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GP-Doctor questions - General Practitioner (GP) Doctor Updated: 2023

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Exam Code: GP-Doctor General Practitioner (GP) Doctor questions November 2023 by team

GP-Doctor General Practitioner (GP) Doctor

Exam Details for General Practitioner (GP) Doctor:

Number of Questions: The number of questions in the exam may vary depending on the country and regulatory body conducting the exam.

Time Limit: The time allocated for the exam varies depending on the format and structure of the exam. It may range from a few hours to multiple days, including practical assessments and written components.

Passing Score: The passing score also varies depending on the country and regulatory body. It is typically determined by the level of proficiency required to practice as a General Practitioner.

Exam Format: The exam format may include a combination of written tests, practical assessments, and clinical evaluations. The specific format will be determined by the regulatory body responsible for the certification.

Course Outline:

The course outline for becoming a General Practitioner typically includes the following areas of study:

1. Basic Medical Sciences:
- Anatomy
- Physiology
- Biochemistry
- Pharmacology

2. Clinical Medicine:
- Internal Medicine
- Pediatrics
- Obstetrics and Gynecology
- Surgery
- Emergency Medicine

3. Preventive Medicine and Public Health:
- Epidemiology
- Health Promotion and Disease Prevention
- Environmental Health
- Occupational Health

4. Diagnostic Skills:
- History taking and physical examination
- Medical imaging interpretation
- Laboratory test interpretation

5. Communication Skills and Professionalism:
- Patient communication and counseling
- Ethics and medical professionalism
- Cultural competency

Exam Objectives:

The objectives of the General Practitioner (GP) Doctor exam typically include assessing the candidate's:

1. Knowledge and understanding of core medical sciences.
2. Diagnostic and clinical skills in various medical specialties.
3. Ability to effectively communicate with patients and provide appropriate counseling.
4. Proficiency in preventive medicine and public health principles.
5. Knowledge of medical ethics and professionalism.

Exam Syllabus:

The exam syllabus covers a wide range of medical topics and may include, but is not limited to, the following:

1. Anatomy and Physiology
2. Pathophysiology
3. Internal Medicine
4. Pediatrics
5. Obstetrics and Gynecology
6. Surgery
7. Emergency Medicine
8. Preventive Medicine and Public Health
9. Pharmacology
10. Medical Ethics and Professionalism

Please note that the specific exam details, course outline, objectives, and syllabus may vary depending on the country and regulatory body governing medical practice. It is essential to consult the relevant medical authority or educational institution in your region for accurate and up-to-date information on the certification process and requirements for becoming a General Practitioner (GP) Doctor.
General Practitioner (GP) Doctor
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General Practitioner (GP) Doctor
Question: 191
A 6-year-old boy fell in the playground and has been holding his forearm complaining of pain. Exam: no sign
However, there is minimal tenderness on exam.
What is the diagnosis?
A. Green stick fx of distal radius
B. Fracture neck of humerus
C. Fracture mid ulnar
D. Fracture mid radius
Answer: A
Question: 192
An 82-year-old man has woken up with incoherent speech and difficulty in finding the right words. Exam: good
Which anatomical site is most likely to be affected?
A. Pons
B. Wernickes area
C. Brocas area
D. Midbrain
E. Parietal cortex
Answer: C
A person with expressive aphasia will exhibit halting and effortful speech. Speech m important content words. Word
comprehension is preserved. The person may still be understood, but sentence grammatical. This contrasts with
receptive or Wernickes aphasia, which is distinguished by a patients inability comprehend language or speak with
appropriately meaningful words though fluency, may be preserved.
Question: 193
A 14-year-old girl presents with primary amenorrhea and a short stature.
What is the most likely diagnosis?
A. Downs syndrome
B. Fragile X syndrome
C. Turners syndrome
D. Klinefelters syndrome
E. Normal finding
Answer: C
Downs syndrome and Fragile x syndrome dont have primary amenorrhea. Klinefelters patients are tall males. So the
likely diagnosis is Turners syndrome.
Question: 194
A 37-year-old woman presents with heavy bleeding. Investigation shows subserosal fibroid-4cm and intramu.
Which is the most appropriate treatment?
A. Abdominal Hysterectomy
B. Vaginal Hysterectomy
C. Abdominal Myomectomy
D. Hysteroscopic Myomectomy
Answer: C
As patient is young we should go for myomectomy. As hysteroscopic myo mainly sub mucosal fibroids we should go
for abdominal myomectomy which will deal with both subserosal a fibroids.
Question: 195
A new screening test has been devised to detect early stages of prostate cancer.
However, the test tends t of people with no cancer, although they do have cancer as diagnosed by other standard tests.
What is this flaw?
A. True Cve
B. False +ve
C. Poor specificity
D. True +ve
E. False -ve
Answer: E
Question: 196
A young girl presented to gynecologist for assessment with lower abdominal pain and per vaginal bleedin of
hysterosalpingograph as a part of her infertility treatment. Observation: BP=90/50mmHg, pulse-120bpm, and revealed
rigid abdomen.
What is the most appropriate next investigation?
A. Coagulation profile
B. Chest X ray
C. Ultrasound abdomen
D. X-ray erect and supine
Answer: C
Likely cause of bleeding and shock is ruptured fallopian tube for which appropriate ne is US abdomen.
Question: 197
A middle aged woman has some weakness of hand after an injury.
Which vertebra will be the lowest to be x-ray to diagnosis the injury?
A. C7/T1
B. C5/C6
C. c8/T1
D. C6/C7
Answer: A
Question: 198
Patient with major depression what is the first line treatment?
A. Tricyclic antidepressant
Answer: B
A SSRIs are the initial antidepressants of choice for uncomplicated depression because of their minimal anti-
cholinergic effects
Question: 199
A 28-weeks pregnant woman presents with uterine bleeding after sexual intercourse.
What is the most appropriate diagnosis?
A. Placental abruption
B. Missed abortion
C. Placental previa
D. Ectropion
Answer: D
Post coital bleeding can be either placenta previa or cervical ectropion. But as ectropion pregnancy so it is the option
Question: 200
Condition not associated with increased alpha fetoprotein:
A. Myelomeningocele
B. Down syndrome
C. Spina bifida
D. Gastroschisis
Answer: B
Down syndrome associated with DECREASED levels of alpha fetoprotein. Not increased.
Question: 201
A 64 years man believes a female newscaster is communicating directly with him when she turns a page.
Where is he suffering from?
A. Delusion of Reference
B. Nihilistic
C. Grandeur
D. Control
E. Persecutory
Answer: A
A delusion of reference is a type of delusion wherein the individual perceives unrelated events or objects in his/her
surroundings to be of significance for himself/herself. For example, a person with schizophrenia might believe a
billboard or a celebrity is sending a message meant for them.
Question: 202
A 48-year-old woman always socially withdrawn has stopped going out of the house. She is afraid to socialize fears
that people will criticize her.
What is the most probable diagnosis?
C. Social anxiety
D. Agoraphobia
Answer: C
Social anxiety disorder is a type of complex phobia. This type of phobia has a disrupt disabling impact on a persons
life. It can severely affect a persons confidence and self-esteem, interfere with relationships and impair performance
at work or school.
Question: 203
Victim of RTA came with multiple injuries to abdomen, chest and limbs. BP is 80/ 50. upper limb has upper third near
amputation that bleeds profusely, what is your first thing to do:
A. Tourniquet the limb to stop the bleeding
B. Check the airway and breathing
C. Five IV fluid
D. Call orthopedic
Answer: B
As rule ABC also in description near amputation so difficult to make tourniquet enough which stops bleeding.
Question: 204
A 72years presents with polyuria and polydipsia. The fasting blood sugar is 8 and 10mmol/l.BP=130/80mm
cholesterol=5.7mmol/l. There is microalbuminuria.
What is the single most appropriate next management?
A. Statin and glitazone
B. ACEi and sulfonylurea
C. Statin and Biguanide
D. Statin and ACEi
Answer: D
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Medical Practitioner questions - BingNews Search results Medical Practitioner questions - BingNews Invasive Mental Health Questions Have No Place on Nurse Licensing Applications

