This may or may not have really happened. All names have been changed to protect the guilty.
Picture THIS:
Med student comes out to give me report on a new patient he just saw and the report I got went something like this:
Student: Well, first of all he says his name is Burger King.
Me: Burger King?
Student: yes, apparently we are supposed to know this already.
Me: let's go meet this guy
Me to patient: Hi, I'm Jane, the nurse practitioner with the hospitalist service, I will be seeing you today; the med student gave me a report that you were having some chest pain.
Patient: Yes, I was, but that ativan is all I need, I been telling the ER and now him and now you, that's all I need. And you know I'm Burger King, right?
Me: (further into the history) - do you do any street drugs?
Patient: Me? Hell, I've done them all in the past, not anymore though, not since 2011. No, really, it's been a long time, not since I became Burger King. I used to do it all, pot, special K; HORSE TRANQUILIZERS - but I don't drive when I do them.
This was the point where I burst into laughter and said THANK GOD FOR THAT!
Saturday, March 26, 2011
Sunday, March 20, 2011
The Hartikle Hernia in My Sokaphus and Other Appalachian Afflictions
The Hartikle Hernia in my Sockaphus...and Other Appalachian Afflictions
So here it is...my anonymous blog. You may not know who I am, but then again, if you were personally invited here, you might figure it out.
I work as a nurse practitioner in a small community hospital somewhere in Appalachia. I am a pure bred, home grown girl myself, which I feel gives me license to poke a little fun and give you "outsiders" some insight into this culture where there's never a dull moment and the language is as foreign to many Americans as German is to me.
The title of this blog was inspired by today's " butchering" of the medical language by (let's call her) Butch.
Picture me, (nurse practitioner) reviewing the history with the SUPER DUPER medical student (go Jamie) before going into the room, so I already knew why she was there and what we MIGHT be planning. Picture me writing notes as she's telling me her story, and med student writing notes as well.
First of all, Butch is kinda out of work, because you see she had a run of bad luck and was born, as my Indian friend says "d-lazy." Anyway...she has this pain in her abdominal that has been there for 3 years and today she just can't take no more. Yesterday, she called down yonder to the GI doc's office and insisted that the doctor had to see her "right now." She was there 14 months ago and had an ulcer "THIS BIG" (makes the shape/size of a basketball with her hands), "he said it was the biggest one he's ever seen!" WELL, I might have been more impressed but so far this week, four patients have told me they had the biggest ulcers that doctor ever did see ...anyhoo (rolling my eyes).
When she saw that clearly I was listening and interested enough to write all this down, she decided to elaborate further and tell us how she has a "hartikle hernia," (I'm not sure I spelled HARTIKLE correctly since it's not a real word). As if that still isn't enough to make me call Lifestar and fly her to Mayo Clinic, she proceeds to tell us that her sockaphus (?is that the same thing as an esophagus?) is "swole up all the way from my neck to here (points at pelvic area)". OMG! Get the crash cart ready, by golly, I just passed ACLS and might get to use it!
So with all this, aren't you wondering what happened between calling the doctor's office and going to the hospital? She came in because she is uninsured and the doctor asked for her to pay a small amount of her balance prior to the visit. So she figured she'd just come to the hospital and get it for free. FREE? WTH?
Oh, yeah, I almost forgot that one final attempt at sympathy and letting her stay to have a million dollar work-up that she never plans to pay a dime on - an ER doctor told her she has a "mask" on her lung and it might be cancer. I got the name of this doctor and he's on my list for the next batch of egg salad gone bad.
When when Jamie and I left the room, we compared notes from our history-taking adventure. Both of us had written three words "hartikle," "sockaphus," and "mask."
I'll miss you, Jamie, you brought smiles to my day - your patients are going to love you :) I'm glad I could teach you how to take good notes!!!
Hey, Y'all, watch 'iss!
