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What A Difference A Day Makes


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   What A Difference A Day Makes                                                                                              RobertMBlumm, MA, PA, DFAAPA, PA-C Emeritus         
                         
As the world turns, it not only effects time zones and light and darkness but, more importantly, it affects events. What is true today may not be true tomorrow. Kingdoms rise and fall. Elected officials discover that they are targets of their own party because of words. Words, events, discoveries and research all affect the present day. Why is this important to us as clinical professionals? There may be changes in techniques, dosages and medications which require our vigilant attention as well as the immediate action of our office staff and our computer systems. 

Three days ago, the FDA published a warning concerning one of our most used medications: Fluoroquinolone Antibiotics. Unless we are vigilant, we can easily miss the warning that has been sent out of all healthcare prescribers and also is disseminated to our patients. In this computer world, all parties become aware simultaneously and like the Boy Scout Motto: Be Prepared, we need to be attentive and to take immediate action. The newsflash warned us that this class of medication can exacerbate hypoglycemia and also has certain mental health side effects. The diabetic implications are that dangerously low blood sugars can cause coma whereas certain Fluoroquinolone classes can cause hyperglycemia. Mental side effects include disturbances in attention, disorientation, agitation, nervousness, memory impairment and delirium.  What’s the clinician to do based on this information? The astute clinician will look for another oclass of antibiotic. All of these need our attention and require a change in prescription.
 
In the same week, we were notified about cancer causing elements in a widely used ARB, Valsartan. I received a call from my internist’s office that I must call them. I was told to stop the medication and fill a different prescription. I was a bit put off by their panic. I called the office nurse, telling her that my prescription was not on the recall list. She stated that the doctor said that there were other incidences of this problem with other generics and, therefore, he wanted all his patients off the medication and he would call in a new prescription tomorrow. What a difference a day makes.
 
Two medication alerts in four days. This requires diligence and effort from ourselves and our office staff. It also represents the need for a good medical record and medication reconciliation. If you happen to be the PA or NP who is unaware and has not taken action, you are liable if your patient has a complication. This represents a medication medical error. So now we come down to the need for malpractice insurance. Do you have an up to date insurance policy that you have seen recently? Some physicians forget or do not renew the policy and then their professional clinicians are going bareback. I have had more than ten occasions where this has been true with my colleagues. It is your responsibility to check on this. How many times a year do you need to see an updated policy? If I am causing you to have paranoia, it is a good thing. Why? Because you will take action and discover your liability and its limits and type of insurance. If you want to put this anxiety behind you, you can purchase a personal liability insurance policy that covers one person: yourself! No one wants to be served with a blue subpoena. But if you do, you can rest more easily with an insurance product from CM&F, a New York company that has been serving professional for seventy-one years. What a difference a day makes.
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