Melnyk is a mental health and evidence-based practice expert. Hsieh is a science writer. Feist is a healthcare executive and advocate for healthcare worker well-being.

There is a public health epidemic of burnout, depression, and suicide in the nursing and healthcare workforce. While the most trusted health profession in the nation does an outstanding job encouraging those suffering from mental health conditions to seek treatment, stigma and other barriers prevent nurses from seeking help when they are struggling.

The Americans With Disabilities Act (ADA) became law in 1990 and serves to protect individuals with physical and mental disabilities from discrimination in numerous facets of life, including employment. Anyone who has completed a job application may recall being asked if they would need any reasonable accommodation to perform their job -- this question is the ADA at work. But what frequently gets overlooked is how the ADA applies to professional licensing, such as nurse licensing applications.

Nurse licensing is controlled by individual state boards of nursing (BONs), which collectively form the National Council of State Boards of Nursing (NCSBN). BONs operate to protect the public by regulating the provision of nurse licensing and removal of unsafe clinicians from practice. To flag any potential problems in nurses, BONs have historically defaulted to including what we view as overly invasive questions concerning applicants' mental health on licensing applications. Often, these questions go beyond inquiries regarding current impairment and request that applicants with a history of mental health disorders detail their related treatment histories, substance use history, breaks in practice, and notarized doctor approvals to practice.

As state entities, BONs are required to adhere to the ADA. Yet, in 2019, a study in the Journal of Psychosocial Nursing and Mental Health Services identified 22 BONs that asked ADA non-compliant questions. More recently, our study in Worldviews on Evidence-Based Nursing used the Dr. Lorna Breen Heroes' Foundation's Toolkit to identify BONs with invasive questioning, concluding that 37 states did not meet the Toolkit guidelines for adherence (Figure 1).

Creative Commons License: Melnyk, Hsieh, and Feist.

Impact on Nurses

While filling out her license renewal application, our peer, Sue Brammer, PhD, RN, came across a question that required her to disclose her bipolar diagnosis and provide treatment documentation.

"When the question appeared about bipolar disorder and I couldn't proceed in my application unless I provided documentation from my doctors about my treatment for it, I was furious," Brammer said. "Who would see it, and what qualifications did the person reviewing my doctors' letters possess to determine whether I was safe? Upon reflection, however, my anger turned to sadness. I was sad for nurses carrying the double burden of managing a mental illness plus the fear of being found out. They won't seek treatment because they're afraid of possible repercussions from the Board, and when they don't get treatment, the suffering can become unbearable and tragic things can happen."

The mental health crisis in health workers pre-dates the COVID-19 pandemic. However, rapid pandemic-related changes only added fuel to a quickly spreading fire. Between 2018 and 2022, health workers reported an increase of poor mental health days experienced during the previous month (from 3.3 to 4.5 days). A 2022 Surgeon General's Advisory noted that up to 54% of nurses and physicians are experiencing burnout, which has played a substantial role in our current health worker shortage. Additionally, death by suicide is higher among nurses than the general population, and poor mental health can adversely affect healthcare quality and may play a role in medical errors. In short, our nation's nurses and health workers are in dire need of support.

A Move in the Right Direction

Approaches to preventing burnout and suicide include decreasing mental health stigma, removing barriers to care, and creating wellness cultures and policies that support clinician well-being. Asking invasive mental health questions on nurse licensing applications supports none of these preventative initiatives. It encourages nurses to withhold information and discourages pursuing care due to a fear of license revocation.

The NCSBN is currently working on national recommendations for the removal of invasive mental health and substance use questions from nurse licensure applications. Until their guidance is released, BONs can look to the Federation of State Medical Boards, the American Medical Association, and the Dr. Lorna Breen Heroes' Foundation for how to modify invasive questions. These entities recommend either removing questions that enquire about an applicant's health completely or using language that addresses both physical and mental health with no added asterisks.

For example, "Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?"

State governments have also been working to legally mandate the removal of inappropriate mental health questions across all healthcare professions' licensing. Virginia's HB 1573 instructs health regulatory boards within the Department of Health Professions to amend its licensure, certification, and registration applications by removing any existing questions relating to mental health conditions and impairment, and replacing these questions with the following:

  1. Do you have any reason to believe that you would pose a risk to the safety or well-being of your patients or clients?
  2. Are you able to perform the essential functions of a practitioner in your area of practice with or without reasonable accommodation?

This Virginia legislation benefits over 500,000 licensed health workers in 62 professions and is quickly becoming a model for other states. For example, similar legislation was signed by the Governor of Illinois in August 2023, but the provisions only apply to the Illinois State Medical Board.

Our Call for Action

The Dr. Lorna Breen Heroes' Foundation uses an audit, change, and communicate model to advance changes to the invasive mental health questions paradigm. Licensing boards, hospitals, and health systems can become "Well-Being First Champions" that recognize and encourage the removal of probing mental health questions. Twenty-six states have received this designation for medical licensing, and 11 more are actively pursuing it. However, no states are currently Well-Being Champions for nursing licensing. States interested in receiving this designation should submit their Toolkit compliant initial and renewal applications to the Dr. Lorna Breen Heroes' Foundation. Advocates who wish to invite their BONs to the challenge can contact their state nursing boards. In past weeks, over 75 emails have been sent to BONs in almost every state. By removing these questions, we can remove a major barrier for nurses to seek help for mental health conditions and, hopefully, prevent more nurses from dying by suicide.

Bernadette Mazurek Melnyk, PhD, APRN-CNP, is vice president for Health Promotion and Chief Wellness Officer at Ohio State University in Columbus, as well as the Helene Fuld Health Trust Professor of Evidence-based Practice in the College of Nursing and Professor of Pediatrics and Psychiatry in the College of Medicine at Ohio State. She is an internationally recognized expert, speaker, author, and scientist in the fields of mental health, evidence-based practice, and intervention research. Andreanna Pavan Hsieh, MPH, is an experienced science writer at Ohio State University's College of Nursing. She applies a public health lens to mental health promotion and champions the prioritization of well-being in the workplace. J. Corey Feist, JD, MBA, is the CEO and co-founder of the Dr. Lorna Breen Heroes' Foundation. He has over 20 years of experience as a healthcare executive, and is an influential advocate for improving healthcare worker well-being.

