DOC Newsletter: September 2011

1. Pre-Clinic Conference PCC (everything needs an acronym in medicine!) has started this month. Thank you to our residents and attendings for participating. Please note that attendance is required if you have clinic in the afternoon at the DOC and that conference will start at 12:30. PCC calendars/schedules are posted at the DOC and reminder emails will be sent to presenting housestaff. Simvastatin FDA Restrictions Remember not to prescribe 80mg doses of simvastatin anymore (unless you have a patient who has been previously on 80mg for >1 year with no symptoms/side effects). SEARCH study: increased risk of myopathy with simva, especially at higher doses. Do not exceed simvastatin 10mg: amiodarone, verapamil, diltiazem Do not exceed simvastatin 20mg: amlodipine, ranolazine Do switch to alternate statin if LDL still not at goal with simvastatin 40mg. Don’t Touch the Warfarin! If you are on call for the DOC and receive a lab alert value call regarding a patient’s INR, do not adjust the dose. If the value is between 5-9, call the patient and tell them to hold their dose that night and that they will be contacted by the Coumadin Clinic in the AM. For values >10, or if using Vit K or think the ED is needed, discuss with the DOC attending on call. Duke Lung Cancer Screening Program -New screening program using low-dose spiral CT for patients ages 55-74 and are current heavy smokers (>30pack years) or former heavy smokers who quit <15 years ago. -National Lung Screening Trial: August 2011, showed 20% reduction in lung cancer related mortality among patients screened with low-dose CT scans vs. standard chest xray screenings. -Schedule your patients for Duke North or Duke South at 1-800-MED-DUKE. -Medicaid does not currently cover lung cancer screening, which means your patient would need to know about Duke’s “discounted” $400 charge due at the time of screening. So happily pass this along to your Pickett Rd colleagues. DOC Newsletter: September 2011 Survey Monkey- Win a Prize! https://www.surveymonkey.com/s/DOC_Question_of_the_Month Promote Thin Partnership Folders -Do not leave items in the folder, if you are not sure what to do, ask an attending! -Watch out for diabetes supplies duplicates from different companies for same patient (considered fraud to sign multiple forms). -Watch out for lumbar brace company requests, tends to be fraud. Resident Dermatology Clinic No, not coming to the DOC; but it is coming to Duke South Clinic 3K starting 9/16/11. Call 919-684-3432 to schedule an appointment for your referrals. Patients likely to need excisions (beyond just a biopsy) will need to be seen as “new patients” and will incur a Private Diagnostic Clinic charge. Charity Care Referrals After you have referred your patient to Resident Derm clinic and the Duke Lung Cancer Screening program, you then need to make sure you are sending Charity Care referrals to the right person! Charity Care is Duke’s program for assisting the uninsured with their medical bills. Gloria Manley and Karen Thompson are the DOC Financial Counselors who assist with Charity Care and are also helpful for patients to discuss Medicare/Medicaid, SSI, and Social Security Disability. Despite popular belief, Jan Dillard does not handle the Charity Care cases. Dictaphones New ones are actually, really, completely, unbelievably, definitely here. Dictaphone assignments have been posted in clinic. Please note, unfortunately you can no longer dictate “copy and paste from previous note” or AEMR, but we are working on this and hopefully will have this feature back soon. • DOC Miscellany: • Diabetes health coaching (Duke Connected Care Diabetes Pilot): For pts with A1Cs ≥8.5 in the last 6 months, have Medicaid or Duke insurance, and can work towards at least 1 self management goal. Will receive 3 months of in-person health coaching and 3 months of telephone coaching. How to refer: send an AEMR task to Duke Well with pts name, mrn, and one line description. Dr. Greenblatt can help with any questions. • Save some money: If you are leaving the DOC after 5:30PM, you must use the back doors to avoid tripping the alarms and annoyed police officers. Must leave building by 6:30PM. • Mini-CEX: need at least 2 per year. Attendings will be on the look out for a quick mini-CEX with time for feedback. • Physical therapist Mike Reiman is at the DOC on Wednesday mornings. Remember to refer your PT patients to him if needed. • Jon Bae couldn’t get no satisfaction (surveys), so you will continue to be subjected to his lame Rolling Stones reference until we accumulate 25 per resident. Give one to your patient today! • Weight loss group: 3 upcoming sessions on December 2nd, 9th, and 16th. Open to Medicaid patients only. Sign your patients up on the encounter form. • 15 minute trickery: The JAR trial for 15 minute earlier appointment times for patient scheduling has been working well and will likely be rolled out to all the housestaff soon. Your patients should be arriving more frequently on time! • Be On the LookOut! for emails on how to participate in various DOC projects for improvements and changes. Contact Juliessa or Alex Cho if you are interested in participating. • Deaths: Please send an email to Carolyn Lawrence notifying her of any of your patients’ deaths so ebrowser can be updated. Tell the ED What to Do (and they might listen) Have a patient frequently go to the ED? Up at night worried that your patient will get unnecessary workup or meds? Tossing and turning, not sure what to do? Well I have the perfect solution for you! Put an ED care plan into your problem list/clinic notes! This is especially applicable for chronic pain patients and could include items like: pain clinic contract, if the patient has been terminated from pain contract and why, recommended acute pain med management (i.e. not necessary to use the typical Duke dilaudid PCA). Sorry, no money back guarantees.