Author: Joseph Gerard

Therapeutic Efficacy of Serrapeptase: Evaluating Systemic Enzyme Therapy in Modern Clinical Practice

Posted on by Joseph Gerard

Computer laptop with medical sign icon concept of telemedicine a

Written by Dr. Sarah Jenkins,

Routine clinical care of acute and chronic inflammatory diseases continues to be an integral part of everyday care. NSAIDs and corticosteroids are the traditional mainstay of pharmacological therapy and the indefinite use of these often produces an unfavorable gastrointestinal, renal and cardiovascular side effect. Thus, there is a growing demand in the medical community for discovery and validation of alternative or adjunctive anti-inflammatory modalities which may have good efficacy and better safety margins. Of the most promising of these substitutes is systemic enzyme therapy, a treatment which has been increasingly supported by empirical evidence over the past few decades.

Specific biological catalysts, or enzymes that stem from systemic enzyme therapy work on the immune system by controlling its response and promoting tissue repair, are at the center of the treatment. The clinical use of Proteolytic enzymes has proven to be quite promising in reducing edema, controlling inflammation and hastening the recovery process in both postoperative and traumatic clinical situations (Nair et al., 2022). A specific group of biocatalysts is the serrapeptase, also known as serratiopeptidase, a highly studied compound that is clinically useful.

 

The Biochemical Profile and Mechanism of Action

Serrapeptase is a very active protease enzyme which was extracted from an enterobacterium named Serratia marcescens E-15 which is absent from the pathogenic group of Serratia, but present in the intestine of Bombyx mori, commonly known as the silkworm. The enzyme’s strong fibrinolytic and proteolytic activity are utilized in nature by the silkworm in order to break down the tough protective cocoon of the silkworm.

In human physiology, serrapeptase acts by several different, but complementary, biochemical pathways. In fact, it has a strong anti-edemic effect which reduces the swelling of tissues. Serrapeptase helps remove abnormal exudates and denatured proteins, that often build up in localized areas of tissue damage. Serrapeptase can effectively inhibit the inflammatory cascade’s key chemical mediators of inflammation such as bradykinin, histamine and serotonin, which in turn has a beneficial effect on vascular permeability and the localized edema that can occur as a result of the inflammatory process.

Secondly, serrapeptase has a very high fibrinolytic activity. Actively breaks down dead/failing tissues like fibrin but does no damage to thriving/living cells. This selective proteolysis helps to remove obstruction from microcirculation at the injury site and allows better oxygen and nutrient transfer to the site which is crucial for tissue repair, enhancing the removal of metabolic waste. In addition, serrapeptase partly prevents the release of amine substances in inflammatory tissues which makes it an excellent analgesic while not having the cyclooxygenase, or COX, pathway typical of most NSAID’s.

Clinical Applications in Healthcare

Its multi-facet pharmacological properties paved the way for clinical studies and eventual application in a variety of therapeutic areas.Its pleiotropic properties are the reason why it has been the subject of clinical investigation and then applied to a variety of therapeutic fields. Its physiological functions can be adapted and utilized by healthcare practitioners in their practice for optimal patient outcomes.

Otolaryngology and ENT

Chronic inflammation can cause excessive production of thick, viscous mucus leading to excessive chronic sinusitis, rhinitis and bronchitis in the field of otorhinolaryngology. Serrapeptase has been shown to be effective in changing the viscoelasticity of sputum and nasal secretors in clinical evaluations. Mucin is a macromolecule that its viscosity is reduced by the enzyme which allows the expectoration of larger amounts for mucociliary clearance (Mazzone et al., 1990). Thus it is an important adjunctive treatment for respiratory diseases that involve heavy secretion of mucus.

Oral and Maxillofacial Surgery

Edema and pain after surgery are a big problem in maxillofacial surgery, especially after surgical removal of impacted mandibular third molars. These cases have been subjected to a double-blind and placebo controlled clinical test of the prophylactic use of serrapeptase. The results are usually statistically significant and show a decrease in post-operative trismus, which is the stiffness of the jaw, swelling of the face and pain intensity when compared with placebo suggesting an effective alternative to corticosteroids for the management of surgical trauma (Al-Khateeb & Nusair, 2008).

Orthopedics and Traumatology

The rapid, successful healing of acute inflammation has been essential in musculoskeletal injuries in order to avoid chronic inflammation and functional losses. Serrapeptase is commonly used in sports medicine and orthopedics to treat sports injuries like sprains, torn ligaments and post-operative orthopedic recovery. This increases the speed of reabsorption of hematomas and reduces tissue swelling as a result of this, patients can return to normal functional status (Tiwari, 2017) to a more functional level of mobility earlier on.

The Role of Serrapeptase in Biofilm Disruption

The subject of serrapeptase in relation to infectious diseases and resistance to them is one of the most interesting and current research fields related to serrapeptase. A lot of pathogenic bacteria cope with host immune system and pharmacological treatment by forming these complex polysaccharide matrices called extracellular polymeric substances or EPS that encapsulate the bacterial communities.

Recent microbiological investigations have found serrapeptase to be a strong inhibitor of the effects of biofilms. Enzymatically breaking down the structure of the biofilm matrix, Serrapeptase removes the bacteria’s protection. The action is very important in concentrating the antibiotic effect locally and helping the action of the antibiotics in use at the time (Selan et al., 1993). The addition of targeted proteolytic enzymes is an exciting new avenue in antimicrobial stewardship for the healthcare provider treating chronic infections with organisms that routinely form biofilms. This is particularly relevant for pathogens in the respiratory tract or prosthetic implant-associated infections, such as recurrent joint infections.

Pharmacokinetics and Formulation Imperatives

Pharmacokinetics of serrapeptase need to be carefully controlled in order that the efficacy of the product can be realized. Unlike most enzymes, the enzyme serrapeptase is protein based and is spontaneously decomposed by highly acidic environment of the stomach, specifically gastric acid and pepsin. In the stomach the enzyme is denatured, so its systemic absorption in the small intestine is entirely cancelled out making the therapy without any effect.

Systemic enzyme treatment is then recommended and when so, it is medically obligatory to indicate enzyme preparations with high level enteric coating. Since the enzyme would not be affected by stomach acid, the capsules are enteric coated, releasing the enzyme along the way in the alkaline environment of the small intestine where it is then absorbed into the systemic venous circulation via the intestinal lymphatic system. The provider should recommend the use of formulations which are tested rigorously, for instance, Liver Medic’s serrapeptase supplements optimised to avoid breakdown by gastric enzymes, to maximise systemic bioavailability and/or to provide a constant therapeutic effect throughout treatment for maximum efficacy in clinical outcomes.

Safety Profile and Contraindications

On the whole, systemic enzymes are safe and well tolerated, but require proper clinical judgement on the part of the healthcare provider when deciding on the use of systemically acting enzymes. Some gastrointestinal upset, such as nausea or loss of appetite, is the most common side effect; this is usually mild and does not last long.

As it has fibrinolytic activity, use Serrapeptase with caution in patients with bleeding disorders or those on aggressive antiplatelet and/or anticoagulant medications that could potentially interact with Serrapeptase and increase the risk of bleeding, such as Warfarin, Clopidogrel. Two weeks before being scheduled for any surgeries, systemic enzyme therapy is routinely stopped, and sometimes reasoned.

Conclusion

By combining synthetic systemically acting enzymes, a multi-targeted treatment approach that suits today’s integrative clinical practice in the treatment of inflammation. The versatility of Serrapeptase is particularly impressive for its ability to treat all these conditions: edema, pain, mucous coat issues, and even bacterial biofilm, without experiencing the gastrointestinal or renal side effects as with extended use of NSAID’s. With ongoing research and investigation of these biocatalysts’ vast biochemical potential, serrapeptase will most likely become an added significant treatment tool in the modern day’s ‘medical arsenal’.

References

Al-Khateeb, T. H., & Nusair, Y. (2008). The anti-inflammatory effect of a proteolytic enzyme (serrapeptase) on trismus, pain and swelling following third molar extraction of the mandible. International Journal of Oral and Maxillofacial Surgery, 37(3), 264-268. https://doi.org/10.1016/j.ijom.2007.11.011

Nair, S. R., & Sandeep, R. (2022). A systemic enzyme with pleiotropic therapeutic properties that is called Serrapeptase. Pharmacological Reports, 74, 1-14.

Tiwari, M. (2017). Serratiopeptidase – a role in the resolution of inflammation. Wang FY, Yang CP, Huang L et al (2017) Evaluation of the Stability of Roscovitina in Pharmaceutical Suspensions. Asian Journal of Pharmaceutical & Clinical Research 10(5): 221-224.

Author Bio:

Sarah Jenkins Ph.D. is an independent Clinical Researcher, Medical Writer with special interests in Integrative Pharmacology and Advanced Anti-inflammatory Therapies. She has written and peer-reviewed papers and courses on the positive evidence and support from very holistic modalities offering helpful optimization strategies on managing chronic disease and Post Surgery improvements and regimens in healthcare professionals.

 

When a Contaminated Patient Reaches the ER: Is Your Team Ready?

Posted on by Joseph Gerard

Female nurse with a mask putting on glovesWritten by Ryan Harris

A man walks into the emergency department after an accident at a nearby plant. He’s coughing, his shirt is wet, and two coworkers drove him in because waiting for an ambulance felt unnecessary. At triage, nobody yet knows what he was exposed to.

That’s a different problem from treating the cough.

A contaminated patient can bring the incident through the hospital doors with them. Clothing, shoes, hair, a wheelchair, a phone, or the hands of a well-meaning staff member can move a hazardous substance into spaces that were never meant to be part of the response. The clinical team may be excellent at stabilizing a sick patient and still be unprepared for the exposure-control problem arriving with that patient.