Wed, 15 Nov 2023 04:45:00 -0600 en text/html
3 questions to help residents find a primary care physician

There are many reasons that older adults may be looking for a new primary care practitioner. Perhaps they are unhappy with their current doctor. Maybe they recently moved or switched to a new insurance plan, or there’s the possibility that their PCP is retiring.

Whatever the reason, choosing a new PCP is an important decision, especially for adults aged 65 or more year — and, in the case of older adults, for the administrators, case workers and other key staff at senior living communities and adult living facilities, it’s imperative that they can help residents keep a sense of independence while improving the quality of their everyday lives.

As a primary care physician and someone with many family members who are older, I’m often asked what people should think about when it comes to primary care. Here are three important questions older adults and their loved ones should consider when beginning the search:

1. What matters most?

The first step in choosing a new PCP is to think about what matters to the resident or patient, because it can vary from person to person. Primary care is personal, and everyone deserves a PCP who is guided by the person’s own values and preferences. What are their health goals? What barriers do they face? Is their current care and treatment helpful? Are any parts burdensome to them?

It may sound simple, but reminding residents and their loved ones that they should make decisions based on what matters most to them is a critical place to start when looking for a new PCP.

2. How do they prefer to use primary care or specialists?

Many older adults are managing multiple chronic conditions, such as hypertension, diabetes or arthritis, so it’s important to think about what role they would like their PCP to play in taking care of all their conditions. Do they prefer a PCP who wants to care for all of their needs directly, or do they prefer a PCP who likes to refer them to specialists? 

Different primary care providers offer different levels of care. Some PCPs take a more hands-on approach and see their role as bringing care together and, as such, they are heavily involved in important decisions such as managing daily medications or chronic conditions, even when those treatments were originally prescribed by specialists. They also may think about a patient’s social and emotional health, providing suggestions to improve their overall well-being.

Other PCPs take a different approach, limiting interactions to annual check-ups or sick visits, seeing patients less frequently throughout the year, and letting specialists take the lead in care with less involvement. Each patient should think about their preference and find a PCP that matches their choice.

3. How and where do they want to receive care?

Most older adults have preferences in how and where they want to access their PCP. For example, they might prefer office visits, telemedicine or maybe even home visits. Or there’s the possibility that they like a mix of one or two ways in which they receive care.

Each option comes with its own set of benefits. For example, at a recent home visit, we noticed that our patient’s walker was causing shoulder pain, which made it difficult for her to get around. We were able to make a simple adjustment that solved the issue, but this couldn’t have been made without seeing the patient in her home environment. For patients who prefer virtual visits, there are many easy tools and technologies that make it possible for examinations to happen through a computer screen and to communicate with a PCP.

When thinking about how and where patients want to receive their care, choose one or a mix of options based on their preference. If they prefer to avoid a crowded office, then perhaps a mix of at-home visits and virtual care is right for them.

For care providers with patients at senior living communities, collaborating with loved ones is especially important. So understanding how their PCP will help with care coordination and communication is critical. Good primary care should make it easy for others to join in visits and medical decisions, allowing them to take an active role and actually be a member of the patient’s care team.

Moving forward: Choosing a PCP

What guidance can you share with the older adults in your community or facility?

Start off by reminding seniors to ask the people they trust — senior living community staff members, friends, family, trusted specialists and their insurance provider — if they know a PCP who matches what they’re looking for. For example, “I am looking for a PCP who is willing to respect my preferences and is ready to help me take charge of all of my specialty care.”

Once they have a referral, make sure that they’re asking the PCP (or their care  team) questions to help determine whether they align with the aforementioned questions. For example, “Does Dr. X usually make referrals for diabetes, or does she manage most diabetics herself?”

By helping older adults understand how to evaluate their needs and how to find providers that align with them, you can help improve their quality of care — and their quality of life as they age.

Neil Patel, MD, is chief health officer of Patina Health, a relationship-centered primary care provider dedicated to improving the healthcare and aging experience for people 65 and older.

The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

Wed, 15 Nov 2023 15:36:00 -0600 en-US text/html
Your 6 Most Pressing Questions About Menopause and Vasomotor Symptoms, Answered No result found, try new keyword!Here, experts answer five of the most pressing questions readers like you have about menopause, and offer both practical solutions and a modicum of hope, so you can move into this next stage of life ... Thu, 16 Nov 2023 05:27:00 -0600 en-us text/html 3 questions for Sherri Shepherd on living a 'full life' with type 2 diabetes No result found, try new keyword!Sherri Shepherd was worried about moving to New York when she got the opportunity to be a permanent co-host on The View in 2007. Not because she was anxious about city life or the new job, but instead ... Tue, 14 Nov 2023 02:32:17 -0600 en-us text/html The Biggest Questions: Is it possible to really understand someone else’s mind?

Technically speaking, neuroscientists have been able to read your mind for decades. It’s not easy, mind you. First, you must lie motionless within the narrow pore of a hulking fMRI scanner, perhaps for hours, while you watch films or listen to audiobooks. Meanwhile, the machine will bang and knock as it records the shifting patterns of blood flow within your brain—a proxy for neural activity. The researchers, for whose experiment you have volunteered, will then feed the moment-to-moment pairings of blood flow and movie frames or spoken words to software that will learn the particularities of how your brain responds to the things it sees and hears.

None of this, of course, can be done without your consent; for the foreseeable future, your thoughts will remain your own, if you so choose. But if you do elect to endure those claustrophobic hours in the scanner, the software will learn to generate a bespoke reconstruction of what you were seeing or listening to, just by analyzing how blood moves through your brain. 

Back in 2011, UC Berkeley neuroscientists trained such a program to create ethereal doubles of the videos their subjects had been watching. More recently, researchers have deployed generative AI tools, like Stable Diffusion and GPT, to create far more realistic, if not entirely accurate, reconstructions of films and podcasts based on neural activity. Given the hype, and financial investment, that generative AI has attracted, this kind of stimulus reconstruction technology will inevitably continue to improve—especially if Elon Musk’s Neuralink succeeds in bringing brain implants to the masses. 

But as exciting as the idea of extracting a movie from someone’s brain activity may be, it is a highly limited form of “mind reading.” To really experience the world through your eyes, scientists would have to be able to infer not just what film you are watching but also what you think about it, how it makes you feel, and what it reminds you of. These interior thoughts and feelings are far more difficult to access. Scientists have managed to infer which specific object, out of two possibilities, someone was dreaming about; but in less constrained settings, such approaches struggle.

That’s because machine-learning algorithms need both brain signals and information about what they correspond to, paired in perfect synchrony, to learn what the signals mean. When studying inner experience, all scientists have to go on is what people say is going on inside their head, and that can be reliable. “It’s not like it’s directly measuring as a ground truth what people experienced,” says Raphaël Millière, a lecturer in philosophy at Macquarie University in Australia.

Tying brain activity to subjective experience requires facing up to the slipperiness and inexactitude of language, particularly when deployed to capture the richness of one’s inner life. In order to meet that demanding brief, scientists like Millière are marrying contemporary artificial intelligence with centuries-old techniques, from philosophical interview strategies to ancient meditation practices. Bit by bit, they are starting to suss out some of the brain regions and networks that give rise to specific dimensions of human experience. 

