Filling In The Patient History Interview: Fill & Download for Free

In other countries, it goes: Money (tax dollars) → DoctorIn the United States, it goes: Money → Health Insurance CompanyAnd then, the health insurance company does everything in its power to deny claims and limit its liability, and then it gives its CEOs a big fat bonus, and then it spends billions on advertising, and making sure they remain profitable, and insuring the folks who need coverage the least, and not insuring the folks that need the most payout. All to support a for-profit system designed to enrich the owners or shareholders.And then, Money → Health Insurance Company → For-profit chain of healthcare clinics and hospitalsWhere the goal is, once again, to make profit. The hospital is owned by another company whose goal is financial gain. And, their goal is to get as much money from the insurance companies as possible, and their other goal is to collect as much as possible from medicare and medicaid, so, for example, Florida Governor Rick Scott’s old company bought up a bunch of hospitals and assigned each hospital a manager whose goal was to generate as much profit as possible, and then they went on to commit a bunch of fraud, wherein they tried to bilk the US government out of billions of dollars in fraudulent payouts. They then were forced to pay the largest fine in US history to the government. To this day, fewer and fewer independent hospital chains exist in Florida, most are owned by fewer and fewer competitors.So, you have to pass through the for-profit Insurance company layer, which adds no value and costs a lot, then you have to pass through the for-profit Healthcare Provider company layer, which adds no value and costs a lot, before you even get to the Doctors.And here, since there’s already a ton of scamming going on, let’s add several more layers of scamming.The drugs. The generic drugs are cheap to manufacture and easy to make. But, we’re in this business to make a profit, so the Pharmaceutical companies convince Healthcare providers to get the name brand, most expensive possible drugs. So you get charged 300 dollars for a single generic painkiller that costs pennies to make.If the Insurance company is willing to pay, then fine. If the welfare system is willing to pay, then fine. And if neither are willing to pay, well, you can always just send the patient a bill, far exceeding any amount they could ever reasonably generate at a standard and common wage, ruin their credit, and bankrupt them. And the ruin that can befall them compels them to try to pay that outrageous amount of money, so, even the poor end up spending every nickel they can scrape together.And, eventually, after all these filters, some of the money eventually ends up in the hands of the doctors and nurses actually giving the patient treatment.Money (out of pocket, and in taxes to pay for Medicare and Medicaid) → for-profit Health Insurance Company → For-profit chain of healthcare clinics and hospitals → for-profit Pharmaceutical companies —→ Doctor, at long last.Meanwhile, as I mentioned above, places with single payer Universal Healthcare skip a lot of these filters and greatly remove a lot of the unneeded profit generation from the system.No Health Insurance companies profiteering, means that there is no longer an incentive to deny claims, not insure people, not pay for treatment. No monopoly of for-profit healthcare clinics eating up all of the patient’s alternative choices means that hospitals themselves don’t get away with jacking up the price throughout an entire region, like Rick Scott’s company did. Generic, easy to produce, low cost pharmaceuticals which do the exact same thing as a name brand drug, also reduce costs. So, the only things you really end up paying for are the doctors, their staff, the cost of medicine, the cost of the facility, and the cost of shop stock.And the doctor knows they’re getting paid, exactly what the bill costs. No one doesn’t have coverage, because everyone does. So the Doctor never has to ask you for your insurance information, have you fill out complicated forms, and your copay (out of pocket cost) is affordable even if you were unemployed and on welfare. Literally no one cannot afford to go see a doctor, and if they somehow didn’t have enough income to pay, like they were an uninsured visitor in the country, the government reimburses the doctor for the small copay.The doctor’s goal is to heal the sick and get paid for his time. He doesn’t work for a hospital administrator slash CEO who has a deal with Big Pharma to upcharge every patient with name brand prescription drugs, a CEO that earns millions of dollars a year working at a hospital, whose job it is to make his company money, not deliver the best possible care. And, of course, buy up every other hospital in the region so you have no choice but to use facilities they own in an emergency.You have to understand the depths of depravity and greed of the typical American politician / businessman, and understand that Donald Trump and Rick Scott are not outliers: These are typical politician / businessmen.Their goal is to make billions for themselves, at taxpayer expense, through unethical but technically legal means, and even illegal means they can get away with, and if a few thousand patients have to die in the process, who cares.Oh, and let’s make sure that we hire non-union nurses and other assistants, give no healthcare coverage to the on-call / float staff who work in our hospitals, and charge one of our own nurses tens of thousands of dollars for care from a single, simple bacterial infection and standard antibiotics. Because, why not nickel and dime and thousand dollar bill our own fucking staff while we’re at it?Why screw over patients and taxpayers, when we can screw over patients and taxpayers AND our own staff?That’s the state of healthcare in Florida, a large state in the USA.Meanwhile, in Norway, most of the costs go directly to the doctors and nurses who know for a fact they’re going to get paid, and have no incentive from big pharma not to recommend the generic version of the pills they prescribe. And there are not multiple layers of no-value-added corporate bureaucracy that simply exist to jack up the price and still leave the biggest costs and co-pays in the hands of the patient wherever possible.I cannot describe for you how jarring it was to live in the USA for over 30 years, born and raised, and deal with the nightmarish healthcare system there, and then come to Norway and deal with 20 dollar doctor’s visits, 200 dollar surgeries, a maximum copay per year, cheap generic drugs, and much higher wages to begin with, making everything even more affordable, since we have, ya know, unions here.It was insane. I’ve been to the doctor dozens