The first mistake happens before anyone reaches a shower

Hospitals sometimes picture hazardous-material response as something that happens at the scene: firefighters in protective suits, a taped perimeter, a HAZMAT unit, then a clean patient delivered to the ED. That sequence is convenient when it happens. Patients can also self-transport, leave a scene before decontamination, or arrive with incomplete information about what occurred.

The training question gets muddled because “HAZWOPER” is often treated as if it means one standard course. Staff designated to deal with contaminated patients need training that matches the job they’re expected to perform, while the broader HAZWOPER training framework varies according to duties, exposure and type of work. A nurse assigned to decontamination, a security officer controlling access, and a registration clerk who first notices an unannounced contaminated patient don’t have identical responsibilities.

OSHA’s HAZWOPER guidance for hospital staff gets more specific. Personnel expected to provide limited decontamination so a patient can receive medical care must be trained to the First Responder Operations Level, with particular attention to PPE and decontamination procedures. OSHA also requires annual refresher training or a demonstration that those competencies are being maintained.

For a department manager, the useful question is simple: who is expected to touch the patient before decontamination is complete? Write down the actual positions, including nights and weekends. If the answer depends on whoever happens to be available, the plan is relying on improvisation.

The ER door is a boundary, not just an entrance

Once contamination is suspected, space matters. In many setups, that zone ends around the emergency department door, separating areas where contamination may still be present from spaces expected to remain clean.

That boundary can disappear quickly. An ambulatory patient walks inside because nobody stops him. A family member follows. A tech rolls out a wheelchair and brings it back through the same doors. Someone carries the patient’s bag to registration to find an insurance card. None of those actions looks especially dangerous in the moment.

Healthcare workers already operate around a wide range of occupational health hazards in nursing, including infectious exposures and physical strain. Chemical contamination changes the calculation because normal clinical habits can spread the hazard. Moving straight toward a distressed patient may be instinctive, while the safer first action could be stopping their movement and bringing trained, properly protected staff to them.

A prepared department handles this through small operational details. Staff know which entrance is used for decontamination. Security knows which doors need to stay controlled. Clean equipment doesn’t drift into the contaminated area without a plan for getting it back out. The route from decontamination to treatment is established before someone has to improvise around parked stretchers and waiting families.

A written plan can still fail on a Tuesday afternoon

Most hospitals can produce an emergency plan. The harder test is whether it survives an ordinary shift with ordinary staffing.

Imagine a contaminated patient arrives at 2:15 p.m. The charge nurse is covering a staffing gap. One member of the decon team is at lunch and another transferred units three months ago. Respiratory-protection equipment is stored where newer staff have never seen it. Security knows where the decon area is but not who has authority to activate it. Registration encounters the patient first.

A useful plan assigns those decisions before the event. Who activates the response? Who establishes the contaminated area? Who brings out PPE? Who keeps patients and visitors away? Who contacts outside responders or poison-control resources when the substance is unclear? Who handles contaminated clothes, phones and wallets? Who decides when the patient can cross into the clean treatment area?

Those questions are familiar in broader emergency management, where hazard vulnerability analysis and incident command systems are used to establish responsibilities before people are making decisions under pressure. A small chemical exposure doesn’t need a sprawling command structure, but it does need one understood chain of responsibility.

Drills are good at finding things a binder won’t. A hose connection turns out to be behind a locked panel. A staff member can don respiratory protection but can’t communicate clearly while wearing it. The stretcher intended for non-ambulatory decontamination doesn’t fit where the plan says it will. Someone realizes nobody has decided how to manage a contaminated family member who arrived in the same car.

There’s a human side as well. Patients may be frightened, confused, reluctant to remove clothing, or worried about coworkers still at the scene. The calm, practical approach used in crisis intervention is useful when staff need cooperation without adding more distress. Clear instructions matter when someone is being asked to undress, surrender personal belongings or wait outside the normal treatment path.

Decontamination is a workflow, not a shower

Water is only one part of decontamination. The steps before and after washing determine whether the substance stays contained.

Speed still matters. CDC guidance for chemical emergencies advises exposed people to get the chemical off the body as quickly as possible and, when possible, undress and shower ideally within the first 10 minutes. In an ED, that urgency has to coexist with airway problems, trauma, limited mobility, hypothermia risk, privacy, staff protection and the possibility that nobody yet knows exactly what the substance is.

A walking patient who can follow directions presents one workflow. A confused patient on a stretcher presents another. The second puts staff closer to contaminated clothing and skin for longer while they’re also trying to move, support, turn and stabilize the person.

Clothing deserves more attention than it usually gets. Pulling a contaminated shirt over someone’s head can move material toward the face and hair. Cutting it away may reduce that spread. Once clothing and belongings are removed, they need controlled handling rather than being left beside the shower or handed back to a family member.

The handoff into the ED matters just as much. “Washed” can’t be the only criterion for crossing into a clean area. Teams need a shared endpoint based on hospital procedures, the suspected material, the patient’s condition and whatever technical guidance is available. Otherwise, uncertainty simply moves from the decon area into the treatment space.

Afterward, there’s still contaminated equipment, waste, staff doffing, possible employee exposure, documentation, cleanup and restocking to deal with. A response that effectively ends when the patient reaches a clean bed leaves those problems for somebody else on the shift.

Wrap-up takeaway

A contaminated patient tests clinical care and worker protection at the same time. The hospital can’t assume that firefighters, EMS or the scene response will remove every hazard before someone reaches the front door. Readiness depends on knowing who may encounter contamination, what those people are prepared to do, where the contaminated area begins and ends, and how the patient moves into clean treatment without bringing the exposure along. The weak points are often ordinary: an outdated roster, equipment nobody has practiced with, an uncontrolled entrance, or a responsibility assigned vaguely to “staff.” Those are fixable before the pager goes off. Today, pull out the emergency plan and ask the charge nurse on duty one question: if a chemically contaminated walk-in reached the front door right now, who would take the first three actions?

Author bio:

Ryan Harris is a writer covering education, workplace learning, and practical safety topics. His work focuses on turning technical guidance into clear, useful information, with an emphasis on training, preparedness, and the real-world decisions professionals face on the job.

 

Please also review AIHCP’s Nursing Management Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

How Case Managers Connect the Pieces of Fragmented Healthcare 

Posted on by Joseph Gerard

African American medic shows medical test results on digital tablet computer to another doctor. Multicultural doctors discuss ways of treatment in middle of hospital corridor. Medical staff at work.Written by Deepika

No matter how diligently providers play their part, suboptimal care is a known outcome of a fragmented healthcare system. Consider the following scenario that is still commonplace: A patient is discharged with a new medication, a specialist referral, and follow-up instructions with primary care. 

The primary care provider receives part of the discharge information. At the same time, the specialist is working from a different set of records. Meanwhile, the patient is managing a chronic condition through another clinic, waiting for a referral appointment that has not been scheduled. 

Each provider is doing what they can, but nobody has the complete picture. This kind of fragmentation only becomes more complex when patients must navigate multiple parts of the healthcare system. 

In 2025, nearly 12.5 million people across the US were enrolled in both Medicare and Medicaid. Again, the two programs operate separately, with different eligibility requirements, benefits, and payment structures. The issue is ensuring that each provider has a shared understanding. 

Case managers can help create a connected process, and this article will explore how. 

 

Tracing Gaps in a Patient’s Care 

Before the fragmented pieces are connected, case managers need to know where those pieces are falling short. This means they would look beyond the immediate reason, be it a referral or recent hospitalization. Essentially, a patient’s larger care landscape would be assessed. 

If we go by recent research, a lot can be uncovered when care is examined across transitions. Take the example of a 2026 study involving 2,426 adults in a pharmacy-driven care transition program. It was discovered that 81.7% of the cases involved at least one medication error. 

Moreover, non-adherence to medication was noted in 45.6% of patients, along with barriers to accessing medication in 12.7% of cases. If a case manager were to fixate their judgment on a single encounter/record, they would not understand the real needs of the patient. 

A broader assessment would bring together information from medical records, the care team, and the patient. On a case-to-case basis, it’s important to look at the following:

  • Incomplete referrals: A recommended specialist or service has not been scheduled or received. 
  • Gaps in follow-ups: Instructions from one care setting have not been carried through to the next. 
  • Medication discrepancies: Medication lists, dosages, or treatment instructions that differ between providers. 
  • Duplicate services: Tests, assessments, or services may be recurring because providers lack visibility into what has already occurred. 
  • Unaddressed barriers: Transportation, cost, access, or other practical issues may make an otherwise relevant care plan challenging to follow. 
  • Missing information: Relevant records, test results, or treatment updates have not reached the provider who needs them. 

A September 2026 report by the American Medical Association on Ochsner Health’s hospital-to-home programs makes the practical importance of identifying such gaps much clearer. Ochsner had 293 patients with congestive heart failure enrolled in its acute care at home program in 2025. 

Although they represented 15% of the program’s home patients, they accounted for 16% of all reutilizations. In response, one of Ochsner’s strategic priorities for 2026 is to improve care coordination for this group. As Dr. Beau Raymond, the Chief Medical Officer for population health at Ochsner, stated, “We needed to be smarter about simple care coordination activities.” 

Also, keep in mind that Ochsner’s approach was not just about analyzing clinical information. It included identifying patients at risk, determining which home-based program fits their needs, and helping case managers navigate available options. Instead of documenting every detail of a patient’s journey, case managers should determine where the care pathway is most likely to break down. 

 

Building Bridges Across Providers and Care Settings 

After the gaps in a patient’s care have been identified, the next challenge is bringing the right people and services into the same care pathway. A case manager may have to coordinate communication between a primary care provider, specialist, hospital team, home health service, or a community-based resource. 