“That’s a problem we can make, and have made, some progress on,” Millière says. “I’m not saying it’s easy, but I think it’s certainly more tractable than solving the grand mystery of consciousness.”

Going to extremes

Over 300 years ago, the philosopher John Locke asked whether the color blue looks the same to everyone—or whether my experience of “blue” might be closer to your experience of “yellow.” Answering such subtle questions could be a distant horizon toward which the neuroscience of experience might aim. In its current, early stage, however, the field has to address itself to much more dramatic forms of experience. “If we want to get a better grasp of what is distinctive about the ordinary, wakeful states in our daily lives, it’s useful to see what happens when you undergo some transition into a different kind of state,” Millière says.

Some scientists focus on deep states of meditation or intense hallucinations. For his part, Millière is particularly interested in understanding self-consciousness—the awareness of oneself as a thinking, feeling individual in a particular place and time—and so he studies what happens to someone’s brain during a psychedelic trip. By comparing how subjects respond post-trip to questions like “I experienced a disintegration of my ‘self’ or ‘ego’” with their brain activity patterns, researchers have discovered some changes that may be linked to the loss of self-consciousness. The default mode network (DMN), for example—a group of brain regions that all become active when people are lost in thought—tends to lose its typical coordination.

Taking a high dose of psychedelics is certainly the easiest way to lose one’s sense of self while awake. But if drugs aren’t your thing, there is another option: spend tens of thousands of hours practicing meditation. Highly skilled practitioners of Buddhist meditation can voluntarily enter a state in which the boundary between themselves and the world begins to seem porous, or even disappears entirely. Interestingly, such states are also associated with activity changes in some core regions of the default mode network, like the posterior cingulate cortex. 

Because the potential pool of subjects is so much smaller, studying meditators can be a trickier way of getting at extreme experiences. But meditators also have some distinctive benefits as experimental subjects, says Sara Lazar, associate professor of psychiatry at Harvard Medical School. Expert meditators are masters of their own internal lives—they can spontaneously produce feelings of profound gratitude or descend into states of deep focus—and they tend to report their inner experiences in far more detail than untrained people are able to. “It’s because we spend so much time just listening and paying attention to what’s actually going on inside of us,” says Lazar, herself an experienced meditator.

We non-meditators are sometimes so unaware of what’s going on in our own heads that when our minds start to wander—which they often do—we might not even notice what is happening. In order to study what the brain does at such times, Kalina Christoff, a psychologist at the University of British Columbia, had to periodically prompt her subjects to consider whether their minds had, at that moment, been wandering, and whether they had realized that they’d lost their focus. Frequently, they did not. Her subjects’ default mode networks were more active while their minds were wandering, and especially so when they were unaware that it was happening. 

To investigate the onset of mind wandering in more detail, however, Christoff had to turn to experienced meditators, who could detect it the moment it occurred. Only with their assistance was she able to determine that the DMN is particularly active in the moments just before the mind begins to drift away.

Altogether, these results paint a fairly coherent picture. When you are wondering what to have for dinner or worrying over a recent disagreement with a friend, your DMN switches on; but in states of intense, selfless focus, the network deactivates or desynchronizes. But that doesn’t mean scientists can tell whether you are conscious of yourself, or whether your head is in the clouds, just by looking at your brain activity. In one study, researchers were able to decode particular internal states—a focus on the breath, a focus on sounds, and a wandering mind, for example—at a better rate than would be expected by chance, but they still got it wrong more than half the time. And these coarse descriptions of people’s inner states hardly paint a complete picture of what it’s like to be them.

Even so, Lazar thinks brain data might help us better understand our own experiences. Deactivation of the default mode network, and of the posterior cingulate cortex in particular, is associated with states of "effortless focus" that beginning meditators often struggle to attain. So some researchers are testing whether seeing live data from their own brains, in a process called neurofeedback, could help people learn to meditate. “Once you’ve felt the right state at least once or twice, then you know: okay, this is what I’m going for, this is what I’m aiming for,” Lazar says. “Now I know what this feels like.”

Asking the right questions

If you’re a neuroscientist interested in subjective experience, times are relatively good: research on psychedelics and meditation has exploded in the past decade, and noninvasive neuroimaging technologies are only growing ever more powerful and precise. But the data means little without a solid indication of what the subject is experiencing, and the only way to obtain that information is to ask. “We simply cannot do away with reports of some sort,” Millière says.

Psychological questionnaires are one approach. They’re conveniently quantitative, and they’re easy to use, but they require subjects to slot their transcendent experiences into preestablished, and potentially ill-fitting, boxes. There are alternatives. Phenomenology, the branch of philosophy that seeks to analyze first-person experience in rigorous, exacting detail, has had over a century to refine its techniques for obtaining such reports—three times as long as the fMRI machine has existed. Millière has organized training sessions for his neuroscientist colleagues in “micro-phenomenology,” a philosophical interview method that seeks to elicit as much experiential information from a subject as possible without leading the responses in any particular direction. 

But long textual descriptions, of the sort produced by a micro-phenomenological interview, are much trickier to parse than questionnaires. Researchers can manually rate each response according to the attributes that interest them, but that can be a messy and labor-intensive process—and it robs interviews of much of the nuance that makes them so valuable. Natural-language-processing algorithms, like those that power ChatGPT, may offer a more efficient and consistent alternative: they can quickly and automatically analyze large volumes of text for particular features. Already, Millière has experimented with applying natural-language processing to reports of psychedelic experiments from online databases like Erowid and discovered that the resulting characterizations correspond well to data obtained from questionnaires.  

Even with the help of micro-phenomenology, however, wrapping up what’s going on inside your head into a neat verbal package is a daunting task. So instead of asking subjects to struggle to represent their experiences in words, some scientists are using technology to try to reproduce those experiences. That way, all subjects need to do is confirm or deny that the reproductions match what’s happening in their heads.

In a study that has not yet been peer reviewed, a team of scientists from the University of Sussex, UK, attempted to devise such a question by simulating visual hallucinations with deep neural networks. Convolutional neural networks, which were originally inspired by the human visual system, typically take an image and turn it into useful information—a description of what the image contains, for example. Run the network backward, however, and you can get it to produce images—phantasmagoric dreamscapes that provide clues about the network’s inner workings. 

The idea was popularized in 2015 by Google, in the form of a program called DeepDream. Like people around the world, the Sussex team started playing with the system for fun, says Anil Seth, a professor of neuroscience and one of the study’s coauthors. But they soon realized that they might be able to leverage the approach to reproduce various unusual visual experiences. 

Drawing on verbal reports from people with hallucination-causing conditions like vision loss and Parkinson’s, as well as from people who had recently taken psychedelics, the team designed an extensive menu of simulated hallucinations. That allowed them to obtain a rich description of what was going on in subjects’ minds by asking them a simple question: Which of these images best matches your visual experience? The simulations weren’t perfect, although many of the subjects were able to find an approximate match. 