Sunday, January 30, 2011
What is a Nurse Practitioner? (another old post reposted)
I was saddened to see an advertisement in the local paper for a new clinic which will be opening up. I'm very happy about the clinic and the fact that a good friend of mine will be the Nurse Practitioner (NP) there. She starts in a couple of weeks. Until then, another NP friend of mine is filling in. They had a ribbon cutting ceremony and pictures were taken outside the building for the local paper. This photo included staff members from the clinic, including a very professional-looking NP, the clinic manager, a "supervising physician," and some local "important people." All this looks great on the surface to the casual observer. Then I read the article. The only mention of the NP was to say that she is "a good listener." Well so what?? Plants are good listeners. Don't get me wrong, listening is a skill that all medical providers need to master, because most of our work is accomplished and proper diagnoses are made because we listen; but one must have an education and some experience with diagnosing and treating illness to go along with those listening skills. I happen to know this particular NP has excellent diagnostic skills, which is what a patient needs to be assured of when seeking out a healthcare professional. Why do you think patients seek out the most qualified person for the job when looking for a healthcare provider? I can listen to her all day, but if I don't know how to diagnose or fix the problem, I'm not of much use to the patient.
The second issue I have with this article is the fact that a medical doctor was interviewed for the article and will have very little to do with the operations of this clinic. You see, in Tennessee, nurse practitioners are required to have a doctor come in and sign off on 20 percent of our charts (100 percent of any charts where a narcotic is written). This does not mean we are working "under the doctor," as so many imply. We are working under our own license and our own DEA prescribing number. They are simply paid to review some charts and put a signature on them. You see how ludicrous this is. Don't get me wrong, the doctor they interviewed is a wonderful guy, and a great doctor. I simply find it so sad that we feel we must give patients the illusion that a "real doctor" is somehow involved in operations of the clinic.
For those of you who don't know, NPs have at least at Master's Degree, which is 6 years minimum. For many of us, it also includes several years as an RN before completing those years of school for the NP degree, which was a priceless part of my educational process. I want to spread the word that we are here to stay, we don't need to hide behind a doctor's name, we have one of our own. Patients have a choice to see us or not, we are not pulling the wool over their eyes or trying to be deceitful just to get patients.
Most NPs, like most MDs do a good job. I urge you to see the difference for yourself. You may not notice any. You may have a bad experience. You may find the provider you want to stick with as long as you live. I just ask that you know who you are seeing and that you give the credit to that person alone for the care they provide.
The second issue I have with this article is the fact that a medical doctor was interviewed for the article and will have very little to do with the operations of this clinic. You see, in Tennessee, nurse practitioners are required to have a doctor come in and sign off on 20 percent of our charts (100 percent of any charts where a narcotic is written). This does not mean we are working "under the doctor," as so many imply. We are working under our own license and our own DEA prescribing number. They are simply paid to review some charts and put a signature on them. You see how ludicrous this is. Don't get me wrong, the doctor they interviewed is a wonderful guy, and a great doctor. I simply find it so sad that we feel we must give patients the illusion that a "real doctor" is somehow involved in operations of the clinic.
For those of you who don't know, NPs have at least at Master's Degree, which is 6 years minimum. For many of us, it also includes several years as an RN before completing those years of school for the NP degree, which was a priceless part of my educational process. I want to spread the word that we are here to stay, we don't need to hide behind a doctor's name, we have one of our own. Patients have a choice to see us or not, we are not pulling the wool over their eyes or trying to be deceitful just to get patients.
Most NPs, like most MDs do a good job. I urge you to see the difference for yourself. You may not notice any. You may have a bad experience. You may find the provider you want to stick with as long as you live. I just ask that you know who you are seeing and that you give the credit to that person alone for the care they provide.
Working Weekend (old post re-posted)
Convincing people
That they really did not need to be there.
That a hangnail could be treated as an out-patient;
And that going out to smoke every 30 minutes
Well - probably was having a negative effect on the outcomes of the care I was Trying to provide.