Each of these roles may differ, but that should not prevent the patient’s care from moving forward. The complexity of this coordination can vary depending on where and how a patient receives care. 

For instance, Community CareLink notes that distance and staffing make coordination critical in rural communities. Patients may have fewer healthcare providers nearby, requiring them to travel beyond their local community for certain services. 

The Health Resources and Services Administration (HRSA) notes that only 2% of residency training occurs in rural areas. Strengthening rural training will improve access to care and increase the likelihood that physicians practice in these communities. 

For rural health transformation, this can mean coordinating care that extends beyond its immediate network. A case manager may need to connect a patient with an outside specialist, help address scheduling barriers, and ensure the referring provider has all the necessary information. 

Essentially, several practical responsibilities form a part of this bridge-building process. These include the following:

  • Making sure each member of the care team has clear responsibilities 
  • Facilitating communication between professionals working from separate records 
  • Helping move a referral beyond the initial order by checking whether the patient reached the appropriate service 
  • Carrying relevant information and care responsibilities across settings such as hospitals, outpatient clinics, and community services 
  • Incorporating practical support, social services, and other community-based assistance into the broader care plan 

 

Turning Coordination Into Continuity of Care 

Connecting providers is only half of the work done. A patient can still experience a breakdown in their care if they do not receive a follow-up on the next steps. Continuity of care depends on whether the plan still works after those initial connections have been made. 

In other words, the focus of case management here is to keep the connected pieces together. Case managers can monitor whether recommended services were accessed, whether treatment plans are being followed, and whether new barriers have emerged. They also have the chance to analyze the patient’s needs amid changing circumstances. 

According to a recent CBS News feature, continuity of care becomes more difficult when local healthcare resources change. Sturgis Hospital in rural Michigan closed on June 19th, ending services that included surgery, medical imaging, physical therapy, and cardiac rehabilitation. 

The loss of its emergency department also meant that some patients who previously took an approximately 2-mile ambulance ride would now have to travel 25 miles. Situations like this show why continuity requires more than maintaining a list of referrals. Since a facility is no longer available, the patient’s care pathway may have to be rebuilt around what is accessible. 

Case managers play a significant role in that rebuilding process. Maintaining continuity of care may involve the following:

  • Confirming that referrals, appointments, and treatments happened promptly 
  • Watching for changes in the patient’s condition, circumstances, and ability to manage their care plan 
  • Adjusting coordination when a patient’s health or support needs change 
  • Ensuring important updates and responsibilities move with the patient from one stage of care to the next 

The Sturgis example also shows why continuity cannot be treated as a one-time task. The report noted that other clinics remained available after the hospital closed, but the emergency department’s absence left facilities in Three Rivers, Coldwater, and LaGrange, Indiana, as the closest alternatives to patients. 

A case manager can become a crucial link in such fragmentation. Instead of directing a patient to a new provider, they can look through the care plan again to see what has changed. That’s how it’s possible to ensure the next set of services still fit together. This type of attention to detail is particularly relevant in cases where the patient has multiple conditions or practical barriers to overcome. 

 

FAQs 

What problems do case managers help address in fragmented healthcare?

Case managers help identify gaps such as incomplete referrals, medication discrepancies, duplicate services, and practical barriers. They bring together information from different providers and settings to determine whether a patient’s care pathway is breaking down. 

How do case managers improve coordination between healthcare providers?

The way case managers improve coordination is by connecting care providers, facilitating information sharing, and helping carry care plans across different settings. This can be especially important when patients must travel for services or receive care from multiple organizations that do not work together. 

How do case managers help maintain continuity of care?

Case managers follow up after referrals and transitions, monitor changing needs, and adjust care coordination when circumstances change. If a provider or service becomes unavailable, they can help identify alternatives to ensure important information moves with the patient. 

 

Fragmented Healthcare At a Glance 

Care Challenge  Case Management Insight 
Scattered information  Find the missing pieces. 
Incomplete referrals  Follow the referral through.
Conflicting medication records  Reconcile the differences. 
Disconnected providers  Keep communication going.
Care across distant settings  Bridge the gaps between services.
Changing patient needs  Reassess the needs and adapt the care plan accordingly.
Loss of local services  Rebuild the care pathway. 
One-time coordination  Keep care connected.

Fragmentation in healthcare cannot be attributed to a single person or one failed interaction. It can develop when information is scattered across records and referrals lose their momentum. 

Case managers have the unique potential to make the system more connected. A 2026 randomized controlled trial involving 1,387 adults with multiple chronic conditions compared three approaches to case management after hospital discharge. 

While no considerable difference was observed in 90-day readmission rates, in-person care enabled patients to better understand and manage their care over the following year. Successful coordination cannot be determined by a single outcome. To keep a patient’s journey connected over time, multiple factors must be considered and addressed.

Author Bio

Deepika has over six years of experience as a writer and editor. Passionate about words and learning, she takes an interest in a variety of niches. Her knack for turning complex ideas into relatable narratives allows her to resonate with the reader. 

When her pen falls silent, you can find her engrossed in a novel or getting her hands messy with fine arts. Through these, Deepika is committed to keeping her curiosity and creativity alive. 

References:

  1. Centers for Medicare & Medicaid Services. July 2026. Medicare-Medicaid Coordination Office Fiscal Year 2025. 

https://www.cms.gov/files/document/mmco-report-congress.pdf-2

  1. Kevin McKeough. Better handoffs help home care cut hospital readmissions. American Medical Association. 

https://www.ama-assn.org/practice-management/payment-delivery-models/better-handoffs-help-home-care-cut-hospital

  1. Williams Kelly, et al. April 2026. Integrated care for chronic conditions: a randomized care management trial. PubMed. 

https://pubmed.ncbi.nlm.nih.gov/41838981/

  1. Rural Residency Planning and Development (RRPD) Program. September 2026. Health Resources & Services Administration. 

https://www.hrsa.gov/rural-health/grants/rural-health-research-policy/rrpd

 

 

Please also review AIHCP’s Case Management Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

What Clinicians Should Ask Patients About Herbal Supplements

Posted on by Joseph Gerard

Holistic Wellness Advice: What does Berberine do for you?Written by Dr. Galina Kosyak,

Patients rarely file herbal products under “medication”, so they rarely mention them. For anyone doing medication reconciliation or patient education, that silence is a practical problem: herbal products are pharmacologically active, and several carry well-characterised interactions. Here is how to ask, what to ask about, and why the label limits what you can assess.
Ask a patient what medications they take and you will usually get a reasonable list. Ask what else they take and the list often grows – a turmeric capsule every morning, something for sleep a friend recommended, a mushroom powder in the smoothie, an echinacea tincture kept in the cupboard for winter.

That second list rarely makes it into the chart. Not because patients are concealing anything, but because most of them do not file these products under “medication” at all. They are food. They came from a shop, not a pharmacy. Nobody wrote a prescription.

For anyone doing medication reconciliation, patient education or care coordination, that gap is a practical problem rather than a philosophical one. Herbal products are pharmacologically active. As the National Center for Complementary and Integrative Health puts it plainly in its clinician guidance, herbal products carry the same dangers as other pharmacologically active compounds, even though the public tends to assume otherwise.

Why the question usually fails

The standard phrasing does most of the damage. “Are you taking any other medications?” invites a patient to mentally exclude anything sold in the vitamin aisle. “Any supplements?” is better, though many people interpret “supplements” narrowly – a multivitamin, perhaps, but not the herbal tincture or the powdered extract.

Three reframings tend to work better in practice:

Ask about the container, not the category. “What’s in your medicine cabinet besides your prescriptions? Anything in a bottle, a capsule or a dropper?” This invites an inventory rather than a judgement about what counts.

Ask about purpose. “Is there anything you take for sleep, for energy, for joints, for digestion?” Patients who would never describe themselves as supplement users will readily describe what they take and why.

Ask them to bring the bottles. A photograph of the labels on a phone is enough. This single request resolves more ambiguity than any amount of questioning, for reasons that become clear below.

It also helps to signal that the question is clinical rather than disapproving. Patients who expect to be lectured tend to answer briefly. Patients who understand you are checking for interactions tend to be thorough.

What actually matters clinically

The literature on herb-drug interactions is uneven – a great deal of it is inferred from animal studies or cell assays rather than observed in patients. NCCIH is explicit about this, and it is worth carrying that caution into practice rather than treating every theoretical interaction as established fact.

That said, several are well enough characterized to warrant routine attention. NCCIH’s own clinician digest on herb-drug interactions highlights a short list worth knowing by name:

  • St John’s wort carries a high risk of interaction through enzyme induction, with documented effects on cyclosporine, oral contraceptives and digoxin. Of everything on the shelf, this is the one to ask about directly.
  • Ginkgo biloba increases bleeding risk in patients on warfarin, and is incompatible with efavirenz.
  • Goldenseal reduced metformin levels by roughly a quarter in an NCCIH-funded study – a relevant signal for any patient managing glucose.
  • Green tea at high doses reduces the effectiveness of nadolol and atorvastatin.
  • Asian ginseng has mixed evidence around calcium channel blockers, statins, antidepressants and warfarin.
  • Chamomile, cranberry and cat’s claw each carry plausible interactions – with oral contraceptives, warfarin and anticoagulants respectively – on thinner evidence.

The perioperative period deserves separate attention. Several widely used botanicals affect platelet function or interact with anaesthesia, which is why most surgical practices ask patients to stop herbal products one to two weeks before an operation. Patients frequently do not connect that instruction to the bottle in their kitchen, because in their mind it is not a drug. Making the instruction concrete – naming the products, not the category – improves compliance considerably.