Unlike the decoding research, this study involved no brain scans—but, Seth says, it may still have something valuable to say about how hallucinations work in the brain. Some deep neural networks do a respectable job of modeling the inner mechanisms of the brain’s visual regions, and so the tweaks that Seth and his colleagues made to the network may resemble the underlying biological “tweaks” that made the subjects hallucinate. “To the extent that we can do that,” Seth says, “we’ve got a computational-level hypothesis of what’s happening in these people’s brains that underlie these different experiences.”

This line of research is still in its infancy, but it suggests that neuroscience might one day do more than simply telling us what someone else is experiencing. By using deep neural networks, the team was able to bring its subjects’ hallucinations out into the world, where anyone could share in them. 

Externalizing other sorts of experiences would likely prove far more difficult—deep neural networks do a good job of mimicking senses like vision and hearing, but they can’t yet model emotions or mind-wandering. As brain modeling technologies advance, however, they could bring with them a radical possibility: that people might not only know, but actually share, what is going on in someone else’s mind.

Tue, 14 Nov 2023 20:00:00 -0600 en text/html
Why are doctors leaving Rochester Regional Health's Linden Medical Group? What we know now

Patients of Rochester Regional Health's Linden Medical Group are seeking answers about potential disruptions to their health care services after five doctors decided to leave the practice.

The Rochester-based health network recently sent digital notices to patients announcing the pending departure of doctors Paul Burns, Edith Dale, Charis Lee, Kelly Lisciandro and Jeffrey Vuillequez from the primary care practice, according to a copy of one of the notices obtained by The USA TODAY Network.

The doctors didn't immediately respond to phone calls and emails seeking comment on the situation. Rochester Regional noted two nurse practitioners — as well as other nurses and staff — will continue to provide services at the Linden Medical Group offices in Rochester in the notice.

The health network noted it looks "forward to sharing exciting details" with patients in the coming weeks regarding "the team of providers that will be delivering high quality care" to meet their ongoing health care needs, the notice added.

In a statement provided Wednesday to the USA TODAY Network, Rochester Regional said: "All physicians will continue to see patients at the Linden Medical Group practice through the end of the year." It added the network will then be replacing those physicians with other doctors from Rochester Regional Health.

What's next for Linden Medical Group doctors?

Several doctors are leaving Rochester Regional Health's Linden Medical Group to start a "retainer-based concierge medicine practice," the network said in a statement.

Patients of the doctors leaving Linden Medical Group took to social media to seek answers about their future health care, Joe Gonzalez, a patient of one of the doctors, said in a phone interview.

Those questions included a Facebook post that featured a photo of an apparent flyer that suggested several of the doctors will soon be affiliated with MDVIP — a Florida-based company that includes a national network of doctors serving a self-described alternative form of concierge medicine, according to its website.

Mental health: Rochester Regional Health fined $925K for failing to reopen 34 psychiatric beds

The flyer noted MDVIP is signing up members for the doctors in Rochester for a new practice opening in February. A woman who answered the phone number on the flyer said she works for MDVIP. She refused to give her name to a reporter and referred questions about the flyer to the company's corporate phone number.

MDVIP, which noted it charges patients a membership fee that typically ranges from $1,800 to $2,200 per year, did not immediately respond to questions about the matter.

What Rochester Regional says about Linden Medical Group

On Wednesday, Rochester Regional's statement noted several Linden Medical Group doctors made "a personal and professional decision to resign and create a retainer-based concierge medicine practice."

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The network added its staff is "actively contacting all patients to assist them in transitioning to other providers" within its 400-member network.

Patients can and should continue to call the Linden Medical Group office with medical questions, to make or change appointments, and to schedule their medicine refills, the statement noted, urging patients with questions about the transition to call (585) 922-9253.

This article originally appeared on Rockland/Westchester Journal News: Doctors leave Penfield's Rochester Regional Health office: What we know

Wed, 15 Nov 2023 02:39:00 -0600 en-US text/html
Linden Medical Group patients impacted by staff changes No result found, try new keyword!Patients at Linden Medical Group in Penfield are receiving notice about staffing changes at the facility. According to a statement from Rochester Regional Health, ... Mon, 13 Nov 2023 12:09:33 -0600 en-us text/html Questions Remain About Nirsevimab’s Impact

The new monoclonal antibody nirsevimab may radically change incidence and outcomes for respiratory syncytial virus (RSV) infections in young pediatric patients, especially when combined with the impact of the new RSV vaccine approved in pregnancy. However, many questions remain about the implementation of nirsevimab in the 2023-24 RSV season and its more long-term impacts.

Current impact of pediatric RSV

Dr. Shah

“RSV is the most common diagnosis pediatric hospitalists see over the winter months,” said Samir S. Shah, (@SamirShahMD), MD, MSCE, MHM, vice chair of clinical affairs and education at Cincinnati Children’s Hospital in Ohio, editor-in-chief of the Journal of Hospital Medicine, and pediatric hospital medicine and infectious diseases physician. “RSV typically occurs in infants and children less than two years of age, with the most severe illness occurring in infants less than six months.”

No direct treatment is available, but very young children with severe disease may require hospitalization for supportive care such as oxygen and intravenous (IV) fluids to prevent mortality. In most of the U.S., the RSV season runs from the beginning of October through the end of March.

Andrea R. Hadley, (@AndreaHadleyMD), MD, FAAP, FHM, is chief of acute care pediatric medicine at Cornell Health/Helen DeVos Children’s Hospital in Grand Rapids, Mich. She pointed out that pediatric RSV infections can significantly strain hospital resources and contribute to staff burnout, especially combined with the concurrent impacts of SARS-CoV-2 and influenza. She said, “Especially since COVID-19, pediatric inpatient beds and resources like pediatric nurses have been decreasing around the country for a variety of reasons. That has made it even more difficult for the children’s and community hospitals to handle these big surges of patients.”

Dr. Hadley

Until recently the only therapy available to help prevent pediatric RSV was the monoclonal antibody palivizumab. However, it has an onerous administration schedule, requiring five monthly shots. Because of this and its high price ($1,500 or more per shot), the American Academy of Pediatrics and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommended it only for those with certain preexisting medical conditions which put them at risk of poor outcomes from RSV, which is less than 5% of infants.1

Like palivizumab, nirsevimab is a monoclonal antibody, but one that clinicians can administer in a single shot. Like palivizumab, nirsevimab is not a vaccine in the traditional sense, in that it does not provoke active immunity. Instead, the monoclonal antibodies themselves provide fast-acting and direct protection against disease for at least five months.2 The recombinant long-acting monoclonal antibody binds the F1 and F2 regions of the RSV fusion protein, locking the protein in place and thereby blocking viral entry into host cells.3 

Russell McCulloh, (@RMcCulloh), MD, a professor in the divisions of hospital medicine and infectious diseases and vice president for research at the University of Nebraska Medical Center in Omaha, said, “Nirsevimab is much more effective in its binding than palivizumab, and consequently has better activity in reducing symptom severity. Based on studies looking at the anticipated effect on hospitalizations, it looks to be far more cost-effective than palivizumab.” A global trial showed that a single injection of nirsevimab reduced the incidence of RSV infections requiring medical attention by about 75% in otherwise healthy infants.3

Dr. McCulloh

Dr. McCulloh explained that because of these differences, the ACIP recommended that all infants born during RSV season receive nirsevimab, as well as infants less than eight months old when entering the season. They also recommended that older children, aged 8 to 19 months, also receive the vaccine if they are at risk for severe RSV disease.2 Dr. Shah also pointed out that nirsevimab has only shown mild adverse events in clinical trials, and that it had no differences in terms of serious side effects compared with palivizumab.