That swallowing a toe ring
Probably had nothing to do with the abdominal pain.
What did you do this weekend?
p.s. don't try to figure out who these patients were, I made it all up.
"He Saved My Life!"
Nurse Practitioners are becoming more recognized by healthcare organizations because of our financial contributions to the bottom line, and salaries are finally starting to reflect that. However, if you think for one minute that you will be recognized for your excellent exam and diagnostic skills, you might consider getting your head out of the sand. Granted, there will be that one physician, and the handful of patients who notice when you are able to diagnose and treat something other than a sinus infection or UTI, but beyond that, most people we care for would prefer if you call an emergency consult with the pulmonologist for their community acquired pneumonia, or the gastroenterologist for their chronic abdominal pain cause by too many narcotics and blocked plumbing.
So you diagnose this CVA, after the patient was admitted with sinusitis and "cant swallow," you start Plavix, order a swallowing study and rehab, and for safety's sake, you order a Neuro consult because it's expected. Nothing will kill an ego quicker than for a family or patient to say " yeah, that Dr Saint saved my life, I know he did, he's really good ." the appropriate response to this is NOT " oh, actually I did that!" Although that's exactly what we want to say, it's not very good PR for when you really need the neurologist. Just agree and "manage up" your specialists, it will get you much more respect and the patient will at least realize that you, the nurse who "almost made a doctor," are part of the TEAM that has provided the best care possible. This is the part where you take a deep breath, roll your eyes (don't let them see you,) and smile.
So you diagnose this CVA, after the patient was admitted with sinusitis and "cant swallow," you start Plavix, order a swallowing study and rehab, and for safety's sake, you order a Neuro consult because it's expected. Nothing will kill an ego quicker than for a family or patient to say " yeah, that Dr Saint saved my life, I know he did, he's really good ." the appropriate response to this is NOT " oh, actually I did that!" Although that's exactly what we want to say, it's not very good PR for when you really need the neurologist. Just agree and "manage up" your specialists, it will get you much more respect and the patient will at least realize that you, the nurse who "almost made a doctor," are part of the TEAM that has provided the best care possible. This is the part where you take a deep breath, roll your eyes (don't let them see you,) and smile.
Saturday, January 29, 2011
We're Not Going Away
As I browsed my twitter account today, I came across a post that mentioned me and was curious, so I clicked on the link and found that I couldn't just sit by and let his post stand alone without a rebuttal. Dr. Wes was confused as to why I was a "self-procalimed" hospitalist NP.
You see, I work in the hospital setting with a group of physicians that care for inpatients when their primary care providers choose not to come there. This group of providers is called "Hospitalists." Therefore, I am a Nurse Practitioner Hospitalist. As far as I know, there is not a copyright on this title or the title of "doctor" or "physician." Do I introduce myself as a hospitalist? No (because patients still have no idea what that is). I always say I'm a nurse practitioner (most do know what that is in our area, as we make up the majority of primary care providers in our community), and I tell them what I do. Depending on the patient, I may say " I work with the hospitalist program," or I may just say "I work with the hospital's doctors' service (because let's admit it, everyone still calls their provider a doctor whether they are or not), we take care of you while you are in the hospital, and we communicate back to your doctor or nurse practitioner what happens while you are here." I tell them the name of the physician I'm working with that day, and that we work as a team. This description of what I do has not caused any confusion among my patients, although clearly it's the quick-to-remind-me "real doctors" who are confused.
Initially, I took it personally (for all NPs). Then I read a few more of his blog posts, and realized I am just small beans in the huge pot of paranoia stew. To add fuel to the fire in my butt, he sent me a message that said "No doubt you're great, and relatively cheap, for your hospital-employer." I had to tell him that the hospital does not employ me, a group of physicians does, and of course it's all about the money. In turn, I asked how he would feel if he were referred to as "over-priced." No response.