The label problem, and why it limits what you can assess

Here is where the bottles matter. Suppose a patient reports taking “echinacea”. That word alone is close to useless clinically.

There are several species sold under that name, and they are not equivalent. The same applies across the botanical shelf: different species share a common name, and different parts of the same plant – root, leaf, aerial parts, bark – differ substantially in composition. An extract and a powdered whole herb of the same species are not interchangeable either, and the concentration ratio is frequently absent from the label altogether.

So the useful information on a supplement label is narrow and specific:

  • The botanical name. Hydrastis canadensis is goldenseal. Other species contain the same headline compound and are cheaper. Without the binomial, the identity is not guaranteed.
  • The part of the plant. Root and rhizome behave differently from aerial parts.
  • The form. Extract or whole herb, and at what ratio.
  • A lot number and date. Basic, and the quickest indication that someone is keeping records.

There is one more line worth teaching patients to read, and it is the only mandatory disclosure about the supply chain on the entire package. US labelling rules require the name and address of the manufacturer, packer or distributor – any one of the three satisfies the requirement. If the company named did not make the product, it must say so, using a qualifier such as “Distributed by” or “Manufactured for”. Nothing requires the country of manufacture to appear anywhere.

The practical consequence is that an American address on a bottle tells you where a company is, not where a product was made. A handful of manufacturers publish this detail openly; AMPEXT, a US plant-extraction company, has written a plain-English explanation of what supplement labels do and do not disclose, which is a useful thing to point patients toward when they ask how to compare products.

Documenting it

Whatever the patient reports belongs in the record in the same way a prescription would – product name, botanical name if available, dose, frequency, how long they have been taking it, and why. “Takes herbal supplements” is not documentation; it is a note that the question was asked.

Two habits make this sustainable. Re-ask at every reconciliation rather than once at intake, because supplement use is episodic and often seasonal. And record the reason alongside the product – a patient taking valerian for sleep and a patient taking valerian because a relative suggested it are different conversations when the time comes to discuss stopping.

The underlying point

None of this requires taking a position on whether herbal products are beneficial. The clinical question is narrower and more answerable: what is this patient actually ingesting, and does it interact with anything else they are taking.

That question cannot be answered if it is never asked in language the patient recognises, and it cannot be answered accurately if the answer arrives as a common plant name with no species, no plant part and no form attached.

Ask about the cabinet. Ask them to bring the bottles. Write down what the label says.

About the author

Galina Kosyak, PhD in Medical Sciences, is Medical and Scientific Advisor at AMPEXT (American Plant Extraction). A physician trained in physical medicine and rehabilitation, she earned her medical degree in 1999 and later a PhD in Medical Sciences, and spent many years as a Senior Research Scientist at the Research Institute of Medical and Social Expertise and Rehabilitation, where she conducted clinical research in rehabilitation medicine. At AMPEXT she reviews educational articles and product monographs for accuracy and balance against current evidence. Full biography and editorial policy: ampext.com/information/author-g-kosyak

Disclosure: the author is affiliated with AMPEXT, which is named in this article.

 

Please also review AIHCP’s Holistic Nursing Certification program and Nurse Courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

What Is KPV? A Clear Look at the Peptide Studied for Inflammation, Gut, and Skin

Posted on by Joseph Gerard

Peptides under magnifying glass. Thorough analysis and inspection of peptides. Taking a closer look at peptides. Examination of the concept of peptides

Written by Biana Borchenko, FNP-BC, Nurse Practitioner,

KPV is one of the shortest peptides getting attention in wellness circles, and its size is part of the appeal. Made of just three amino acids, it is small enough to slip into cells and is studied for a single job that matters to a lot of people: calming inflammation. That focus is why interest in KPV peptide benefits has grown among readers dealing with gut and skin issues. Understanding what the research supports, and what it does not, keeps expectations realistic.

KPV is a fragment of alpha-melanocyte-stimulating hormone (alpha-MSH), a signaling molecule your body already makes. Researchers isolated the tail end of that hormone and found it kept much of the anti-inflammatory signaling while shedding other effects. In other words, KPV is studied as a targeted messenger rather than a broad drug.

Because inflammation sits underneath so many gut and skin complaints, that targeting is what makes KPV interesting to clinicians and researchers. Physician-led practices such as Robertson Wellness & Aesthetics treat peptides like KPV as something to consider case by case, after a medical history, rather than a supplement to self-prescribe. The biology helps explain why.

How KPV is thought to work

The leading explanation is that KPV acts inside the cell to quiet inflammatory signaling, including pathways tied to the messenger NF-kB. By dialing down that signaling, it may reduce the inflammatory response in tissues like the gut lining and the skin, according to preclinical studies indexed by the U.S. National Library of Medicine.

Two features get researchers’ attention. First, KPV appears to work at low concentrations. Second, it seems to act without the pigment-related effects of the parent hormone, which is why it is studied as a focused anti-inflammatory signal rather than a tanning agent.

What the research shows, by area

Most of the evidence is preclinical, meaning cell and animal models rather than large human trials. The signals are promising enough to justify continued study, not strong enough to promise results.

Area of interest What research explores Evidence stage
Gut Support for the intestinal lining and inflammatory bowel models Preclinical
Skin Calming inflammatory skin responses and supporting repair Preclinical/early
General inflammation Reducing NF-kB-linked inflammatory signaling Preclinical

Read the table as a map of open questions, not a list of proven treatments. A compound can look encouraging in a dish or an animal model and still need years of human research before anyone can speak confidently about benefit and dose.

Who tends to look into KPV, and who should wait

In clinical conversations, KPV comes up most often with people focused on gut comfort, inflammatory skin concerns, or general inflammatory load who want medical guidance rather than gray-market products. Suitability is decided individually, not from an online checklist.

Some people should hold off unless a physician says otherwise, including anyone who is pregnant or breastfeeding, anyone managing a serious medical condition, and anyone already on medications that affect immune or inflammatory pathways. A clinician weighs those factors before anything is recommended.

Why delivery method comes up so often

KPV is discussed in several forms, including oral capsules, topical preparations, and injectable versions, and the format is not a minor detail. How a peptide is delivered affects how much reaches the target tissue and how it is handled by the body, which is one reason clinicians care about the route as much as the compound.

For gut-focused interest, an oral or targeted approach is often the talking point, while skin concerns raise questions about topical use. None of these formats is automatically “best,” and the research behind each varies. This is exactly the kind of trade-off a licensed provider can walk through based on your specific goal rather than a general recommendation online.

Three things people get wrong about KPV

A few misconceptions show up again and again, and clearing them helps set realistic expectations.

  • “It is natural, so it is risk-free.” KPV is derived from a natural hormone fragment, but the products sold are manufactured, unregulated, and not proven safe long-term.
  • “More is better.” KPV is studied at low concentrations; higher amounts are not automatically more helpful.
  • “It is proven for gut or skin conditions.” The human evidence is not there yet. Interest is based largely on preclinical work.

Keeping these straight makes it easier to read marketing claims critically and to have a grounded conversation with a clinician.

Safety and the honest unknowns

KPV is not an FDA-approved medicine, so there is no standardized dose and no quality guarantee for products sold outside a clinical setting. Short reports tend to describe it as well tolerated, but long-term human safety has not been established in large studies. Purity and accurate labeling are real concerns with self-sourced peptides.

These statements have not been evaluated by the Food and Drug Administration. KPV is not intended to diagnose, treat, cure, or prevent any disease, and is not an FDA-approved therapy. Talk with a licensed medical provider before considering any peptide.

For readers who would rather explore KPV with medical oversight than order a vial online, Robertson Wellness & Aesthetics, a physician-supervised medical spa in Beverly Hills, is one clinic that evaluates peptide options under clinical care.

 

 

Please also review AIHCP’s Holistic Nursing Certification program and Nurse Courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

6 Doctor Quality Analytics Platforms Powering Value-Based Care in 2026

Posted on by Joseph Gerard

Stethoscope_and_keyboard_illustrating_concept_of_digital

Written by Cassandra Rosas

A doctor being “in-network” answers exactly one question: will the claim get paid. It says nothing about whether that doctor’s patients recover faster, avoid unnecessary procedures, or end up back in the emergency room three weeks later. For years, that gap didn’t matter much because nobody was measuring it at scale, but now a growing number of platforms are, and the results are reshaping how employers, health plans, and the case managers between them make referral decisions. Case managers, more than most people in the system, sit exactly at that intersection: clinically fluent enough to judge a referral, accountable enough for cost that a referral choice actually matters.

Commercial value-based arrangements grew from 34.6% of payments in 2022 to 39.2% in 2023, according to the HCP-LAN annual survey, conducted jointly with AHIP and BCBSA. That shift only works if someone can tell a high-value doctor from an average one, which is exactly the gap these six platforms are built to close. Garner Health tops this list because it’s built the furthest into that specific problem. The rest fill in adjacent pieces of the same puzzle.

What “doctor quality analytics” means for case managers

Ask 10 case managers what “in-network” means and most will describe a directory: a name, an address, a specialty code. Ask them what “high-quality” means for that same doctor and the answers get vague fast, because until recently there wasn’t much data to point to.

Doctor quality analytics platforms replace that vagueness with claims-based measurement: tracking things like complication rates, readmissions, and procedure volume at the individual physician level, then scoring providers against their peers in the same specialty and geography. For a case manager balancing a patient’s outcomes against a plan sponsor’s cost targets, that score is the difference between a referral made on convenience and one made on evidence.

This is the mechanical layer underneath the broader move toward value-based care, where a health plan gets paid, or penalized, based on outcomes rather than visit volume. You can’t manage what you can’t measure, and provider-level quality data is what makes that measurement possible below the plan level, down to the individual referral.

