the physician’s role in assessing capacity versus the judicial determination of incompetence can make a significant difference in how these situations should be approached.  In healthcare, medical decision-making capacity refers to “an individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and make and communicate a healthcare decision” (Uniform Health Care Decisions Act of 1993). Medical decision-making capacity is specific to the proposed medical intervention, and it can change over time. Incompetence is a legal term that refers to an enduring general inability to make valid decisions. This is established by a judge or magistrate, and it is reserved for...

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