In another tweet, he said it "devalues our degrees and hospital-employers are encouraging this. Doctors should take notice." Really? My employer is a physician owned group of providers who provide services to hospitals (not hospital-owned). The hospital pays the same amount monthly for our services, so obviously, again, it is about the money as I make one half the salary of my doctor/supervising physicians, making it possible to have more staff available for the same price. However, they have a job much more difficult than mine, including seeing and signing all my charts, seeing the critical care patients, and taking call 24/7. Our company, and many others, realize the quality of care they get for the price with NPs, and when they pair us up with a quality physician, they get more bang for their buck. Insurance companies reimburse for our services at 85 percent of the physician fee, we work under our own license (not the physician's,) we cost half the price of a physician, so anyone with any financial accumen at all would see the benefit in this.
This was the second physician I've been in contact with recently who needed a little education. One of the orthopedic docs I work with recently said to me, when he was looking for someone to do rounds and help in surgery (and he thought he needed a PA, but I suggested one of our NPs who worked in acute care), and he said "nurse practitioner, that's like LPN, right?" Seriously.
This article is a great complilation of just a few of the studies that have been done to demonstrate NP competency and quality of care, as well as patient satisfaction (which is the ultimate quality indicator).
It really doesn't have to be "us against them," but sometimes it sure does seem that way.
You see, I work in the hospital setting with a group of physicians that care for inpatients when their primary care providers choose not to come there. This group of providers is called "Hospitalists." Therefore, I am a Nurse Practitioner Hospitalist. As far as I know, there is not a copyright on this title or the title of "doctor" or "physician." Do I introduce myself as a hospitalist? No (because patients still have no idea what that is). I always say I'm a nurse practitioner (most do know what that is in our area, as we make up the majority of primary care providers in our community), and I tell them what I do. Depending on the patient, I may say " I work with the hospitalist program," or I may just say "I work with the hospital's doctors' service (because let's admit it, everyone still calls their provider a doctor whether they are or not), we take care of you while you are in the hospital, and we communicate back to your doctor or nurse practitioner what happens while you are here." I tell them the name of the physician I'm working with that day, and that we work as a team. This description of what I do has not caused any confusion among my patients, although clearly it's the quick-to-remind-me "real doctors" who are confused.
Initially, I took it personally (for all NPs). Then I read a few more of his blog posts, and realized I am just small beans in the huge pot of paranoia stew. To add fuel to the fire in my butt, he sent me a message that said "No doubt you're great, and relatively cheap, for your hospital-employer." I had to tell him that the hospital does not employ me, a group of physicians does, and of course it's all about the money. In turn, I asked how he would feel if he were referred to as "over-priced." No response.
In another tweet, he said it "devalues our degrees and hospital-employers are encouraging this. Doctors should take notice." Really? My employer is a physician owned group of providers who provide services to hospitals (not hospital-owned). The hospital pays the same amount monthly for our services, so obviously, again, it is about the money as I make one half the salary of my doctor/supervising physicians, making it possible to have more staff available for the same price. However, they have a job much more difficult than mine, including seeing and signing all my charts, seeing the critical care patients, and taking call 24/7. Our company, and many others, realize the quality of care they get for the price with NPs, and when they pair us up with a quality physician, they get more bang for their buck. Insurance companies reimburse for our services at 85 percent of the physician fee, we work under our own license (not the physician's,) we cost half the price of a physician, so anyone with any financial accumen at all would see the benefit in this.
This was the second physician I've been in contact with recently who needed a little education. One of the orthopedic docs I work with recently said to me, when he was looking for someone to do rounds and help in surgery (and he thought he needed a PA, but I suggested one of our NPs who worked in acute care), and he said "nurse practitioner, that's like LPN, right?" Seriously.
This article is a great complilation of just a few of the studies that have been done to demonstrate NP competency and quality of care, as well as patient satisfaction (which is the ultimate quality indicator).