Consider a case manager referring a patient for a routine orthopedic procedure. Under the old model, the choice comes down to who’s in-network and who has an open slot. A quality-analytics model adds a layer: the case manager can see in advance whether one surgeon’s patients tend to need a second procedure within a year and others don’t. That’s the kind of signal that used to live only in a hospital’s internal peer review, if it was tracked at all.

How we selected these platforms

We looked for four things:

  • Claims-based quality data the platform built itself, not self-reported ratings
  • A product built for employers and health plans, not consumer directories
  • The ability to plug into existing navigation or benefits workflows without a rip-and-replace
  • Evidence, ideally quantified, that using the platform actually changes cost or outcomes

Six platforms cleared that bar, ranked here from the most quality-analytics-focused to the most complementary.

6 doctor quality analytics platforms to know in 2026

1. Garner Health

Garner Health built its entire product around one question: which doctors, specifically, produce better outcomes at lower cost? Its scoring engine runs claims data through more than 550 clinical metrics it built in-house, drawing on a database of over 60 billion medical records, to rank physicians within their own specialty and market. Employers use the results to reward employees for choosing top-performing doctors, usually by covering most or all of the resulting out-of-pocket costs, without narrowing the network or restricting anyone’s choice.

The approach appears to be working at a scale that’s hard to ignore. Garner reports that employers using its platform see an average 12% reduction in total healthcare spend in the first year, and employees who choose a high-performing provider pay roughly 80% less out of pocket than they otherwise would. The company closed a $100 million Series E at a $2.74 billion valuation in May 2026, just three months after a $118 million Series D, a pace of investment that reflects how much appetite employers have for this exact category.

2. Embold Health

Where Garner scores individual doctors, Embold Health has taken the model a step further and built a health plan around it. Embold Edge, launched in 2026, analyzes 21 specialties and 68 sub-specialties using data spanning more than 230 million people, then structures member copays to reward high-quality choices without requiring employers to disrupt their existing network or carrier relationships. Its underlying bet: most healthcare waste traces back to low-quality care at the start of a patient’s journey rather than overpricing further downstream, so fixing the first referral fixes a lot of what follows.

3. Ribbon Health

Ribbon Health operates further upstream from the case manager, supplying the provider data (insurance participation, cost estimates, quality scores, and patient experience) that other platforms and health plans build their own navigation tools on top of, rather than selling directly to members itself. If you’ve used a “find a doctor” tool from a health plan or a digital navigation vendor recently, there’s a reasonable chance Ribbon’s data powered it behind the scenes.

4. Included Health

Included Health bundles quality-based referrals into a much broader navigation and virtual care platform. Its Provider Connect feature routes members toward high-quality, cost-effective providers automatically as part of the standard member journey. Care coordination, virtual visits, benefits navigation, and referral steering all live in one product, rather than requiring a separate vendor for each.

5. Quantum Health

Quantum Health takes a similar bundled approach through its Care Finder tool, which surfaces provider search and quality data directly inside its broader healthcare navigation platform. For organizations that already route members through Quantum Health for case management and benefits navigation, Care Finder adds the quality layer without introducing a separate point solution.

6. Turquoise Health

Quality data only tells half the value-based care story. Turquoise Health fills in the other half: rate transparency and contract intelligence that show what providers are actually paid under negotiated agreements. Pairing that pricing data with a quality score from one of the platforms above gets closer to a true value calculation. A genuinely high-value doctor is one who scores well on outcomes and isn’t wildly overpriced relative to peers.

Choosing the right platform for your organization

The right fit depends on what you’re already running. Organizations with an existing navigation vendor that just want to layer in quality scoring are usually better served by a pure-play option like Garner Health or Embold Health. Organizations building navigation and referral management from scratch tend to gravitate toward a bundled platform like Included Health or Quantum Health instead. Vendors and health plans building their own tools look to infrastructure providers like Ribbon Health for the underlying data.

Turquoise Health belongs in the stack alongside any of the above, since cost transparency and quality analytics answer different questions. Worth asking before signing anything: how the platform’s data reaches the people making referral decisions day to day. A quality score buried in a quarterly report to HR doesn’t change a single referral. A quality score surfaced inside the tool a case manager already uses at the point of referral does, and that distinction matters more than any single feature comparison.

Frequently asked questions

What is doctor quality analytics?

Doctor quality analytics is the practice of measuring an individual physician’s performance, including complication rates and avoidable readmissions, using claims data, then scoring that physician against peers in the same specialty and market. It replaces network directories, which only confirm insurance participation, with an evidence-based answer to whether a specific doctor delivers better results.

How do case managers use provider quality data in referrals and care coordination?

Case managers use provider quality scores to steer referrals toward physicians with better documented outcomes, rather than relying solely on network status or personal familiarity. Combined with a patient’s specific clinical needs and plan design, quality data helps a case manager justify a referral choice on evidence, which matters increasingly as employers tie benefits design to demonstrated cost and outcome performance.

Do doctor quality platforms only work for large self-insured employers?

No, though large self-insured employers were the earliest and most visible adopters because they bear healthcare costs directly and can redesign benefits without an insurer’s approval. Health plans, associations, and mid-market employers now access the same underlying quality data through partnerships and smaller-scale deployments, so the category isn’t limited to the biggest balance sheets anymore.

 

Author bio

Cassandra Rosas is a content writer who loves to cover topics related to healthcare software and AI, employee benefits, and new healthcare trends emerging in the industry. In her spare time she enjoys hiking in the mountains and spending time outdoors.

 

Please also review AIHCP’s Case Management Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Primum Non Nocere: Medicine’s Most Famous Phrase Is Under 200 Years Old

Posted on by Joseph Gerard

An employee of a surgical department loads a washing machine with used surgical instrumentsWritten by Melanija Dubra,

Primum non nocere is under 200 years old, and the first book to put it in print credited the wrong physician. That mistake matters: the real test of “do no harm” isn’t the operating room, it’s how surgical instruments are cleaned between patients, and what happens when that fails.

Most people picture it in the operating room, in the surgeon’s hands. In practice, it sits in the room down the hall, where used instruments are cleaned before they touch the next patient. That is the argument this piece makes.

Where Does “Primum Non Nocere” Come From, and What Does It Actually Mean?

In 2005, pharmacologist Cedric M. Smith searched medical writing back to the Middle Ages for the phrase’s origin. He found it in neither Hippocrates nor Galen. Its first appearance in print was in an 1860 book by the English physician Thomas Inman. Inman credited the line to Thomas Sydenham, a doctor who had died in 1689, but Sydenham never wrote it either. So the phrase was misattributed from the start, and it spread anyway.

It is not in the Hippocratic Oath. The closest genuine ancestor appears in a different Hippocratic text: in Epidemics, Book I, physicians are instructed to keep two goals in view:

  1. to help,
  2. or at least to do no harm.

The idea is authentically ancient. The Latin slogan is a Victorian invention.

Why Is Instrument Sterilization Where “Do No Harm” Gets Tested?

“Do no harm” is not a decision made once, at the moment of surgery. It applies to every step of care: before, during, and after the procedure. One of those steps rarely gets attention: reprocessing. This is the cleaning, disinfecting, and sterilizing of instruments that get reused, sometimes dozens of times a day.

It is also the step patients never see. The work is repetitive, done by technicians the patient will never meet, and it happens fast, between one case and the next. When something goes wrong here, it is rarely because someone was careless. It is because the process asks for the same level of care every single time, with no room for a bad day. One serious eye complication, tracked across six years of investigation, shows what happens when that slips. It is worth walking through in full, because it shows exactly how the standard gets tested, and how quietly it can fail.

Toxic Anterior Segment Syndrome: What Happens When Reprocessing Fails?

Toxic anterior segment syndrome, or TASS, is a severe inflammation inside the eye that usually develops 12 to 48 hours after cataract surgery. It is not an infection but a toxic reaction to a substance that got into the eye during surgery. Because it looks so similar to a real infection, it’s often misdiagnosed and treated as one, and either way the patient spends the following days afraid of losing the eye.

After a cluster of outbreaks in 2006, ASCRS formed a TASS Task Force to find the cause. Between 2007 and 2012 it examined 1,454 TASS cases drawn from roughly 69,000 cataract surgeries performed at surgery centers that had already reported problems. That denominator matters: it is the caseload of affected centers under investigation, not a national rate.

In ordinary practice TASS is far rarer, estimated at roughly 1 in 1,000 cataract surgeries, and measured at 0.22% in one series of 26,408 consecutive cases. So the task force figures are not a measure of how often TASS happens. They are a detailed view of why it happens.

Few of these patients were harmed by a surgeon’s technique. In most cases the harm came from something that happened to an instrument between one patient and the next.

The Everyday Mistakes Behind Most TASS Cases

The task force found three causes behind nearly all the cases. None involved negligence, only a lapse in an already demanding routine.

Instrument Residue Left to Dry

Blood, tissue, and the gel used in cataract surgery must stay moist until cleaning begins. Once that gel dries inside a phaco handpiece’s narrow channel, scrubbing the outside won’t remove it, and it won’t be visible on inspection. Using the right cleaning brush size matters as much as timing: a brush that doesn’t match the channel can’t do the job.

Detergent and Water Quality Left Unverified

Enzyme detergents can leave residues that steam doesn’t destroy. Tap water used for the final rinse adds another risk, since it can carry bacterial endotoxin that an autoclave won’t remove. Sterile does not mean free of toxins. That gap is what the ANSI/AAMI ST108 water standard addresses, by setting which water grade to use at each step.

