Helen MacDonald

Anesthesiology and internal medicine.

So in some ways you think, well, that's kind of justified because those people are probably the people that are dealing with chronic pain.

But at the same time, they sort of make a suggestion that not all of that prescribing can be

So they say that those top prescribers are consistently prescribing well above the CDC recommended opioid doses and durations for the management of chronic pain.

So they think that there's something unusual about that group of people.

And it's quite interesting because I like the way that they try to apply this to then what should happen in the real world.

And their suggestion is that with this top centile, there's clearly a group of people that have sustained high prescribing over time and their patients are perhaps at the highest risk of harm.

So they suggest that those are the target clinicians or maybe they're not clinicians, they're healthcare services, whatever provider means in this paper.

They're the places to target for education and support for clinicians on prescribing.

And that might be a better approach if you want to minimise inappropriate prescribing than just targeting blanket education initiatives at everybody.

Because it actually seems to be a much smaller proportion of prescribers who are doing that work.

Yes, I think that's what they're saying when they're looking at the prescriptions above and beyond the CDC recommendations because that's very similar to what they lay out in the paper, that short-term defined duration.

Well, my start was to start looking at your opioid prescribing and comparing it to other people, not in a judgmental way.

If you're high or if you're low, I don't know that that means that you can be either very pleased with yourself or disappointed with yourself, but just really as a signal to look at your practice.

And if you had problems, Carl, I think other people will struggle.

Which, of course, is important here because if you're treated for lung cancer, there may be harmful things given to you that may cause your other reasons for dying to increase.

What's a natural frequency?

I think we should explain that.

Interestingly, I was just looking up while you were talking, I was looking at the consort statement which is the reporting guideline for trials to give researchers guidance on what information to include in their journal publication and in the results section on the outcomes and estimation item 17b it says for the outcomes you need to present both the absolute and the relative effect sizes

So that's interesting, isn't it?