American College of Physicians: Internal Medicine — Doctors for Adults ®


Mandate puts e-prescribing on front burner

From the September ACP Internist, copyright © 2008 by the American College of Physicians

Janet ColwellThe government got serious this summer about pushing doctors toward using electronic health records (EHRs). Ready or not, physicians must start e-prescribing over the next few years or eventually face penalties, according to a mandate written into new Medicare legislation passed by Congress in July. But as Ryan DuBosar reports of this issue, most primary care physicians—many of whom are already struggling to keep their practices in the black—still can’t afford to make the switch.

Cost is a major barrier to adopting e-prescribing for many physicians, especially since experts and physician groups (including ACP) advise that only a fully functioning EHR can deliver the promised patient safety and efficiency benefits of electronic prescriptions. However, going completely paperless can cost up to 10 times as much as purchasing a standalone e-prescribing package. One option is to hook up with hospitals, many of which are offering discounted EHRs to physicians in their communities. That idea sparked discussion on ACP Internist’s blog. recently, with comments ranging from wholehearted support of e-prescribing to concerns about patient privacy and off-label prescribing. You can read the comments and post your own.

Also, Jessica Berthold reports on the challenges of diagnosing and treating post-traumatic stress disorder (PTSD) in returning war veterans. Many PTSD sufferers slip through the cracks of the military health service for a variety of reasons and end up in the private sector, if they seek treatment at all. Recognizing red flags and asking questions during a primary care visit can be the key to uncovering PTSD in patients who are often reluctant to discuss mental health issues. The story offers tips on how to screen for PTSD, as well as experts’ tips on recognizing symptoms and initiating treatment.

Many of you have sent case study suggestions for the Mindful Medicine column by Jerome Groopman, FACP, and Pamela Hartzband, FACP. In this issue, our columnists consider a case submitted by Moshe Chasky, ACP Member, concerning a 50-year-old man with chronic lymphocytic leukemia who was mistakenly diagnosed with fibromyalgia. The handling of the case illustrates how “diagnosis momentum” can cloud the path to a right diagnosis, according to Drs. Groopman and Hartzband. Read the analysis on the next page. And please continue to send your case study suggestions for future Mindful Medicine columns to

Our coverage continues online. Visit our Web site at or our blog at for current news and discussions on important issues affecting internal medicine. Your feedback and suggestions are always welcome. E-mail us at

Janet Colwell
ACP Internist


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