Dr. Hadley added, “The number needed to treat to prevent hospitalizations is in the 50s. So, if we can distribute it in the way we hope, that’s a lot of hospitalizations prevented, and that is going to have a huge impact on pediatric access to hospital beds and resources.”3

Nirsevimab implementation and availability

It’s unclear how widely health care practitioners will be able to deploy nirsevimab this season, but it will be covered under the federal Vaccine for Children Program (VFC), which provides vaccines at no cost to children who might not be vaccinated due to the inability to pay. The product is available at $395 via the VFC and for $495 through the private sector.4

Dr. Hadley said, “Some insurance companies have already said that they’re going to reimburse for it, but a lot haven’t yet. We’re waiting eagerly to hear that information.”

Dr. Hadley explained that ideally most eligible patients would receive nirsevimab at their primary-care home, and this will likely be how it is mostly administered in future seasons. However, she also pointed out that it may be financially challenging for some small practices to take on this uncertainty and financial risk, given that reimbursement for the current RSV season is still unclear.

“The great debate is how we can best get as many shots into kids across the country as possible,” she said. Some hospital systems may try to make nirsevimab available to qualifying patients, e.g., those born during the current RSV season, or perhaps to a subset of patients, e.g., higher-risk infants or those who qualify for the VFC program. Dr. Hadley speculated, “It may be that for a short window, we give it in the nurseries to try and get it to as many babies as we can until the private offices start ordering it.”

However, this will likely differ among institutions, and hospitals face barriers to practical implementation and reimbursement. Due to current payment structures, hospitals would not receive similar reimbursement for nirsevimab compared to current vaccinations given in the nursery such as hepatitis B.

Dr. McCulloh also pointed out that carrying costs for VFC could be very high for health systems outside of clinics, and it can be logistically difficult to manage VFC versus non-VFC administration. He suspects that most hospitals will not opt to stock nirsevimab, particularly those that don’t exclusively treat pediatric patients. Only 10% of birthing hospitals have traditionally participated in the VFC program.4

Supply issues have also been a challenge. Ordering through the VFC program was put on hold in October, although it is expected to resume with preference to providers who have not previously ordered. The maker of nirsevimab, Sanofi, reported higher-than-expected demand for nirsevimab, especially for the 100-mg dose, used for infants of 5 kg or more. This formulation is not currently available for ordering through Sanofi, and using two 50-mg doses instead has not been studied.4

“It’s going to be imperative that pediatric nursery and hospital clinicians work closely with their pharmacy and therapeutics committees to understand what’s going to be available, even if that’s not in the hospital, to maximize equitable access post-discharge from the nursery,” Dr. McCulloh said. “You’ve got to be able to provide some information to patients.”

Maternal RSV vaccine

Another complicating factor for systems administration is that the mother’s vaccination status must be considered. In September, ACIP recommended that pregnant women receive a dose of the new adult RSV vaccine (Abrysvo) at 32 to 36 weeks of pregnancy, giving at least some protection to infants for approximately three to six months after birth.5

According to guidelines from the American Academy of Pediatrics, infants whose mothers received an RSV vaccine should not receive nirsevimab unless the mother received it less than two weeks before delivery.2 Dr. Shah explained that trials showed a statistically nonsignificant difference in preterm births in pregnant people who received the RSV vaccine at 24 weeks or later, compared to placebo. Thus, out of caution, the current recommendation is to give the vaccine to the patient at 32 weeks to 36 weeks gestational age.6

“We know that the hospital is an opportune place to talk about vaccines for adults as well as children,” Dr. McCulloh said. “If you are seeing a pregnant adult, you should be surveilling for the COVID-19 vaccine, the flu vaccine, Tdap, the RSV vaccine. Because all of those are associated with the reduced risk for acute illness, disability, and death in pregnant people, and all have downstream positive impacts on their child’s risk of infection and illness.”

Looking forward

It’s unclear how the availability of these new products will affect the current RSV season. Dr. Hadley said, “We’re still going to see a surge. We’re forced to brace for the worst just because of so many unknowns.”

By fall 2024, more of the infrastructure for administering nirsevimab should be in place, such as order sets and decision aids for clinicians. In terms of implementation this season, health disparities are likely in terms of who gets access to nirsevimab, as more educated parents proactively seek it out. “Despite good solid efforts from public health officials and providers, I think this first rollout will be more inequitable and hitchy this year compared to next,” Dr. McCulloh said.

Even though nirsevimab is not a vaccine in the traditional sense, another potential barrier is vaccine hesitancy. However, Dr. McCullough notes that in his experience, patients have been more open to RSV vaccines compared to SARS-CoV-2, which has a less than 10% coverage rate in children under five years. He asked, “Is our coverage going to be around mid-40s like we see for seasonal flu? We’re not sure.”

Long term, it will also be important for health care systems to consider and plan for the potential impact of these new preventative measures on hospital volumes and income. Dr. Shah noted that the impact may ultimately be similar to that of the rotavirus vaccine, which has radically decreased what had been a relatively common hospitalization in infants.

“This is a good thing for individual children and their families, for the community,” Dr. McCulloh said. “For health systems, it may mean they have to watch this closely and adapt to changes moving forward.”

Ruth Jessen Hickman is a graduate of the Indiana University School of Medicine in Indianapolis. She is a freelance medical writer living in Bloomington, Ind.


  1. Jones JM, Fleming-Dutra KE, et al. Use of nirsevimab for the prevention of respiratory syncytial virus disease among infants and young children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(34):920-5.
  2. American Academy of Pediatrics. Nirsevimab frequently asked questions. AAP website. Updated October 26, 2023. Accessed November 3, 2023.
  3. Hammitt LL, Dagan R, et al. Nirsevimab for prevention of RSV in healthy late-preterm and term infants. N Engl J Med. 2022;386(9):837-46.
  4. Jenco MSupply issues plague nirsevimab ordering. American Academy of Pediatrics website. Published October 17, 2023. Accessed November 3, 2023.
  5. CDC Media Relations. CDC recommends new vaccine to help protect babies against severe respiratory syncytial virus (RSV) illness after birth. CDC Newsroom website. Published Sept 22, 2023. Accessed November 3, 2023.
  6. The American College of Obstetricians and Gynecologists, Ault KA, et al. Maternal respiratory syncytial virus vaccination: Practice advisory. ACOG website. Published September 2023. Updated October 10, 2023. Accessed November 3, 2023.
Thu, 16 Nov 2023 01:53:00 -0600 en-US text/html
Telemental Health Laws: 2023 Overview

Since 2016, Epstein Becker Green (EBG) attorneys have researched, compiled, and analyzed state-specific content relating to the regulatory requirements for professional mental/behavioral health practitioners and stakeholders seeking to provide telehealth-focused services.

We are pleased to once again release our latest update to EBG’s Telemental Health Laws app, an extensive compilation of laws, policies, and other state guidance for practitioners supporting the mental/behavioral health practice disciplines.

2023: Emerging from PHE Flexibilities, Changes Afoot in the States

Since EBG began tracking state telemental health laws in 2016, we have watched the gradual but steady pace of adoption by state professional boards across the mental/behavioral health professions of laws, guidance, and other policies related to the use of telehealth as a modality for providing care. States certainly have not lost their interest in and focus on regulating in this space! In 2023, a key focus by the states has been addressing questions about how to modify existing regulatory infrastructures sustaining the provision of telehealth services to support the continued use of these services in a post-public health emergency (PHE) world. Using pandemic flexibilities and waivers as a basis, states continued movement in 2023 toward making certain PHE-era policies and guidance permanent, illustrating that while states remain committed to supporting the use of telehealth services, regulators also are committed to ensuring these services are provided safely and effectively, and acknowledging that health care professionals need and want a clear regulatory framework within which to operate. Some states took action by replacing pre-PHE telehealth laws entirely, while other states set forth to create brand new parameters and requirements not previously addressed.

May 2023, the official expiration of the PHE, was a significant turning point for states. The telehealth industry scrambled to understand what the post-PHE regulatory environment would look like and, in turn, relied on regulators for guidance and support. At the federal level, passage in December 2022 of the Consolidated Appropriations Act of 2023 ensured an extension of many federal telehealth flexibilities until December 31, 2024, which has provided certain assurances with respect to coverage parameters for providing telehealth services to Medicare beneficiaries (including a continued delay of the initial and periodic in-person visit requirements for telemental health services). Telehealth providers also have benefitted from an extension of the waiver by the U.S. Drug Enforcement Administration regarding the remote prescribing of controlled substances.

What trends emerged in 2023 among the states? EBG’s Telemental Health Laws app is a useful tracking tool for providers to help understand state-by-state changes and developments. In 2023, many states have continued to push the boundaries of existing telehealth policies. Yet, no two states are exactly alike in their approach to defining and regulating telehealth. Rather, individual states continue to take their own unique approaches to creating and refining the legal and regulatory framework through which professionals are expected to operate.

2023: Continued Recognition of the Benefits of Telehealth

In 2023, we have observed how state professional boards are taking a closer look at how to regulate certain specific needs and circumstances related to telehealth-based care models. For example, states have focused significantly on questions around the use of telephones and other audio-only modalities and the question of whether practitioner-patient relationships established solely via these modalities can be considered “valid” telehealth encounters that meet professional standards of care. This is an important consideration for professionals in the mental/behavioral health space, where verbal communication is essential to forming, functioning in, and maintaining practitioner-patient relationships. States also continue to focus on questions around remote prescribing, again wanting to ensure that, despite the greater use of telehealth, prescriptions are still issued only through valid practitioner-patient relationships. Furthermore, 2023 has also seen significant activity by state Medicaid programs and specifically efforts by the states to expand coverage and reimbursement for the types of telehealth-based modalities, providers, and services that can effectively serve the Medicaid populations in these states.

2023: More Focus on Telefraud and Enforcement

As was the case throughout 2022, efforts have continued in 2023 by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) to identify and prosecute “telefraud” schemes. In June 2023, the DOJ announced the agency’s latest takedown that resulted in criminal charges against 78 defendants for alleged participation in health care fraud and opioid abuse schemes resulting in more than $2.5 billion in alleged fraud. The DOJ confirmed that as part of the June 2023 takedown, charges against 11 of the defendants were filed in connection with the submission of more than $2 billion in fraudulent claims resulting from telemedicine-related schemes.

While the OIG did not release any new guidance in 2023 along the lines of what the agency published in 2022, there is still undoubtedly a focus by the OIG on telehealth. As of November 2023, current open items in the OIG Work Plan include ongoing work on audits related to the use of telehealth for the provision of opioid-use disorder treatment services and the provision of home health services, as well as examination of claims and other data related to the general use of telehealth services by Medicare Part B beneficiaries and telehealth-related expansion efforts by state Medicaid programs during the PHE.

Ongoing enforcement actions and program integrity activities at the federal level illustrate that providers of telehealth services must remain vigilant about tracking and ensuring compliance with the applicable legal requirements related to providing telehealth services from both a policy and operations perspective. The priorities of the DOJ and OIG should also motivate telehealth providers to continue prioritizing the development and integration of robust operational compliance infrastructures. Providers should expect to see continued efforts at both the federal and state levels with respect to enforcement and likely coordination between federal and state regulators on these issues.

2023 Trends: General Telemental/Telebehavioral Provisions Across the States

With so much variation across states in the legislative and regulatory priorities, it can be difficult to spot the patterns and trends, but some always emerge, and 2023 is no exception in this regard. Following historical trends, much of the state-level regulatory guidance on telehealth services continues to focus on physician-provided services. However, state boards regulating other types of professionals have also continued efforts to develop comparable parameters and guidance, especially for mental/behavioral health professionals, such as psychologists, social workers, counselors, and therapists.

Across many of the health professions, interstate compacts have persisted as the most meaningful approach by states to address challenges associated with professional cross-state practice. While all states require physicians and other health care professionals to hold valid licenses to practice that have been issued by the state’s relevant professional boards, interstate compacts have allowed specific types of professionals to engage in cross-state practice provided they hold a license in good standing in their home state. EBG’s 2023 Telemental Health Laws update highlights the ongoing efforts by states to join one or more of the professional licensure compacts. As of November 2023:

  • 37 states, the District of Columbia, and the territory of Guam are members of the Interstate Medical Licensure Compact (for physicians);
  • 41 states have enacted the Nurse Licensure Compact (for registered nurses and licensed practical nurses);
  • 40 states have enacted the Psychology Interjurisdictional Compact (PSYPACT);
  • 30 states have enacted the Counseling Compact, and applications for Counseling Compact privileges to practice are expected to open in 2024; and
  • two states have enacted the APRN Compact, which only goes into effect once seven states have enacted the legislation. Notably, the number of states has not changed since last year.

Another continuing trend in 2023 has been states creating exceptions to their professional licensure requirements for specific types of professionals and specific circumstances where cross-state practice may help to support pre-existing relationships between professionals and their existing patients. This is a long-standing challenge and regulatory consideration for professionals in the mental/behavioral health space, and the exceptions are to help support their patients who travel and spend time outside their home states for school and other temporary travel reasons. Here are some examples of exceptions:

  • Alabama allows physicians licensed in other states to provide services to patients in Alabama without a license on an irregular or infrequent basis, defined as less than 10 days per calendar year or 10 patients per calendar year.
  • Washington State created an exception available to patients seeking second opinions from out-of-state specialty providers, such as cancer centers, or accessing providers in their home state while temporarily traveling within Washington State for the intended purpose of ensuring continuity of care.
  • Other states have created exceptions through telehealth registration processes that allow out-of-state professionals to operate via telehealth by completing a registration with the state’s professional boards (where available), agreeing to certain terms and conditions, and paying a registration fee. An example of a state with such an out-of-state registration process is Florida.