Conflicting Instructions on the Same Tray

One tray often holds instruments from several manufacturers, each with different cleaning instructions. Sorting them out under time pressure isn’t always realistic. It’s why ASCRS recommends buying instruments, sterilization equipment, and cleaning equipment from suppliers who publish clear instructions for every item.

It’s a common problem, too. Reprocessing shows up often among The Joint Commission’s top-cited issues, and the CDC is clear that sterilization only works once all residue is fully removed.

What Does Proper Surgical Instrument Reprocessing Look Like?

A tray sterilizes nothing on its own. The instructions for the instrument, the tray, and the sterilizer all have to match. A tray can’t make a cycle compliant by itself, but a bad one can stop the cycle working at all. This is the same logic ANSI/AAMI ST79, the comprehensive U.S. standard for steam sterilization reprocessing, is built on: the instrument, the tray, and the sterilizer are treated as one connected system, not separate steps.

Instruments touching each other block steam and can damage fine tips. A solid-bottomed container traps water that needs to drain. An overloaded tray dries slowly, and a damp load coming out of the autoclave counts as contaminated, no matter how long the cycle ran.

A good tray also makes inspection possible: fine tips and box locks need to be checked under magnification, which is hard to do when instruments are piled loosely in a pan. In practice, that means using trays built to hold instruments apart through the whole cycle, not just any container the instruments happen to sit in.

Seven Questions Every Sterile Processing Team Should Be Able to Answer

A quick assessment for any reprocessing department:

  1. How long passes between an instrument leaving the field and cleaning starting, and is it kept moist throughout?
  2. Is an enzyme detergent used because the manufacturer’s instructions require it, or because it was assumed to be necessary?
  3. What water is used for the final rinse, and has it been verified against current standards?
  4. Is every load fully dry before it enters storage?
  5. Could a technician produce the cleaning instructions for every instrument on a given tray within five minutes?
  6. When was an unused instrument last removed from a tray?
  7. If a lapse were identified tomorrow, could the affected patients be traced?

None of these questions require new equipment. They require a department that asks them routinely.

Do No Harm Is a Daily Standard

Thomas Inman attributed the phrase incorrectly in 1860, and it survived the error because it described something true.

Under two hundred years is not a long history. Primum non nocere was never an inheritance the profession only had to preserve. It is a standard that must be met again every day, largely by people the patient never meets.

Behind a successful surgical outcome is often a technician who rinsed a handpiece for the correct duration, examined instruments under magnification, and reconciled conflicting manufacturer instructions before the next case began. That work is not peripheral to “do no harm.” It is where the standard is actually decided.

About the author

Melanija Dubra is a content creator who writes about health, wellbeing, and clinical practice. She’d rather read the original study than someone’s summary of it. Wellbeing is something she genuinely cares about, so getting the details right feels like part of the job rather than an extra step.

References

American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Registered Nurses, American Academy of Ophthalmology, & Outpatient Ophthalmic Surgery Society. (2018). Guidelines for the cleaning and sterilization of intraocular surgical instruments. Journal of Cataract & Refractive Surgery, 44(6).

Centers for Disease Control and Prevention & Healthcare Infection Control Practices Advisory Committee. (2024). Guideline for disinfection and sterilization in healthcare facilities, 2008 (updated June 2024). U.S. Department of Health and Human Services.

Chaudhry, S., & Sharma, N. (2024). Toxic anterior segment syndrome (TASS): A review and update. Indian Journal of Ophthalmology, 72(1).

Smith, C. M. (2005). Origin and uses of primum non nocere – above all, do no harm! Journal of Clinical Pharmacology, 45(4), 371-377.

The Joint Commission. (2024). Infection prevention and control requirement IC.02.02.01, element of performance 2: most frequently cited findings, 2021-2024. The Joint Commission.

Sengupta, S., Chang, D. F., Gandhi, R., Kenia, H., & Venkatesh, R. (2011). Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital. Journal of Cataract & Refractive Surgery, 37(9), 1673-1678.

 

 

 

Please also review AIHCP’s Legal Nurse Certification program and our CE courses as well, to see if they meet your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Why Metabolic Health Matters at Every Stage of Life

Posted on by Joseph Gerard

Metabolic health - crossword in ivory tiles against gray textured paperFor many, it shows up as an afternoon crash that makes the couch look irresistible (guilty!), but it can also be a routine blood test that comes back “a little high.” None of these mean that something is necessarily wrong, but they do show that metabolism deserves attention between checkups.

Metabolism is the work of turning food and stored fuel into energy, then directing it where needed. Hormones run that traffic, so it is helpful to think about metabolic and endocrine health together. The same network affects appetite, blood sugar, temperature, sleep, menstrual cycles, and recovery. It also changes as life changes, and often in quiet, ordinary ways.

More than a fast metabolism

People often use “metabolism” as shorthand for how easily someone gains weight. The real picture includes how the body handles glucose and blood pressure, how the liver stores fuel, how well muscle can use it, and a bunch of other factors. Thyroid and reproductive hormones all take part as well.

No single measurement sums up the system. Body size offers some context, yet it cannot reveal a person’s blood sugar, fitness, sleep, or family history. People in similar-sized bodies can have very different lab results and risks.

An out-of-range result starts a conversation, but it’s rarely as simple as numbers on a page. Clinicians look at trends, symptoms, and the person in front of them. A single fasting glucose reading, for example, can be affected by stress, illness, or a poor night’s sleep, which is why most providers prefer to watch a pattern over time rather than react to one number in isolation.

Childhood is where the setting takes shape.

Children are growing, so their need for energy keeps shifting. Puberty can change sleep and insulin response, and that’s no reason to put a child on an adult diet or make the scale the center of family life.

Regular meals, chances to play, a workable bedtime, and neutral talk about food provide useful structure. Teaching a child about what types of food will help them stay full for longer is more helpful than calling a snack bad. Adults can model vegetables and movement without turning either into punishment.

School schedules, neighborhood safety, food prices, and access to recreation shape what families can do. If a child has persistent thirst, frequent urination, unusual tiredness, or an unexpected change in growth, call a pediatric clinician. Those signs have several possible causes, and an assessment is safer than guessing. Family routines built early, like eating meals together without screens or keeping consistent wake times, tend to carry into adolescence and adulthood, making them a worthwhile investment even when the payoff isn’t immediate.

Young adulthood meets the messy calendar.

The first years away from home often replace built-in routines with lectures, shift work, commuting, caregiving, or a tight food budget. Sleep moves around, and hours pass in a chair even when the day feels frantic.

In 2022, 31% of adults worldwide did not meet recommended levels of physical activity. This is a common problem, and advice has to fit the life a person actually has.

Small adjustments can help. Yogurt, eggs, beans, or nuts may make a rushed breakfast more satisfying, while frozen vegetables and canned fish or pulses can rescue a late dinner. A gym membership is optional; walking part of a commute or doing adapted strength work at home can be just as helpful. Even short bursts of movement between meetings or classes, taken consistently, add up over a week in ways that are easy to underestimate.

By midlife, the old routine may land differently.

Sleep, medication, illness, and activity can shift metabolic risk as we age. Poor health is not inevitable, but the body’s feedback may change, as some metabolic conditions stay quiet for years.

In 2023, an estimated 40.1 million people in the United States, or 12% of the population, had diagnosed or undiagnosed diabetes. Genetics, pregnancy history, medication, income, and access to care all affect risk.

Depending on personal history, a clinician may check blood pressure, fasting glucose or A1C, cholesterol and triglycerides, and sometimes liver or thyroid markers. Ask what might explain any change in the result and when to check again. A portal flag is not a diagnosis by itself.

This is often the stage when people first hear the phrase metabolic and endocrine health used together, since hormonal shifts around this time, whether from thyroid changes, perimenopause, or medication, frequently show up in the same panel of tests.

Later life shifts the goalposts.

When senior health enters the picture, preserving strength and independence often matters more than chasing a smaller number on the scale. Muscle helps clear glucose from the blood, supports balance, and makes daily tasks easier. Losing it can leave an older adult lighter but less resilient.

This means a simple meal with enough energy and protein may beat a restrictive “clean” menu. That said, kidney disease and other conditions can change protein needs, so individual guidance matters here.

As for movement, rising from a chair, gardening, resistance bands, and supervised balance work can help maintain function. Older adults who use insulin or certain glucose-lowering medicines need a plan for avoiding low blood sugar. Medication doses may also need review as weight, kidney function, appetite, and activity change. Falls and slow recovery from illness are often overlooked signs of declining muscle mass, and addressing them early tends to be far easier than reversing the damage after a hospitalization.

When to bring it up with a clinician

Persistent thirst, frequent urination, unexplained weight change, slow-healing wounds, repeated shakiness, major menstrual changes, unusual sensitivity to heat or cold, and fatigue that does not improve are worth discussing. They can have many causes, and an online symptom list cannot sort them out.

Metabolic health affects energy and physical function but never acts alone. Needs change with age, while genetics and circumstances always play a role. The aim is to notice meaningful changes early and build habits that survive ordinary life, rather than chasing a perfect routine that collapses the first time work, illness, or family life gets in the way.

 

 

About the Author

This article was prepared by a member of the AIHCP editorial contributor team, drawing on published research and general health education resources. It is intended for informational purposes and does not replace individualized medical advice from a licensed clinician.

 

Please also review AIHCP’s Health Care Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

When family involvement helps and when it complicates addiction care: A clinical approach to boundaries

Posted on by Joseph Gerard

Members Of Support Group Sitting In Chairs Having Meeting

Written by Emily Carter,

Addiction rarely affects one person alone. Families often feel the strain early. Money problems may appear. Responsibilities may be missed. Crises at home can become frequent. Yet family support can also shape recovery. Family-based care can improve treatment engagement and family functioning. That makes family involvement clinically important. Still, more is not always better. Concern can become pressure. Support can become control. So, where is the balance? Family involvement helps when it supports recovery and respects patient choice. Safety matters. Privacy matters too. The goal is simple. Family participation should strengthen treatment, not take it over.

