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Stefan 🇺🇦 Kertesz, MD

@StefanKertesz

Apr 9

@AllysonVarley

1/Recruiting people who lose someone to suicide after Rx opioids are stopped, is hard but feasible.
That a beginning.

That’s pilot work for CSI:OPIOIDs -
Presented at #SGIM22
So thankful to:
⁦@AllysonVarley⁩ ⁦@PainPtFightBack⁩ ⁦@AJ_Gordon⁩

A word more-

2/Our view is that statistical studies of Rx opioid stoppage are sufficient to show there is risk of suicide but they don’t explain what happened.

When a plane crashes- we look closely at why.

Suicide deaths occurring after Rx reductions deserve no less.

@DrewQJoseph

3/But how does one recruit nationally?

How do you do that ethically? How would families decide whether to trust
“Researchers”
from a “Health System”
..when they *just lost someone they love because the healthcare system changed pain meds? @DrewQJoseph

statnews.com/2021/11/22/her…

Read 8 tweets

Stefan 🇺🇦 Kertesz, MD

@StefanKertesz

Apr 7

1/A criminal justice matter, like court debt or risk of re-incarceration can emerge as a contextual factor resulting in worse medical status

I didn’t realize there are model letters for us docs to assist at

Docsforhealth.org
#SGIM22

2/This remarkable session at #SGIM22 merged two distinct areas of work for ways doctors and other clinicians.

A physician can detect when there is a contextual red flag, and probe it to reveal a contextual factor that might be addressable !

3/The research finds that detecting patients’ presentation of contextual red flags in the office:

doesn’t take more time
can be taught
does improve medical health outcomes

Assessing them is- in a way- broader than SDOH.
sciencedirect.com/science/articl…

Read 4 tweets

Stefan 🇺🇦 Kertesz, MD

@StefanKertesz

Apr 3

@roddreher

1/In the annals of disturbingly bad takes- the salivation of @roddreher over Hungary’s Prime Minister is a sad example.

Prime Minister Orban of Hungary famously announced his goal was “illiberal democracy”

Many Hungarian voters want that, but it is worth asking what it means

https://twitter.com/roddreher/status/1510746411591159816

2/Illiberal democracy is one in which a government like Hungary’s seized control of universities, courts and the media, and handed them over to political allies

3/Illiberal democracy can be popular. But the Hungarian model is one where the state uses its power to to suppress opposing points of view, to limit free academic inquiry, to control the electoral apparatus as well. Hungary is rated “partly free” freedomhouse.org/country/hungar…

Read 8 tweets

Stefan 🇺🇦 Kertesz, MD

@StefanKertesz

Mar 1

1/Having listened to the Supreme Court this AM, I couldn't hear any common sense clear arguments from the attorneys for Ruan or Kahn.
Worse:

I heard them accept that opioid Rx decisions are the same as following clearly posted speed limits

They harmed their own case 🧵

2/To my non-trained ear, the argument put forward by the Justices and accepted by all sides was this:

"if a doc violates a posted set of rules, that everyone can see, can that doctor be convicted of a crime if they didn't intend to violate, or for ignorance of the rules?"

3/I want to say just how devastating it is that the attorneys accepted the analogy between clearly posted speed limits and guidance on opioid prescribing.

The CDC's Guideline (the original) says their guidance can't be used for legal standards, & individualization is required

Read 10 tweets

Stefan 🇺🇦 Kertesz, MD

@StefanKertesz

Mar 1

1/The IOC has urged something unique for sport: that Russian & Belorussian athletes not be invited to international events - this is an exceptional situation since normally athletes are not punished for actions of their governments.
olympics.com/ioc/news/ioc-e…

2/it is a trivial issue by comparison to whether entire countries will survive, but that's the core issue. Ukrainian athletes can't readily compete and certainly can't in good faith "play against" representatives of the country attacking their own.

https://twitter.com/StefanKertesz/status/1498189474710401029?s=20&t=tim1uhSJVdCROJ310m9_EQ

3/For now IOC has declared this problem one for which there is no proper solution but they urge all international sports governance organizations to not invite Russian or Belorussian competitors

Read 4 tweets

Stefan 🇺🇦 Kertesz, MD

@StefanKertesz

Feb 28

@nytimes

1/Tomorrow’s Supreme Court Case about two doctors with alarming clinical practices goes to the heart of a question on the legal risks for *all doctors* who prescribe controlled substances - I am happy @nytimes quoted me on this

https://twitter.com/daniapal/status/1498303551667417092

2/The fundamental question before SCOTUS is whether the of Controlled Substances Act allows a doctor to be convicted *criminally* if experts for prosecution say they don’t think the care aligns with what they see as standard of care.

It is a lower bar than for civil malpractice

3/In civil malpractice the experts have to be from the physician’s own state, and there has to be demonstration of actual harm that resulted from deviation from standard. The penalty is a payout, and the licensing board may investigate

Read 11 tweets

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