Fatal opioid overdoses have increased dramatically in the past 15 years, leaving physicians cautious about overprescribing pain medication. At the same time, doctors often hear about patients being undertreated for pain, and the ways this can adversely affect their outcomes and lives. How should hospitalists balance concerns about drug seeking with those of undertreatment of pain? In our cover story, Stacey Butterfield explores ways to discern true drug-seeking behavior from a straightforward desire for pain relief—and what to do with patients who fall into both categories.
Our inside feature takes a look at how to prepare for the unthinkable: large-scale disasters like the Boston Marathon bombings. According to a recent Institute of Medicine report, too few health care facilities have established indicators and triggers to guide patient care decisions during crises like these. Writer Alicia Gallegos summarizes the IOM recommendations for how to prepare and discusses advice from experts on actions hospitalists in particular can take to get ready for the worst.
Our clinical focus this month is on ascites, the most common complication of cirrhosis. Read our Expert Analysis about treating ascites in patients with portal hypertension, then test what you've learned with our MKSAP questions. Also in this issue, we have our first installation of the Newman's Notions series on vital signs, which covers blood pressure, and a Success Story on the prophylactic power of yogurt.
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Editor, ACP Hospitalist