of times, each time getting excellent care, and for something I actually needed. Anti-depressant medication which I could never afford in the USA. Surgery on my foot. My wife and I needed help with starting our family, and we got help there as well. I have sleep problems, and actually got prescription sleep meds. If I am sick, I actually GO TO THE DOCTOR now.I’ve been to the dentist for the first time in decades. Why? Because I can actually afford to go, even if it is not covered by the universal system. Why? Because the dentist’s model is similar to the doctor’s model. So much of the unnecessary profit-adding layers don’t exist here.In Norway, I am paying what it costs to treat me, and give the doctors and nurses a cushy paycheck.In the USA, I was paying what it cost to treat me, what it cost to make several healthcare administrators filthy rich, what it cost to fund Rick Scott’s entry into political life and become the governor of Florida, what it cost to make Pharmaceutical companies insanely rich, what it cost to pay for all the patients who went without healthcare coverage at all and allowed themselves to get credit hits for not paying, and what it cost to make insurance companies rich.That always costs more than single payer universal healthcare.And if there was one message I wish every single person in the United States would absorb into their brain and finally agree with, it is that you already spend way more than what single payer healthcare costs.So whenever they try to scare you by saying “Bernie Sanders’ universal healthcare scheme will bankrupt America! It will cost trillions to implement!”Always ask, how much does the US public, the consumer, already spend on healthcare. They already spend trillions more than that figure on a private healthcare system that doesn’t cover everyone, doesn’t treat everyone, and people avoid using and literally die because they can’t use.You will save literally trillions of dollars, and get better care, and the people having that conversation will be you and your doctor, not you, and a doctor who has to make sure that the hospital administrator’s supply costs don’t go over budget this quarter, or else he won’t get to fly to Maui this month.Will switching over to a better system be difficult? Yes.Should you probably do it in steps, like expanding medicare incrementally? Possibly. But the end goal should be that every man, woman, and child in the USA is covered by a public option, and they don’t have to use a private insurer.Then, make it standard practice that you use generic drugs instead of drugs priced purely for profits. “Do you want the name brand drug for 400 dollars a bottle, or this generic equivalent that uses the same exact formula and has the exact same effect, and the pills are 20 bucks?”Then, if people want to still buy gold plated for profit insurance and spend on name brand drugs, and only use the greediest chain hospital in the land that grossly overcharges them and spend a ton more than is necessary, they have that option. No one’s freedom has been curtailed.And the government can use its negotiating power as the single largest, united healthcare market, to negotiate with the healthcare provider companies over the cost of care.You won’t get charged 30,000 dollars for a week’s stay at a hospital for basic monitoring and cheap ass antibiotics.The government won’t pay that, but will require you to treat the patient anyway if you want to accept any other money. So, all of a sudden, it will be a lot less profitable to make a chain of businesses whose sole purpose is to bilk the government and coverage providers out of their money, ultimately, to bilk the patient.They’ll say, fair market value for that treatment is 10 times less money than that, and we will pay that much, and the consumer will pay 10 percent of that amount.Amount owed to hospital: 3000Amount paid by patient: 300Amount they used to charge: 30,000Amount the patient used to pay out of pocket: thousands.Total cost to the consumer: between 2 to 10 times less, depending on how much of the original cost was pure greedy businessman fat.But, of course, in order to make these changes, you need to have almost zero Republicans (like Donald Trump or Rick Scott) in office, and you sure as hell won’t get significant changes passed while center-right politicians like Obama or Clinton or Nancy Pelosi are in charge of the Democratic party.The drug companies, insurance companies, and other corporate interests make too many billions, and they don’t mind paying a 1 percent tax of donating millions to politicians from both parties in order to keep the system in the USA the way it is.Meanwhile, in Canada, UK, Norway, and over 100 other countries, you can get far, far cheaper healthcare with better or equivalent results for the patient, all of them with some variant of a universal healthcare model.List of countries with universal health care - WikipediaThat’s just ones with a fully universal system.There are even more that are not.I get tired of the USA lagging behind the modern world in countless categories of governance. Healthcare cost and coverage being just one of those categories. Being a den of violent crime and murder is also terrible.40 years of center right to far right and authoritarian policy is to blame, but people keep voting to move both parties further right and more authoritarian, despite the bad results they bring.Wages in the USA stagnate, costs skyrocket, landowners and shareholders make billions, the working class gets nothing, and doctors and nurses deal with the nightmare of working under administrative penny pinchers whose sole motivation is to separate the patient from his money, and navigating the nightmarish sea of insurance companies denying claims or not covering patients who are bleeding to death on their hospital beds, and they’re legally required to render aid and assistance, not to mention morally obligated.What a stupid system, for everyone in the USA except the super rich.I can’t think of a single policy that should be more unpopular than this, and yet, it’s not going to change, ever, so long as Republicans retain at least 40 seats in the Senate, or the filibuster still exists.70% of Americans now support Medicare-for-all—here's how single-payer could affect you70 percent support universal healthcare. Still could never pass in this corrupt Congress controlled by Republicans like Trump who campaigned on making sure everyone was covered, much more cheaply. Which was a lie.6 promises Trump has made about health care“We’re going to have insurance for everybody,” Trump said in an interview with The Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”I am also tired of Trump lying to people, but that will stop being such a big problem when he’s no longer the President.