It really doesn't have to be "us against them," but sometimes it sure does seem that way.
Low Carb
Since it's the beginning of a new year, I usually try to start out by making some healthy changes. I'm happy to say I stuck to a healthier diet for the most part last year, more than previous years. UNTIL the last couple of weeks of December, then I ate everything in sight it seemed. Diabetes runs in my family, so since I am not getting any younger or thinner as each year passes, I am trying to ward it off as long as I can.
If you or someone you know is diabetic, I'm sure you have seen all the conflicting information out there regarding diabetes. As a nurse practitioner, conversations with diabetics or pre-diabetics are a part of my day - every day. What I have found is:
1. diabetics are confused
2. too much information is bad sometimes
3. due to time constraints, there is no way to get into all the "details" of dieting.
How do I know who to believe, what to read, what to eat/not to eat? If you will follow a few simple rules, whether you are diabetic or just want to lose a few pounds, glucose levels will come down; and, even if they are not "normal," I'm sure you will see a major improvement in your energy level and lab results.
When I have 5 minutes to share with someone, I advise them to follow the "No White Diet" In other words, if it starts out white and powdery (cocaine doesn't count), it will "run your sugar up" and cause you to deposit fat around your abdominal area. So what's considered "white?"
*flour
*sugar
*corn meal
*pasta
*rice
*potatoes (ok, they are not powdery but they ARE EVIL)
Remember, if it CONTAINS any of these ingredients, it's high-carb.
That means NO SODAS unless diet
No JUICE unless tomato or V8 vegetable (not the fruity kind) - fresh fruit is ok in moderation, but avoid over-doing it with the bananas. No canned fruit.
If you eat bread, limit it to one or two slices of very high fiber bread : I like this one:
(note it says "double fiber")
The good news: EGGS are white and they are ok - eat up! Try an omelet made with your favorite cheese and salsa, or do what I did and stuff it with your left-over New Year's Eve Spinach Artichoke dip - Amazing!
I will post more of these notes and low carb ideas if anyone is interested. Feedback is welcome.
Here's a link to a reputable medical journal research study in case you are interested:
http://www.annals.org/content/153/3/147.abstract
*Pink shirt above is available HERE
If you or someone you know is diabetic, I'm sure you have seen all the conflicting information out there regarding diabetes. As a nurse practitioner, conversations with diabetics or pre-diabetics are a part of my day - every day. What I have found is:
1. diabetics are confused
2. too much information is bad sometimes
3. due to time constraints, there is no way to get into all the "details" of dieting.
How do I know who to believe, what to read, what to eat/not to eat? If you will follow a few simple rules, whether you are diabetic or just want to lose a few pounds, glucose levels will come down; and, even if they are not "normal," I'm sure you will see a major improvement in your energy level and lab results.
When I have 5 minutes to share with someone, I advise them to follow the "No White Diet" In other words, if it starts out white and powdery (cocaine doesn't count), it will "run your sugar up" and cause you to deposit fat around your abdominal area. So what's considered "white?"
*flour
*sugar
*corn meal
*pasta
*rice
*potatoes (ok, they are not powdery but they ARE EVIL)
Remember, if it CONTAINS any of these ingredients, it's high-carb.
That means NO SODAS unless diet
No JUICE unless tomato or V8 vegetable (not the fruity kind) - fresh fruit is ok in moderation, but avoid over-doing it with the bananas. No canned fruit.
If you eat bread, limit it to one or two slices of very high fiber bread : I like this one:
(note it says "double fiber")The good news: EGGS are white and they are ok - eat up! Try an omelet made with your favorite cheese and salsa, or do what I did and stuff it with your left-over New Year's Eve Spinach Artichoke dip - Amazing!
I will post more of these notes and low carb ideas if anyone is interested. Feedback is welcome.
Here's a link to a reputable medical journal research study in case you are interested:
http://www.annals.org/content/153/3/147.abstract
*Pink shirt above is available HERE
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