Clinical Documents

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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Course: Should Licensing/Credentialing Organizations Inquire About Clinicians' Past Mental Health?

CME Credits: 0.00

Released: 2023-05-02

To earn full credit for this activity, you must review all accompanying resources, which have been curated to support your learning of the subject matter.
The Myth
The Joint Commission and the Federation of State Medical Boards (FSMB) require that medical licensing boards, credentialing bodies, and professional liability insurance carriers ask applicants about any past history of mental illness or substance use disorder on licensure, credentialing and other applications.
Debunking the Myth
Neither The Joint Commission, nor the FSMB, require that licensing and credentialing organizations such as state licensure, physician credentialing services, and professional liability insurance carriers ask probing questions about clinicians' past mental health, addiction, or substance use history on licensure and credentialing applications. Rather, they strongly encourage them to refrain from including these types of questions when collecting professional information from clinicians for credentialing, privileging or other purposes.
Despite a growing body of evidence demonstrating that asking questions about mental health, addiction, or substance use history on licensing and other applications deters physicians from seeking care, several state medical license applications and credentialing applications continue to ask these questions.,
For state medical boards that prefer to include questions that address physicians' mental health to elicit information intended to protect patients, the FSMB advises that they do so in ways that (1) limit inquiries to current impairments and (2) don't discourage physicians from seeking out treatment., Further, the FSMB recommends that these organizations avoid public disclosure of a physician's diagnosis and offer non-reporting options to physicians who are receiving treatment and in good standing with a recognized physician health program (PHP) or other appropriate health care professional.
AMA Policy
Resources
Federation of State Medical Boards (FSMB). Physician Wellness and Burnout: Report and Recommendations of the Workgroup on Physician Wellness and Burnout.; 2018. Accessed December 8, 2022.
The Joint Commission. Joint Commission Reiterates Importance of Removing Barriers to Mental Health Care for Staff. Published online March 31, 2021. Accessed November 15, 2022.
Dr. Lorna Breen Heroes Foundation. Improving Licensure & Credentialing Applications. Dr. Lorna Breen Heroes Foundation. Accessed November 15, 2022.
All In: Wellbeing First for Healthcare, Dr. Lorna Breen Heroes Foundation. Remove Intrusive Mental Health Questions From Licensure and Credentialing Applications: A Toolkit to Audit, Change, and Communicate.; 2022. Accessed November 15, 2022.
Saddawi-Konefka D, Brown A, Eisenhart I, Hicks K. Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health. JAMA Network. 2021;325(19). Accessed November 15, 2022.
Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele DV, Shanafelt TD. Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions - Mayo Clinic Proceedings. Mayo Clinic Proceedings. 2017;92(10):1486-1493. Accessed November 15, 2022.


Learning Objectives
1. Describe the myth or issue that impacts physicians and their care teams
2. Explain how state licensure, physician credentialing services, and professional liability insurance carriers should frame questions about clinicians' mental health, addiction or substance use history on licensure and credentialing applications


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