It's a pretty awesome place to work. There are actually several different positions for nurses in the OR, each with very different scopes and responsibilities. I can speak to one of the roles that I have worked in.Circulator- This is the nurse that brings the patient into the OR. They verify it's the correct patient, ensure the consents were properly filled out and signed. They interview the patient and make sure they understand what's about to happen and who their surgeon is.Before this step they check to make sure all pre-op meds are given and that the doctor has written a history and physical (here's a major source of delay, ahem). After these t's are crossed and i's dotted we escort the patient into the OR and introduce them to the team. (I'll spare you all the cat herding that's involved with getting these people there, but if it's an emergency, it's a major process.) This is often the last memory most patients will have.Having been a patient myself for surgeries, I remember scooting myself over from the gurney to the OR table, and then nothing. I know from standing on the other side, that this is when the anesthesiologist pushes the happy juice, which doesn't actually make you unconscious, but relaxes the crap out of you while erasing all memories of what's happening.If the patient is getting a spinal as opposed to a general, then we help with positioning the patient for placement. Once anesthesia is in, we then position the patient for surgery. We do an initial count with the scrub of instruments, needles, sponges, and prep the site for surgery. Not necessarily in that order. While we are doing these things we are also tying gowns for doctors, connecting things like suction and the cautery, receiving objects from the sterile field that aren't needed, or, depending on the surgeon, holding open the trash lid for them to attempt a two pointer.This is the part that should move like a well oiled machine. You get to know the routine so well that it turns into a kind of routine dance( Roll trash to the corner, pivot and carefully grab the surgeons ties, tie, tie, tap. Now spin and tie the assistant, tap. Now turn and grab the chart and announce "Time out!")"Time Out" means everyone needs to freeze and shut up while we verify that yes, this is the right patient who signed the consents, what are their allergies, what is the procedure etc. and then we all need to agree. After that, the surgeon (after they have verified anesthesia is working, usually by grabbing skin with a clamp and announcing "checking") makes the cut. It's at this point the circulator can take a breath. The main job during surgery is to observe the field to ensure sterile technique isn't broken, and be available to get items that might be needed and then hand them over to the scrub while maintaining their sterility.It's usually at this point that I grab a stool and position myself with the computer so that I can observe and start the charting. Depending on the surgeon, anesthesiologist and assistant, the OR can be very quiet or we can play music and have lively chats. It's very individual. The crew and surgeon are often just randomly thrown together and the atmosphere resembles a dinner party where none of the guests really know each other. Other times it can be like a Friends reunion with witty banter and non stop teasing. It's always the surgeon that sets the tone.If everything is going well and it's routine, that's when the relaxed chatting is happening. If there's a complication or a concern then there's usually silence or the quiet discussion between the people who are scrubbed in. This is when I position myself to closely watch and listen. As the circulator it's always wise to be at least one step ahead of the surgery. If I'm seeing complications or hearing the scrub ask the surgeon if they need a different suture or retractor that isn't on the table, then I'm already pulling it. If they're making a request of the anesthesiologist who is looking tuned out, then I ask "Did you just say..." in a voice loud enough to puncture any reverie they might be engaged in.The feeling of terror does occasionally present itself. Not often, but usually at 2 or 3 am, when you feel like the OR is a remote island where you'll never be reachable by reinforcements. Watching blood shoot from an artery or just silently well up from the incision site so that the field is a pool of blood makes your brain both freeze and spasm simultaneously. It's bad when all you can do is exchange looks. This is when shit goes sideways and it feels like a wild bird is trapped in your chest.Thankfully, this moment passes and you're moving by instinct and training. This will always involve getting on the phone and calling someone. Culling resources and organizing them is really the circulator's job. You can't physically help them, but you can contact other people who can. I've called general surgeons, vascular surgeons, and more OR crew, who were at home from the OR to request they hustle in. I've called blood bank and had them prep a massive hemorrhage tray. I've called out to the floor and requested every able body be assigned tasks. When you go into a case knowing it might go sideways, you already have these people tapped. They know you'll need them at a moment's notice and are ready. And usually, because of this, nothing will go wrong. The