Another important trend among states in 2023 has been the evolution of guidance on remote prescribing practices. Generally, many states have gradually allowed licensed physicians (and other professionals for whom prescribing is within their scope of practice) to prescribe non-controlled substances via telehealth. Over time, states adjusted this guidance to permit these professionals to prescribe remotely without requiring that the provider conduct a prior in-person examination, allowing instead for the necessary examination to occur via telehealth. Although the in-person examination requirements imposed by states have become more flexible and accepting of telehealth, states have maintained expectations that these encounters meet the standards set by states and their professional boards regarding appropriate clinical standards of care. In 2023, continued activity in states has focused on creating more specific practice standards for remote prescribing. Often, states maintain two separate policies, one addressing non-controlled substances and a separate one addressing controlled substances (and often deferring in this latter instance to the federal standards set by the Controlled Substances Act). A related trend that has continued in 2023 is states creating remote prescribing policies that are specific to certain types of treatment, such as substance use disorder.


Telehealth providers will invariably face certain legal and regulatory complexities because of the end of the PHE, so it remains important that providers track the evolution of state laws, policies, and other guidance to ensure operations remain compliant with the changing standards being set by states. At the same time, the increased use of telehealth has put a much greater focus on the potential for fraudulent behavior and the need for enforcement activity. For this reason, telehealth providers also have an ongoing responsibility to make investments in compliance infrastructures to operate in accordance with applicable laws.

[View source.]

Thu, 09 Nov 2023 10:01:00 -0600 en text/html
Village’s public health director shares early details on new bipoc resident survey

When Dr. Theresa Chapple-McGruder was first hired as the public health director for the Village of Oak Park in May 2021, she came into the job with a singular mindset: Keep people alive. 

With the height of the COVID-19 pandemic now behind her, Dr. Chapple has set her sights on keeping people alive in a different way — by creating a survey.

Chapple, along with the village’s epidemiologist, Emma Betancourt, are working together to create the first in a series of community-focused surveys that will, in part, help determine the factors impacting Oak Park’s Black and BIPOC residents’ health outcomes. 

Chapple explained when she first began working in the Oak Park Department of Public Health, there wasn’t an epidemiologist on staff nor any data about chronic diseases, maternal health, or environmental health hazards. She said the only data available was for communicable diseases such as STIs and HIV.

“One of my major goals in 2022 was to go to our village board and ask for funding to do an annual health survey and hire an epidemiologist to lead the survey and analyze the data,” Chapple said. 

“We were given that funding to start our 2023 and we are 10 months into that year. The hope is that we can get this survey off of the ground and start collecting data on the prevalence of diseases and be able to look at that data by race, age, gender, so we can get a full understanding of what the community needs are.”

Chapple told Growing Community Media that Betancourt was hired in August 2023 after the Village received a $350,000 grant through the Strengthening Illinois Public Health Administration for three years from the Illinois Department of Public Health grant on July 1, 2023. 

“I am an epidemiologist by training but I always like to say I am not the Village’s epidemiologist, I am the Village’s health department director. I can’t do two jobs,” she said.  

“In the time that we didn’t have an epidemiologist, I was able to work with outside consultants to help design the health survey. So as soon as Emma joined our team, she was provided with the health survey and her job is now to deploy it in the community to get us back data as quickly as possible so that we can start to make recommendations based on it.” 

Lee Edwards, a Growing Community Media contributing reporter, recently sat down with Chapple to talk about the new initiative.

This is a condensed version of the conversation. It has been edited lightly for space and clarity.

Growing Community Media:  With regards to the survey, is it based just on health outcomes? Is it necessary to have community or residents’ input as part of that survey’s creation? 

Chapple: That’s a good question. We did not have community input in this round of survey development, but we did talk about different ways to get community input. And so, our plan right now is to have the survey as a base, and then share the results with the community and say, “Does this resonate with you? Did we ask the right questions? Are there different things that we should have been getting from you?” Help us with the context with the numbers that we have. There’s two different approaches: you can go to the community with nothing and ask for something or you can go to the community and ask how well did we do it. That’s the approach we ended up with. 

Growing Community Media:  What is the timeline for the survey that is informed by science? 

Chapple: If I had my way it would have been yesterday. I am hoping to get it done in 2023, but I would not be shocked if it went out in the first quarter of 2024.

Growing Community Media:  What is a reasonable expectation the public should have for these reports and surveys? How much time and resources does it take to complete these kinds of reports? 

Chapple: Good data takes time. When we’re really thinking about what it’s going to take for us to have good data on the health of the community, I would not think that a one-time data annual survey is going to give us information. Once we get the data from the survey, we want to take it to the community and see if it resonates with them, to see if there’s a different way that they would have preferred us to ask this question, things like that. I really see this first year as being kind of a feedback loop with the data in the community. And then year two, really tweaking the survey based off of what we found from year one. And then once we have two years’ worth of data points, we can start to say, are we getting consistent data, or do we think that one year was a fluke? And then we have three years’ worth of data that’s a trend and based on trend data, you make your program based on everything you’ve learned. 

Growing Community Media: When you think about all this work that’s necessary, is the village able to provide enough resources to make sure that all those goals stay on track?

Chapple: The village has agreed to an annual health survey as part of our budget. We are in our budget cycle right now. And this would be the second time that an annual health survey is in our budget. The budget gets presented now for the following year. So, for 2024 we have asked for the second annual health survey to be in there. The health department has found external funding to support an epidemiologist. So we have three years where epidemiologist salaries are covered based on external support.

Growing Community Media:  Have you received support for these efforts from the board of trustees and the village president?

Chapple: I think since it’s so new, I think it’s kind of waiting to see what happens with this. I haven’t gotten any opposition to it. But this isn’t an aspect of healthcare that people are talking about because we’re just so new and getting up and running.

Growing Community Media: As part of this survey, will racism be viewed as a public health issue as well as low income or any other societal issues?

Chapple: I totally believe that racism is a public health issue and I believe that poverty makes people sick. That’s just the kind of the things that I bring with me as I’m running the health department. What the questions and surveys will focus on more are more around social determinants of health as well as the current health status. So yes, there will be questions about age and income and experiences that people face as a result of how they present to the world. What comes out of it is what it could be up to the data, and it won’t be skewed by my preconceived values, but questions will be in the survey and will pick the results as they come. 

Growing Community Media:  What does that look like to rebuild the health department three years after the pandemic?

Chapple: Challenging. It’s challenging on all levels, I would say.  One of the challenges is the workforce. The pandemic has been extremely tough for public health practitioners to work in. All in the news throughout the pandemic you heard about health department officials being harassed and all that. So, it’s really hard to say to people to come work in the health department if they know that they have the potential for harassment. The public health workforce has a turnover rate similar to police. Yet many people talk about what’s happening and how hard it is to recruit for the police. But you don’t hear that similar refrain when it comes to people talking about the need for good public health practitioners. There’s also the situation of public health that has kind of been overlooked for many years. Public health has been underfunded for as long as public health has existed. And we see that that’s a problem whenever a big issue comes.

Growing Community Media:  How does that make you feel about the work that you’re doing, especially since a portion of the work is focused on helping people from underserved portions of the community as well as people from bipoc backgrounds or different sexual orientations?

Chapple: I have been in public health since 2000, so 23 years doing this work. It is my jam. I am dedicated to the health of the population and will always continue to fight for it in good times and bad times. 

Mon, 13 Nov 2023 06:27:00 -0600 en-US text/html

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