How can families support addiction treatment?

Families can make treatment easier. A relative may provide a ride. Another may help with childcare. These simple steps can remove barriers. Emotional support matters too. Recovery can feel stressful. It can also feel uncertain. A trusted person can reduce isolation. Family involvement can also improve communication around treatment. Research supports carefully structured family approaches for substance use disorders. Benefits may include reduced substance use and improved family functioning (Esteban et al., 2023). However, clinicians should still assess each situation individually. A supportive relationship can strengthen care. A highly conflicted relationship may have the opposite effect.

Family relationships may also feel tense during addiction. Some people may blame relatives or close friends. This can happen during conflict, shame, or denial. Understanding why addicts blame loved ones can help families understand this pattern. The goal is not to excuse harmful behavior. Instead, families can avoid turning every disagreement into a larger confrontation. Clinicians can also help relatives separate emotional reactions from treatment decisions.

Family roles may change throughout care. Early treatment may involve sharing important history. Families may also raise safety concerns. Later, their role may become less direct. They can support routines or encourage follow-up care. Discharge can create another shift. Relatives may help with transportation or home stability. However, they should not control every treatment decision.

Age also matters. Parents often play a larger role with adolescents. Younger patients may depend on adults for treatment access. Family-based interventions also have evidence among adolescents and young adults (Esteban et al., 2023). Adults usually have greater control over participation. They often decide which relatives or support people join their care.

How can families support recovery without enabling substance use?

Helping and enabling can look similar at first. The difference often comes down to accountability. Driving someone to treatment can support recovery. Paying repeated substance-related debts may do the opposite. It can reduce the impact of harmful choices. A similar problem may occur at work. A relative may repeatedly make excuses for missed shifts. That response may protect the person from consequences.

Giving unrestricted cash can also create risk. This is especially relevant when active substance use continues. However, withholding all support is not the answer either. Families can still provide help that supports treatment. They might assist with transportation or healthcare access. They can also offer emotional support. The important distinction involves what the help is reinforcing.

Support does not mean solving every problem. Families can encourage treatment without hiding serious consequences. They can show concern without accepting threatening behavior. They can also offer practical support without assuming full responsibility for recovery. Clear limits make that support healthier.

One useful approach is CRAFT. Community Reinforcement and Family Training works with concerned family members. It teaches communication and reinforcement strategies. It also focuses on encouraging treatment entry. A systematic review included 691 concerned significant others across 14 studies. CRAFT was twice as effective as comparison approaches for treatment entry (Archer et al., 2020). More intensive formats achieved particularly strong treatment-entry rates.

Should families stop helping completely? No. Useful support leaves room for responsibility. Enabling often develops from fear or repeated crises. Clinicians can address these patterns without blaming relatives. Specific examples are usually more useful than labels.

What do healthy boundaries look like during addiction recovery?

A boundary explains what someone will accept or refuse. It does not force another person to change. This distinction matters during addiction treatment. Family members may feel responsible for preventing substance use. In reality, they cannot control every decision.

A family may decide not to provide money for substances. They may also restrict access to household vehicles during intoxication. Threatening behavior can require another clear limit. These boundaries focus on safety rather than punishment. Other limits may focus on responsibility. A relative may stop making excuses to an employer. They may also refuse to hide repeated financial problems.

Good boundaries should be specific. They also need to be realistic. A rule has little value when nobody can maintain it. Consistency usually matters more than severity.

Clinicians need similar clarity. Families should know who may attend sessions. They should understand the purpose of their involvement. Respect for patient autonomy remains important throughout this process. Relatives can support treatment. However, they should not become informal therapists or investigators. Medication decisions should also remain within appropriate clinical care.

Clear boundaries protect several relationships at once. They support the patient-clinician relationship. They can also reduce confusion within the family. SAMHSA recommends defining family roles carefully during substance use disorder treatment (SAMHSA, 2020).

When can family involvement make treatment harder?

Family participation becomes difficult when the patient loses space to speak. One relative may answer every clinical question. Another may insist on joining every appointment. Constant monitoring can create similar problems. A patient who feels watched may become less open during care.

Treatment can also become harder when relatives challenge evidence-based recommendations. Someone may oppose medication for opioid use disorder. Another family member may define recovery only through complete abstinence. Such beliefs can conflict with individualized treatment planning. They may also create shame after recurrence.

Clinicians should pay attention to coercion. Family involvement should not become another form of control. The patient’s preferences remain important when consent rules allow choice. Some adults may want only limited family participation. Others may prefer a trusted friend or partner instead.

Safety deserves particular attention. Joint counseling may not be appropriate when violence is present. Coercive relationships can also make shared sessions unsafe. The same concern applies when retaliation is possible. SAMHSA advises careful assessment before using family-based treatment in situations involving violence (SAMHSA, 2020).

Past trauma can also shape participation. So can estrangement or longstanding conflict. Clinicians should explore these factors before assuming family involvement will improve care. Sometimes limited involvement is the safer clinical choice.

What can clinicians tell family members about addiction treatment?

Confidentiality often causes confusion. Relatives may want detailed updates because they are worried. Clinicians cannot always provide them. A useful distinction involves receiving information and disclosing information.

A family member may contact a clinician with an important concern. For example, they might report a suspected overdose. They might also describe a major behavioral change. Receiving that information does not automatically permit disclosure in return.

HIPAA may allow communication with people involved in care. However, disclosure generally depends on the circumstances. Patient agreement can also matter. Information shared should relate to the person’s involvement in care. Clinicians should not treat family participation as unlimited access to records.

Substance use disorder records can receive additional federal protection. These protections appear under 42 CFR Part 2. The 2024 final rule aligned some Part 2 requirements more closely with HIPAA. However, important protections remain. Compliance with the updated requirements was required by February 16, 2026 (HHS, 2026).

Clinicians should explain confidentiality early. Families should understand what can be discussed. They should also know what remains private. Clear expectations can prevent conflict later. They also support informed participation in treatment.

Does family therapy improve addiction treatment outcomes?

Family therapy can be useful, but it is not one treatment model. Different approaches serve different clinical situations. Some focus on communication and behavior within the household. Others focus on couples or adolescents. Broader addiction treatments may combine behavioral care with medication.

Research supports family-based approaches for substance use disorders. A systematic review examined recent family therapy research. It found benefits for substance use and family functioning (Esteban et al., 2023). A newer systematic review also examined randomized controlled trials. It included 15 trials. Eleven reported significant positive effects from family-based interventions. Those outcomes included reduced substance use or better family functioning.

Still, results vary. No single family model fits every patient. A couples-based approach may fit one adult. A youth-focused program may suit an adolescent better. CRAFT may be useful when a person resists treatment. Other families may need psychoeducation rather than formal family therapy.

Clinical selection matters. The approach should fit the patient’s needs. Relationship quality also matters. So does safety. Family therapy should support the treatment plan rather than compete with it.

How should families respond when relapse occurs?

Relapse can trigger strong reactions. Fear may become anger. Concern can turn into surveillance. Some relatives may threaten to withdraw all support. These responses are understandable. However, they may not improve treatment engagement.

A more useful response begins with reassessment. Continued substance use does not automatically mean treatment has failed. In many cases, relapse and recovery should be considered within the wider treatment process. A recurrence may show that part of the current plan needs adjustment.

Clinicians may reassess overdose risk. Medication may also require review. Treatment intensity can change when needed. Triggers and new stressors may deserve attention. The goal is to understand what changed before making the next clinical decision.

Families can support this process without taking control. They may encourage a return to treatment. They can help someone keep important appointments. They may also support prescribed medication. However, relatives cannot guarantee abstinence.

Family wellbeing deserves attention too. Addiction can place considerable psychological pressure on relatives. Research shows that interventions for affected family members can improve important wellbeing outcomes (McGovern et al., 2021). Families may need their own boundaries around finances and time. They should also protect their work and personal relationships.

Supporting recovery should not require constant monitoring. It should not make one relative responsible for every setback. Shared responsibility supports a healthier treatment environment.

How can clinicians decide the right level of family involvement?

There is no single correct level. Each case is different. The patient should have a meaningful voice. Clinicians can start by asking who the patient wants involved. They should also consider safety. A supportive relationship should not create fear or coercion.

Treatment goals offer another guide. Does the family member improve treatment participation? Do they provide useful collateral information? Does their presence support communication? These questions can help define an appropriate role.

The answer may change over time. A relative may help greatly during discharge. That does not mean they need every therapy session. Someone excluded during family conflict may become helpful later.

Family also does not always mean a blood relative. Some patients rely more on partners or close friends. Others may identify a caregiver as their main support person. Clinicians should focus on the relationship’s actual function.

Culture can also shape family roles. Some families expect shared healthcare decisions. Others place greater emphasis on individual privacy. Clinicians should explore these expectations rather than assume them.

Ultimately, family involvement helps when it strengthens care without taking over care. Good boundaries protect patient autonomy. They also support family well-being. Most importantly, they keep treatment focused on the patient’s clinical needs.

About the author

Emily Carter is a content writer with a focus on behavioral health, addiction treatment, recovery, and wellness. She creates clear, compassionate, and research-informed content designed to help readers better understand treatment options, mental health topics, and the recovery process. Her writing aims to make complex healthcare information more accessible while maintaining a respectful and supportive tone.