more prepared you are, the less likely the Gods of Shitty Outcomes will bother you.You also have to be superstitious and perform the proper sacrifices to be an OR nurse.Once surgery is over, the closing counts done, you're back in the drivers seat and helping with cleaning the patient and applying the dressing. If the patient is coming out of a general there can be some down time while the anesthesiologist is waking them up and feels comfortable that the patient is competent to breathe again. This is indicated by the patient spitting out the airway.Once you have transferred the patient on to the gurney (there's an awesome little invention called a "rollerboard") then you and the anesthesiologist roll them into the PACU, or the post anesthesia care unit. There's another nurse waiting, and together you put on the monitors and get the patient settled while the anesthesiologist gives them report.After your official hand off it's time to take care of the charting and labeling of specimens for pathology. You ensure housekeeping gets in there to turn the room over asap, even if you don't have another case planned. A dirty room is just another way of tempting fate. Which you never want to do.

GrammarlyIn my third year of Podiatric Medical school, one of my rotations was Emergency Medicine. While there, I saw my share of problems ranging from the bizarre (like the ubiquitous set of X-Rays shared by residents with any student passing through showing "anal insertions gone wrong"- seemingly a staple of the student ER experience) to the mundane.One of my more exciting experiences involved a well known homeless individual described by the nurses as a "frequent flier" A glance at his past medical history showed that he had been admitted to the hospital on numerous occasions for the treatment of complications associated with uncontrolled diabetes. Of concern was the patient's severe Diabetic neuropathy with documented damage to the peripheral nerves in the feet that resulted in absent or diminished pain sensation.Because the patient was a member of the homeless population with a history of noncompliance with prescribed medical treatments the patient probably did not routinely self-monitor for injury. Further, a lack of hygiene, proper diabetic shoe gear or any other kind of suitable footwear put the patient at high risk for infection, ulceration and a host of other diabetic related foot problems.After greeting the patient, my interview revealed that the patient had come to the ER seeking medication for his diabetes and other health problems. He complained about pain in his right foot. That's when I noticed the patient wasn't wearing shoes. Instead, newspaper and rags were wrapped around his feet.My visual inspection revealed that all five toes on the right foot were black (defined as an eschar which is dead tissue associated with burns, spider bites, vascular compromise or infection usually gangrene) and the skin of the midfoot behind the blackened toes was red and swollen. When palpated, an audible crunch could be heard ( this is crepitus- resulting from gasses trapped under the skin associated with gangrene infection. Additionally, a foul, but not overpowering odor was present. This was pretty serious. I ordered labs and a consultation with a podiatric physician.The next day, I was invited by the attending Podiatric physician to review the case and scrub in for any surgical intervention. The radiographs of the right foot confirmed the presence of gas in the midfoot and damage to the bones of the forefoot an ominous sign. The plan was for a forefoot amputation (complete or partial removal of the metatarsal bones): incision and Drainage and surgical debridement of any infected midfoot tissue.The surgery began with a small incision on the lateral aspect of the right foot. Immediately, a thick, yellow, foul-smelling discharge poured out a seemingly endless river of pus and liquefied tissue. Additional incisions were made on the medial and dorsal aspects (the top of) of the midfoot with the same result. The presence of isolated pockets of infection is the usual clinical presentation, not this time. There are four layers of muscle in the foot. Typically, each layer can be distinguished visually. In this case, all four layers of tissue were practically dissolved making any such distinction impossible. Unfortunately, a mid-foot amputation would have to be performed.Now, the icky part you were waiting for. The practice of Podiatry is rife with unpleasant odors. Wound care especially. The literature describes the smell associated with Pseudomonas- as fruity and grape-like. Not this time. The noxious odor that emanated from the patient's foot was an infernal mixture of dangerous toxins produced by the bacteria as they dissolved the soft tissues of the patients midfoot. It was without a trace of hyperbole-the most disgusting smell that would ever smell while I was a medical student. Soon, the entire operating room was filled with an odor that I likened to "hot garbage" It was so bad that the scrub nurse and the surgical assistant absconded, leaving me to assume their duties. Even the anesthesiologist discarded her professional demeanor and walked out, returning intermittently to monitor vitals. I wanted to follow, but I soldiered on. Seemingly unaffected was my attending focused like a laser on his work.