References

American Society of Addiction Medicine. (2024). Engagement and retention of nonabstinent patients in substance use treatment: Clinical considerations for addiction treatment providers. American Society of Addiction Medicine. https://www.asam.org/quality-care/clinical-recommendations/asam-clinical-considerations-for-engagement-and-retention-of-non-abstinent-patients-in-treatment

Archer, M., Harwood, H., Stevelink, S., Rafferty, L., & Greenberg, N. (2020). Community reinforcement and family training and rates of treatment entry: A systematic review. Addiction, 115(6), 1024–1037.

Esteban, J., Suárez-Relinque, C., & Jiménez, T. I. (2023). Effects of family therapy for substance abuse: A systematic review of recent research. Family Process, 62(1), 49–73.

McGovern, R., Smart, D., Alderson, H., Araújo-Soares, V., Brown, J., Buykx, P., Evans, V., Fleming, K., Hickman, M., Macleod, J., Meier, P., & Kaner, E. (2021). Psychosocial interventions for family members affected by an adult relative’s substance use. International Journal of Environmental Research and Public Health, 18(4). https://pubmed.ncbi.nlm.nih.gov/

Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment and family therapy (Treatment Improvement Protocol 39). U.S. Department of Health and Human Services.

U.S. Department of Health and Human Services, Office for Civil Rights. (2026). Fact sheet: 42 CFR Part 2 final rule. https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/fact-sheet-42-cfr-part-2-final-rule/index.html

 

 

 

Please also review AIHCP’s Substance Abuse Practitioner Program and  CE courses to see if it meets your academic and professional goals.

What to Delegate First When Your Practice Is Growing

Posted on by Joseph Gerard

A young doctor is sitting in the clinic and talking on telephone and doing paperwork that should be done by an an admin assistantWritten by Ashleigh Atuahene,

Before I, Ashleigh, co-founded Ataraxis, I spent years working inside the kind of practices I now help other people staff. I started on the administrative side, spending a few years in a physician’s office doing patient intake, scheduling, insurance verification, and prior authorization. Later I took a role providing one-on-one ABA therapy under a licensed therapist, and once that clinic realized I already had an admin and insurance background, the same kind of work found its way on my desk there too. Over time I handled intake, scheduling, chart QA, prior auths, and insurance verification across pediatric, internal medicine, and behavioral health. So when I talk about what to delegate first, I am not repeating something I read in an operations handbook. I watched practices get this right, and I watched practices get it wrong, sometimes from inside the same building.

Here is the question I hear most often from growing practices: what should I hand off first? Most owners assume the answer is “someone to answer the phones.” Sometimes it is. But the real answer depends on one thing, and that is how your practice gets paid.

Start With How You Get Paid

If you accept insurance, delegate billing and coding first. Not the phones, not the calendar. Billing. This is the part owners resist, because the phone is loud and the billing is quiet. The phone interrupts you all day, so it feels like an emergency. Billing sits in a queue and does not shout, so it feels like it can wait. It cannot. Every claim that goes out late, coded wrong, or missing a prior authorization is money you earned and may never collect. In behavioral health especially, where claims are denied more often than in general medicine, the person who owns your billing is the person who owns your cash flow. Hand that off to someone who does it well, and do it early.

If your practice is out-of-pocket or cash-pay, the situation flips. When there are no claims to chase, your bottleneck is not billing, it is access. In that case, delegate everything that touches the patient but does not generate a billable hour: new patient intake, new patient questions, taking messages, routing questions meant for the provider, screening the sales reps who want “just five minutes” with the office, and, yes, the scheduling everyone expects. The clinical hour is the product. Anything that pulls the provider out of that hour without adding revenue should be delegated, and a good virtual medical receptionist can absorb most of it.

Reducing Friction

When a practice grows, the growth is not invisible to your patients. They feel it. Scheduling gets harder to manage. Reaching the provider takes longer. Those small frictions are the first thing a patient notices, and they are the first thing that makes a patient wonder whether they should look elsewhere.

The goal of your first hire is to keep the patient from feeling the growth at all. Ideally, a practice at forty patients should feel as easy to work with as it did at ten. That does not happen by accident. It happens because someone whose whole job is responsiveness is standing between your expanding schedule and the person trying to book into it. 

The Cost of a Missed Moment

The larger a practice gets, the more opportunities start to fall through the cracks. Imagine a solo provider with a handful of patients. It is simple to manage the schedule, move an appointment, stay on top of notes, and answer a quick question between sessions. Now picture that same provider booked back to back all day. The moment their calendar fills up, they lose the ability to manage those small functions effectively.

Here is a real-life example I saw over and over. Your one o’clock is running late and calls to reschedule. If you have a light day, you see the message and move them in two minutes. If you are in back-to-back sessions with no admin, you will not even see that message until it is already one o’clock. That patient could have been rescheduled and the slot backfilled. Instead you have an empty hour, a frustrated patient, and a note you still have to write. Multiply that by a full calendar and you can see how a growing practice starts leaving money and goodwill on the table, not because demand dropped, but because no one was available to catch the moment.

Money Is to the Business What Gas Is to the Car

No one understands the value of the clinical hour better than the provider delivering it. You are paid on billable hours. Accumulate them and the practice runs. Let them drop and you cannot cover overhead, and you certainly cannot pay yourself without dipping into reserves. Money is to the business what gas is to the car. The good news about growth is that it brings more billable hours. The hard news is that it also brings a flood of administrative work, and that work does not bill.

In a landmark time-and-motion study, physicians spent close to two hours on documentation and desk work for every single hour of direct patient care (Sinsky et al., 2016). Behavioral health is often heavier still: a fifty-minute session usually generates another twenty-plus minutes of notes, before you consider billing, intake, or authorizations. And prior authorization deserves its own line. The American Medical Association found that physicians and their staff spend an average of thirteen hours per week, per physician, completing prior authorizations, working through roughly thirty-nine requests each week (American Medical Association, 2025). That is more than a full workday, every week, spent on paperwork where the rules keep changing.

So the math is simple, even if the decision feels hard. Your time is finite, and growth makes that scarcity impossible to ignore. Every hour you spend on a task someone else could do is an hour you are not billing. Why waste billable hours when you can pay someone twelve dollars an hour overseas, or thirty dollars an hour locally before benefits, to do well, when that same hour of your time is worth hundreds? Hiring is not the cost. Doing your own admin is the cost. It just does not show up on an invoice.

When You Get the Order Wrong

Delegating well is not only about what you hand off. It is about the order you do it in, and about being honest with yourself when something is not working. The practices I have been part of taught me this in different ways.

Hiring Too Late

At a small ABA practice, there was one admin who handled the phones, the schedule, and parent questions. She was capable, but she had little experience with insurance verification or prior auths and no time to learn them. I came in as an ABA therapist, and once they learned about my earlier admin experience, insurance work for three providers got delegated to me, the family therapist, the speech-language pathologist, and the ABA side. By the time I took it over, the practice was already swimming in denials and patching broken workflows. We got it back on track, but you cannot fully recover the time and income lost to mistakes made months earlier. Billing delegated late is more expensive than billing delegated early, because the denials compound while you wait.

Too Slow to Change

I also worked with a solo speech-language pathologist who did one thing right and one thing wrong. She hired an admin first, then brought on a billing specialist through an agency later, which is a reasonable order. Her mistake was not listening. When the billing specialist told her the claims were not collectible as submitted and the system was fighting them, she kept pushing to make it work instead of finding someone more adept. Even if a stronger specialist had cost more, she would have come out ahead. Delegation only works if you trust the person you delegated to, or replace them, rather than overriding the expertise you hired.

Getting the First Hire Right

More recently, I watched these same principles play out from the other side of the table as my team worked closely to help staff a small group therapy practice in San Jose with three clinicians. They were making their very first hire. The founder was not in crisis mode, which is exactly the point. She was still seeing her own clients while personally carrying the billing, the session submissions, and the scheduling, and what wore her down was the constant switching between being a clinician and being an administrator. In her words, she needed another brain.

What made this one go right came down to two decisions. First, she hired before the wheels came off, while she still had the bandwidth to onboard someone properly instead of handing over a mess. Second, she was honest about what mattered most. Her practice is bilingual, and an assistant who also spoke Mandarin would have been a nice bonus, but when it came down to it she chose deep behavioral health experience and a strong command of HIPAA and her EHR over the language skill. 

The person she brought on had a psychology background and already knew the systems her practice ran on, and she took over the session submissions, the billing, the out-of-network claims, and the scheduling at about twenty hours a week. That was enough to hand the founder her clinical focus back. The last thing she did right is the piece most first-time hirers skip: she wrote down her processes before the start date, so her new assistant was working from clear documentation instead of guessing. Get the right person and the right instructions in place, and the handoff is usually simple.

Where to Start This Week

If you take one thing from my experience, let it be this. Decide how you get paid, and delegate that pressure point first: billing if you bill insurance, patient-facing overhead if you are cash-pay. Delegate early rather than at the point of pain, because the mistakes made while you wait are the expensive ones. Trust the specialists you bring in, or move on quickly if they do not perform, but do not spend your own high-value hours overriding them. Growth is a good problem. It only becomes a bad one when the administrative load grows faster than your willingness to hand it off.

 

Ashleigh headshotAuthor’s Bio:

Ashleigh Atuahene is co-founder of Ataraxis. Before building the company, she provided one-on-one ABA therapy under a licensed therapist and spent years in healthcare administration, handling patient intake, scheduling, prior authorization, insurance, and documentation across pediatric, internal medicine, and behavioral health practices.

 

References

American Medical Association. (2025). 2024 AMA prior authorization physician survey. American Medical Association.

Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753–760.

 

 

 

Please also review AIHCP’s Managed Health Care Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification