© 2014 Jones and Bartlett PublishersChapter 3Refle.docx

© 2014 Jones and Bartlett Publishers
Chapter 3
Reflections of the Past
History is relevant to understanding the
Past, defining the Present, and influencing
the Future.
3
LEARNING OBJECTIVES
• Explain purpose of the Patient Protection and
Affordable Care Act.
• Describe how advances in medicine over the
centuries have not consistently been followed
& continue to serve as reminders of the need
to understand & build upon best practices.

4
LEARNING OBJECTIVES
• Explain how the conflicts of society due to
politics, religion, & warfare have often
impeded the growth of hospitals & at times
contributed to their progression and many
successes.
• Describe how the advances in medicine led to
the rise of the modern day hospital &
improved upon the quality of patient care.
5
Who Am I?
I was Created at the End of the Renaissance,
Watched Pirates Rule the Oceans,
As Ivan the Terrible Ruled Russia,
And witnessed the arrest of Galileo,
For Believing the Earth Revolved Around the
Sun.
I AM HISTORY

6
History, despite its wrenching pain,
cannot be unlived,
but if faced with courage,
need not be lived again.
−Maya Angelou
7
Hindu & Early Egyptian Hospitals
• 6th century BC: Buddha appointed a
physician for every 10 villages
– built hospitals for the crippled & the poor;
– Provided Fresh Fruits & Vegetables
– Administered Medications
– Provided Massages
– Maintained Rules of Personal Cleanliness

Hindu Physicians
• Took Daily Baths
• Keep Hair & Nails Short
• Wore White Clothes
• Respected Confidence of Patients
9
Egyptian Physicians
• Used Castor Oil & Opium
• Used Wooden Mallet for Anesthesia
• Surgery mostly limited to Fractures
• Medical Care in the Home
• Temples functioned as Hospitals
10
Early Greek & Roman Hospitals

• Hospital derives from Latin word hospitalist,
which relates to guests & their treatment
• Early use of these institutions not merely as
places of healing but as havens for the poor &
weary travelers
• Medical Practice Rife with Mysticism
11
Greek Temple Medicine - I
• Hospitals first appeared in Greece as Aesculapia
– named after Greek god of medicine
• Patients Presented Gifts before Altar
• Greek Temples - Refuge for Sick
• Holistic Medicine - Body & Soul
• Medications - Salt, Honey, Sacred Springs
• Hot & Cold Baths
• Sunshine, Sea Air, Pleasant Vistas
• Libraries for Visitors
12
Temple at Epidaurus
• 1st Clinical records

– Inscribed on columns of temple
– Recorded
• Patients Names
• Brief Histories
• Treatment Outcomes
13
Hippocrates – The Physician
• Noted for:
– Principles of Percussion & Auscultation
– Performed surgery
– Wrote about fractures
– Described Epilepsy, TB, Malaria, & Ulcers
– Maintained detailed records
14
Early Christian Era
• Hospitals Outgrowth of Religion
• Care included - Magical & Religious Rites
• Doctrines of Jesus - Love & Pity
• Sick treated outside temples & churches

15
Islamic Hospitals
• Luxurious hospital accommodations
frequently provided School at Gundishapur
• Medical care free
• Gundishapur
– home to world’s oldest known teaching
hospital
16
Persian Physician Rhazes
• Skilled in Surgery
• Used Sheep Intestines for Suturing
• Cleansed Wounds with Alcohol
• 1st descriptions of smallpox & measles
17
Islamic Medicine – I
• Inhalation Anesthesia

• Precautions against Adulterated Drugs
• Origination of New Drugs
• Asylums for Mentally Ill
• Brilliant beginnings in Medicine
• Promise that glowed in early medicine not
fulfilled
• Wars, Politics, Superstitions, stunted growth
18
Early Military Hospitals – I
• Limestone pillar – 2920 B.C.
– Pictures illustrating wounded
• Moses laid down rules of Military Hygiene
• Hippocrates – “war is the only proper school
for a surgeon”
• Under Romans, Surgery Advanced
– Experience through military surgery
19
Medieval Hospitals – I
• Religion – dominant influence in hospitals
• England built Municipal Hospitals

• Military Hospitals during Crusades
• Lazar Houses Established
Hotel Dieu of Paris
• Provided rooms for various stages of disease
• Provided room for Convalescents
• Provided room for Maternity Patients
• Two persons often shared 1 bed
• Draperies not washed, infection spread
• Patients often worked on hospital’s farm
Dark Age of Hospitals
• Hospitals Commonly crowded patients into
one bed
• Monks preserved the writings of Hippocrates
• Al-Mansur Hospital, built in Cairo in 1276
– Equipped with separate wards for the more
serious diseases
– laid the groundwork for hospital progress to come
in later centuries
22

Hospitals of the Renaissance – I
• Building of hospitals continued
• New Drugs
• Anatomy - Recognized Study
• New writings Printed
• New writings Printed
• Dissections Performed
• Surgery was more scientific
• Van Leeuwenhoek- Microscope
23
Hospitals of the Renaissance – III
• 16th Century
– Hospitals associated with Catholic Church
ordered by Henry VIII to be given over to
secular uses or destroyed
– Sick Turned into Streets
– Hospitals conditions intolerable
– St. Bartholomew’s restored
24
Hospitals of the Renaissance – III

• Long robed surgeons
– Trained in universities
– Permitted to perform all surgeries
– Royal College of Surgeons founded-1540
• Short robed surgeons (barber-surgeons)
– Generally allowed only to leech & shave
25
Hospitals of the 18th Century
• Royal College of Physicians Establishes
Dispensary
– Medications Distributed at cost to Poor
– Free Medical Care for Poor
– Controversies & lawsuits
• Untimely End to Early Clinic
26
Westminster Charitable Society
• Established Similar Dispensary in 1715

• Established Westminster hospital in 1719
– Infirmary built - voluntary subscription
– Staff provide services gratuitously
• Deterioration of hospitals continues
27
Early Hospitals in the U.S. – I
• Manhattan Island
– 1st account of hospital for sick soldiers
• Philadelphia
– 1st Almshouse Established - Philadelphia
– The Pennsylvania Hospital – 1st chartered
• Williamsburg, VA
– Site of 1st Psychiatric Hospital
28
Early Hospitals in the U.S. – II
• Hotel-Dieu Paris, Dr. Jones wrote
– 3-5 patients placed in 1 bed

– Convalescent patients placed with dying
– Fracture cases placed with infectious cases
– 1/5th of 22,000 patients died each year
– Patient wounds washed with same sponge
– Infection rate said to be as high as 100%
– Mortality after amputation as high as 60%
29
Early Hospitals in the U.S. – III
• Increase in Surgical Procedures
• Inappropriate Wound Care Administered
• Wards Filled with Discharging Wounds
• Nurses of that period are said to have used snuff to
make conditions tolerable
30
Late 19th Century Renaissance – I
• Nurses used Snuff to make Conditions Tolerable

• OR Coats Worn for Months without Washing
• Same Bed Linens Served Several Patients
• Mortality from Operations 90 to 100%
Late 19th Century Renaissance – II
• Florence Nightingale improves care
– Considered 1st hospital administrator
– Founded Nightingale School of Nursing -
1860
• Crawford Long uses ether as anesthetic to
remove small tumor
• American Medical Association founded - 1847
• Chloroform 1st used as an anesthetic - 1847
32
Mass General Hospital - 1846
• W.T.G. Morgan Develops Sulfuric Ether

• Morgan arranges for 1st operation under
Anesthesia, using ether vapors
– Surgery at Operating Theater - Mass
General
33
W.T.G. Morgan
• Morgan performed surgery with on looking
skeptical audience
• Audience Astonished
– Patient did not Scream
• “Gentlemen,” Dr. Warren proclaimed, “this is
no humbug!”
• Discipline of anesthesiology was born.
34
Semmelweis Of Vienna
• Determined Deaths from Puerperal Fever of
Maternity patients
– due to infections transmitted by students

leaving dissecting room to take care of
maternity patients without washing hands.
35
Civil War Days
• As many as 25 to 50 beds in ward
• Little provision for segregation of patients.
36
Roosevelt Hospital - 1871
• Built on lines of pavilion
• small wards
• set the style for new type of architecture
– became know as the American plan
Dr. W.G. Wylie - 1877
• Favored Roosevelt Hospital pavilion

• Wylie advocated temporary structure
– to be destroyed when it became infected.
America's 1st Nursing Schools
• Brigham and Women’s Hospital – 1872
• Bellevue – 1873
• Massachusetts General Hospital - 1873
39
Medicine 1880 - 1890
• Tubercle Bacillus Discovered
• Pasteur vaccinated against anthrax
• Koch Isolates Cholera Bacillus
• Diphtheria 1st treated with antitoxin
• Tetanus Bacillus & Parasite of Malarial Fever
Isolated
• Rabies Inoculation Successful
• Halstead & Rubber Gloves – 1890
• Bergmann & steam sterilization - 1886
• Roentgen discovers the X-ray - 1895

19th Century Inventions
• Clinical Thermometer
• Laryngoscope
• Hermann Helmholtz Ophthalmoscope
41
Medicine 1880 - 1890
• Hospitals crowded, patients suffering
– Scarlet Fever
– Diphtheria
– Typhoid
– Smallpox
• Most Disorders Untreated for
– Metabolism
– Glandular Disturbances
– Nutritional Diseases

42
20th Century Progress
• Development of New Services
• Progress of Non-profit Insurance Plans
• Increased Public Confidence in Hospitals
43
20th Century Inventions
• Einthoven invents Electro-cardiograph
• Wassermann Test for Pancreatic Function
• Introduction of Radium for Treatment of
Malignant Growths
• Increased use of Examination of Tissue
44
Hospital Standardization - 1918

• American College of Surgeons - development
of “Minimum Standards” for Hospitals
• Established Requirements for Care of Patients
• First Survey Conducted - 1918
• Became “Joint Commission on Accreditation of
Hospitals” in 1952
• Today known as The Joint Commission
1929 Trying Period for Hospitals
• Critical economic conditions
• Lowered bed occupancy
• Decreasing revenues from endowments
Latter Half of 20th Century
• Increased hospital competition
• Many advances in medical technology
– CT, MRI, & PET scanners
• For-profit chains spring up
• Competing delivery systems

• Many new medications introduced
47
The 21st Century
• 47 Million Uninsured Americans
• Skyrocketing malpractice insurance premiums
• High expectations of the public for miracles
• Zero tolerance for mistakes
48
The 21st Century- 2
• Ethical Dilemmas (e.g., human cloning)
• Era of information explosion
• Physicians exiting the marketplace
• Shortages of nurses, physical therapists
• National Health Reform
– Insurance

• Boutique Medicine
Just a Beginning
Because history often repeats itself, society must
learn from its many lessons; otherwise, it will
be doomed for a return to the dark ages of
medicine.
50
Research: National Library of Medicine
• Library collection contains 6 million items
• One of worlds finest medical history
collections
• Website: www.nlm.nih.gov
51
What we have come to expect,

and Our future directions,
Have been influenced by what has preceded us.
−Author Unknown
Review Questions - I
1. Who is often recognized as being the first
hospital administrator?
2. Which invention attributed to Van Leeuwenhoek
had a pronounced influence on the creation of
the sciences of cytology, bacteriology, and
pathology?
3. What issue did Florence Nightingale identify in
the 1800s as being a major source/vehicle for the
spread of infection and continues to be so today?
53
Questions - II
4. What data did Semmelweis collect? What was
the significance of that data as related to
performance improvement in the present-day
hospital?
5. What were two of the greatest influences in
the development of present-day hospitals?

6. Describe how you think history is repeating
itself in today’s health care system.
54
Letter 21
Letterhead
April 14, 2012
Mr Eric Ojeda
85 Westwind Way
Northfolk, VA 07225
Dear Mr Ojeda
RE: Conservatorship, Elmer Edward Essing
I am writing you in regard to my psychiatric evaluation of the
above-named individual, conducted at Sweetwater Home Board
and Care on November 5, 2012.
I was requested by his wife to evaluate the patient
psychiatrically because of the difficulty he has been
experiencing recently in terms of confusion and agitated
behavior. His wife asked me to evaluate him at Sweetwater as it
is very difficult for her to transport the individual to my office
because he is confused disoriented and at times hostile and
belligerent.
According to the records, the patient is 69 years of age, has a
history of rheumatic heart disease with mitral stenosis that is
severe, C. H. F., afib, with history of multiple cerebral emboli

that probably has caused senile dementia. He did not appear to
recognize the purpose of the interview, nor did he appreciate the
opportunity to present his view to the interviewer. He was able
to state his name but was generally thoroughly hostile and
openly oppositional and sarcastic during the interview. He
refused to give me many details of his past history relating that
I don’t need your help. The patient himself did not speak
spontaneously; he tended to repeat over and over again that he
did not need help, that all he needed was his wife to take him
out of Sweetwater. He did not appear to be able to give me the
current date, time, year or month, nor was he able to give his
location in terms of city or state. He refused to answer most of
my questions, but it was apparent that the patient at times
tended to confabulate and avoided answering questions that he
would have difficulty with by being openly hostile.
He had a very constricted effect that was at times labile, openly
so, in anger and disgust. His mood was depressed, with some
history of sleep disturbance, but he denied any suicidal ideation
or any selfdestructive behavior periods.
(continued)
Date
Page 2
Hypothesis: The patient had general difficulty completing
thought trends. He denied any hallucinations or delusions, but
his guardedness would indicate possible paranoid ideation with
possible unsystemized persecutory delusional system. He felt
there was some type of conspiracy against him to place him at
Sweetwater Home Board and Care. He was unable to recognize
and appreciate his medical and mental circumstances
appropriately and respond to them in an appropriate manner.

Judgement was impaired since the patient could not make
medical or financial decisions in his best interest. I do not feel
that he knows the extent of his medical illness or his financial
situation. The patient was disoriented to time, person and place.
IMPRESSION: Organic brain syndrome, probably secondary to
multiple cerebral embolus from history of rheumatic H.D. and
atrial fibrillation.
At this point in time, I feel that the patient is gravely disabled,
that he cannot provide food, shelter, or clothing for himself nor
make decisions in regard3 to his medical or financial affairs in
his best interest.
I recommend that he be continued in a structured living
situation with supervision of medication and recommend
conservatorship of person and property.
If further information is needed, please feel free to contact me
at any time.
Sincerely
Philip B. Michaelson, MD
jk
Letter 11
Letterhead
Date: July 17 2014

Winthrop G. Macdonald, MD
5700 Fifth Ave
Philadelphia Pa 17532
Dear Mac
RE: Laverne Lampe
Thank you for referring Mrs Lampe to my office for
gynecological evaluation.
She was first seen on November 10, 2103, but this report was
intentionally delayed until the results from the endometrial
biopsy where obtained.
At the time of the initial visit Mrs Lampe stated that she had
had no menses for 6 to 7 months. However, beginning about 3 to
4 weeks ago she developed a clear discharge which was blood-
tinged during the week of her visit. She denied any pain
associated with this bleeding.
As you are familiar with her past history and review of systems
these will not be reiterated at this time.
Gynecological examination revealed the following: Breasts:
Symmetrical. No masses, tenderness, or induration. No axillary
adenopathy. Abdomen: Flat. Liver, spleen, and kidneys not felt.
No masses, tenderness, or hernias. Pelvic: External genitalia
normal with normal female escutcheon. The introitis is parous.
Perinea is intact. Bartholin and skene urethral glands are
normal. There is no significant cystocel or rectocel. The vaginal
mucosa is healthy in appearance. Direct visualization of the
cervix revealed a small cervical polyp at six o’clock, which was

removed. Bimanual palpation revealed the uterus to be retro-
displaced, symmetrical in contour and slightly enlarged. The
adnexal regions and the culdesac felt normal. As noted above,
the cervical polyp was removed.
July 17 2014
RE: Laverne Lampe
Page 2
An endometrial biopsy was done, and the uterus measured 9 CM
in depth, which represents a slight enlargement. A large amount
of hyperplastic/appearing tissue was obtained on the biopsy. As
you know from your copy of the biopsy report, she does have a
grade three cystic endometrial hyperplasia with focal
adenomatous hyperplasia.
This information was conveyed to Mrs Lampe, and the treatment
indicated is a curettage. While I doubt if she has a malignancy,
removal of all this hyperplastic tissue is indicated to make sure
she does not have an in situcarcinoma present. She is a very
apprehensive woman, and at this time, it is unknown whether
she will proceed with the recommended surgery. If she does
return for the curettage, I will see that you receive a copy of the
surgical dictation and the pathology report.
Thank you again for your kindness in referring Mrs Lampe and
for allowing me to assist with her care.
Warmest personal regards.
Very truly yours

Martin P. Douglas, MD
Copy: Frank Horowitz MD
22329877_039836_rtn_sko_dnq.docx
22329877_039836
05/17/2019
Thank you for your recent Medical Transcription Graded Project
submission. However, it appears that there are required key
elements of the project that are incorrect or missing. Your
project will not be graded at this time, and an RTN has been
posted to your record. What does RTN mean? When you upload
your work, an RCD is posted alerting us that you have
submitted files. An RCD prevents you from uploading any other
files for that particular project until your work has been
reviewed. A RTN means that your work has been reviewed, and
the project has been returned rather than graded. RTN is not a
penalty of any sort. Most importantly, an RTN allows the
system to accept your corrected work.
Please do not be discouraged and think that we are going to post
a failing grade for your project. You will need to correct your
work (so we are presenting you with an opportunity to make
corrections) and resubmit it as if it were the first attempt. The
grader has provided the instructions needed to correctly
resubmit your work.
Grader's Notes:

⮚Your Graded Project has been returned to you because the
project is not complete.
Please read the Digital Study Guide associated with the graded
project and it will explain the number of reports required for
each graded project. Each report contributes to the total grade
for the project and the absence of a report will greatly reduce
the overall grade. Please take extra care to be sure that all
reports are included in the project when submitted for grading.
⮚Your Graded Project has been returned to you because the
EDITING Reports have not been completed correctly.
After reviewing your Editing Assignments, it is suspected that
the reports were transcribed. This is not the purpose of the
Editing Assignments and your graded project is returned to you
for correction of this process.
The Editing Assignments are included in the graded project to
measure the ability of the student to edit a letter and/or report.
Editing and proofreading are not the same thing and are
explained in the Study Guide.
Please copy and paste the entire Editing Assignment into a
WORD document and review and correct the report as you listen
to the audio file. Listen carefully and correct punctuation,
capitalization, verb tenses, spelling and the use of numerals in
the reports. Do not add words, subtract words, change words or
add medical terminology. Do not alter the format given.
Upon of your Editing Review completion, the report and/or
letter should be perfect to the best of your ability.
Medical Transcription is a skill-building course. Exam
feedback should be considered a learning tool and all feedback
should be read carefully, understood and put into use on the

following exam. Submitting and exam before the previous exam
is graded and feedback is available is not beneficial to the
learning process. Take your time. Be patient. Transcription
takes practice and focus.
SLOWING THE SPEED OF THE AUDIO FILES USING AN
MP3 PLAYER
If you cannot understand what is being dictated, slow the speed
on the audio files and try listening again for clarity. In order to
adjust the speed of the audio file to better understand the
dictated material:
1.Right click on white arrow in orange circle in upper left
corner of the opened audio
2.Click Enhancements and then Play Speed Settings
3.Adjust the speed of the dictation by using the slide scale
(allow a few seconds to adjust)
Check the textbook for appropriate punctuation and review the
use of periods, commas, hyphens, etc. Please proofread your
submissions prior to sending to avoid simple mistakes.
If you have any questions about your project, the Transcription
instructor is available by email through the Help Center of your
Student Portal during school hours, after hours and weekends.
You may also call Penn Foster at 1-800-982-1288,and an
instructor will be happy to help you with your questions. Thank
you.
Medical Transcription Instructors
Penn Foster

Name : Gomana guirguis
Email : [email protected]
Student number : 22329877
Course Number : MEDICAL TRANSCRIPTION 1 GRADED
PROJECT
Transcription Assignment 1: Letter 21
April 14, 2012
Medical Transcription 1 Graded Project
Mr. Eric Ojeda
Examination number
85 Westwind Way
Northfolk, VA 07225
RE: CONSERVATORSHIP, ELMER EDWARD ESSING
Dear Mr. Ojeda,
I am writing to you in regard to my psychiatric evaluation of the
and Care on November 5, 2012. I was requested by his wife to
evaluate the patient psychiatrically because of the difficulty he
has been experiencing recently in terms of confusion and

agitated behavior. His wife asked me to evaluate him at
Sweetwater as it is very difficult for her to transport the
individual to my office because he is confused, disoriented and
at times hostile and belligerent. According to the records, the
patient is 69 years of age, has a history of rheumatic heart
disease with mitral stenosis that is severe, C. H. F., afib, with
history of multiple cerebral emboli that probably has caused
senile dementia. He did not appear to recognize the purpose of
the interview, nor did he appreciate the opportunity to present
his view to the interviewer. He was able to state his name but
was generally thoroughly hostile and openly oppositional and
sarcastic during the interview.
He refused to give me many details of his past history relating
that “I don’t need your help”. The patient himself did not speak
would have difficulty with by being openly hostile. He had a
very constricted effect that was at times labile, openly so, in
anger and disgust. His mood was depressed, with some history
of sleep disturbance, but he denied any suicidal ideation or any
self-destructive behavior periods.
(continued)
Date
Page 2

the possible un-systematized persecutory delusional system. He
felt there was some type of conspiracy against him to place him
at Sweetwater Home Board and Care. He was unable to
recognize and appreciate his medical and mental circumstances
Judgment was impaired since the patient could not make
multiple cerebral emboli from the history of rheumatic H.D. and
atrial fibrillation. At this point in time, I feel that the patient is
gravely disabled, that he cannot provide food, shelter, or
clothing for himself nor make decisions in regard3 to his
medical or financial affairs in his best interest. I recommend
that he be continued in a structured living situation with the
supervision of medication and recommend conservatorship of
person and property.
at any time.
Yours Sincerely

Transcription Assignment 2: Letter 7
Date: July 17, 2014
5700 Fifth Ave
RE: LAVERNE LAMPE
Dear Mac,
Thank you for referring Mrs. Lampe to my office for
gynecological evaluation. She was first seen on November 10,
2103, but this report was intentionally delayed until the results
from the endometrial biopsy where obtained. At the time of the
initial visit, Mrs. Lampe stated that she had had no menses for 6
to 7 months. However, beginning about 3 to 4 weeks ago she
developed a clear discharge which was blood-tinged during the
week of her visit. She denied any pain associated with this
bleeding. As you are familiar with her past history and review
of systems these will not be reiterated at this time.
normal with normal female escutcheon. The introitus is porous.
normal. There is no significant cystocele or rectocele. The
vaginal mucosa is healthy in appearance. Direct visualization of
the cervix revealed a small cervical polyp at six o’clock, which
was removed. Bimanual palpation revealed the uterus to be
retro-displaced, symmetrical in contour and slightly enlarged.
The adnexal regions and the culdesac felt normal. As noted
above, the cervical polyp was removed.

July 17, 2014
RE: LAVERNE LAMPE
Page 2
This information was conveyed to Mrs. Lampe, and the
treatment indicated is a curettage. While I doubt if she has a
malignancy, removal of all this hyperplastic tissue is indicated
to make sure she does not have an in situ carcinoma present.
She is a very apprehensive woman, and at this time, it is
unknown whether she will proceed with the recommended
surgery. If she does return for the curettage, I will see that you
receive a copy of the surgical dictation and the pathology
report.
Thank you again for your kindness in referring to Mrs. Lampe
and for allowing me to assist with her care.
Very truly yours,

Editing Assignment 1: Letter 11
Date: July 17, 2014
5700 Fifth Ave
RE: LAVERNE LAMPE
Dear Mac,
Thank you for referring Mrs. Lampe to my office for
gynecological evaluation. She was first seen on November 10,
2103, but this report was intentionally delayed until the results
from the endometrial biopsy where obtained. At the time of the
initial visit, Mrs. Lampe stated that she had had no menses for 6
to 7 months. However, beginning about 3 to 4 weeks ago she
developed a clear discharge which was blood-tinged during the
week of her visit. She denied any pain associated with this
bleeding. As you are familiar with her past history and review
of systems these will not be reiterated at this time.
normal with normal female escutcheon. The introitus is porous.
normal. There is no significant cystocele or rectocele. The
vaginal mucosa is healthy in appearance. Direct visualization of
the cervix revealed a small cervical polyp at six o’clock, which
was removed. Bimanual palpation revealed the uterus to be

retro-displaced, symmetrical in contour and slightly enlarged.
The adnexal regions and the culdesac felt normal. As noted
above, the cervical polyp was removed.
July 17, 2014
RE: LAVERNE LAMPE
Page 2
This information was conveyed to Mrs. Lampe, and the
treatment indicated is a curettage. While I doubt if she has a
malignancy, removal of all this hyperplastic tissue is indicated
to make sure she does not have an in situ carcinoma present.
She is a very apprehensive woman, and at this time, it is
unknown whether she will proceed with the recommended
surgery. If she does return for the curettage, I will see that you
receive a copy of the surgical dictation and the pathology
report.
Thank you again for your kindness in referring to Mrs. Lampe
and for allowing me to assist with her care.
Very truly yours,

Editing Assignment 2: Letter 21
April 14, 2012
Medical Transcription 1 Graded Project
Mr. Eric Ojeda
Examination number
85 Westwind Way
Northfolk, VA 07225
Dear Mr. Ojeda,
I am writing to you in regard to my psychiatric evaluation of the
and Care on November 5, 2012. I was requested by his wife to
evaluate the patient psychiatrically because of the difficulty he
has been experiencing recently in terms of confusion and
agitated behavior. His wife asked me to evaluate him at
Sweetwater as it is very difficult for her to transport the
individual to my office because he is confused, disoriented and
at times hostile and belligerent. According to the records, the
patient is 69 years of age, has a history of rheumatic heart
disease with mitral stenosis that is severe, C. H. F., afib, with

history of multiple cerebral emboli that probably has caused
senile dementia. He did not appear to recognize the purpose of
the interview, nor did he appreciate the opportunity to present
his view to the interviewer. He was able to state his name but
was generally thoroughly hostile and openly oppositional and
sarcastic during the interview.
He refused to give me many details of his past history relating
that “I don’t need your help”. The patient himself did not speak
would have difficulty with by being openly hostile. He had a
very constricted effect that was at times labile, openly so, in
anger and disgust. His mood was depressed, with some history
of sleep disturbance, but he denied any suicidal ideation or any
self-destructive behavior periods.
(continued)
Date
Page 2
the possible un-systematized persecutory delusional system. He
felt there was some type of conspiracy against him to place him
at Sweetwater Home Board and Care. He was unable to
recognize and appreciate his medical and mental circumstances

Judgment was impaired since the patient could not make
multiple cerebral emboli from the history of rheumatic H.D. and
atrial fibrillation. At this point in time, I feel that the patient is
gravely disabled, that he cannot provide food, shelter, or
clothing for himself nor make decisions in regard3 to his
medical or financial affairs in his best interest. I recommend
that he be continued in a structured living situation with the
supervision of medication and recommend conservatorship of
person and property.
at any time.
Yours Sincerely

Files for Required Transcription Assignment 1/Editing
Assignment 2 - Letter 21 - Edit This File.docx
Letter 21
Letterhead
April 14, 2012
Mr Eric Ojeda
85 Westwind Way
Northfolk, VA 07225
Dear Mr Ojeda
I am writing you in regard to my psychiatric evaluation of the
and Care on November 5, 2012.
I was requested by his wife to evaluate the patient
psychiatrically because of the difficulty he has been
experiencing recently in terms of confusion and agitated
behavior. His wife asked me to evaluate him at Sweetwater as it
is very difficult for her to transport the individual to my office
because he is confused disoriented and at times hostile and
belligerent.
According to the records, the patient is 69 years of age, has a
history of rheumatic heart disease with mitral stenosis that is
severe, C. H. F., afib, with history of multiple cerebral emboli
that probably has caused senile dementia. He did not appear to
recognize the purpose of the interview, nor did he appreciate the
opportunity to present his view to the interviewer. He was able
to state his name but was generally thoroughly hostile and
openly oppositional and sarcastic during the interview. He
refused to give me many details of his past history relating that

I don’t need your help. The patient himself did not speak
would have difficulty with by being openly hostile.
He had a very constricted effect that was at times labile, openly
so, in anger and disgust. His mood was depressed, with some
history of sleep disturbance, but he denied any suicidal ideation
or any selfdestructive behavior periods.
(continued)
Date
Page 2
possible unsystemized persecutory delusional system. He felt
there was some type of conspiracy against him to place him at
Sweetwater Home Board and Care. He was unable to recognize
and appreciate his medical and mental circumstances
Judgement was impaired since the patient could not make

multiple cerebral embolus from history of rheumatic H.D. and
atrial fibrillation.
At this point in time, I feel that the patient is gravely disabled,
that he cannot provide food, shelter, or clothing for himself nor
make decisions in regard3 to his medical or financial affairs in
his best interest.
I recommend that he be continued in a structured living
situation with supervision of medication and recommend
conservatorship of person and property.
at any time.
Sincerely
jk
Assignment 2 - Letter 21 Audio.mp3
Blues
254737.05
Assignment 3 - Letter 11 - Edit This File.docx
Letter 11
Letterhead

Date: July 17 2014
5700 Fifth Ave
Dear Mac
RE: Laverne Lampe
Thank you for referring Mrs Lampe to my office for
gynecological evaluation.
She was first seen on November 10, 2103, but this report was
intentionally delayed until the results from the endometrial
biopsy where obtained.
At the time of the initial visit Mrs Lampe stated that she had
had no menses for 6 to 7 months. However, beginning about 3 to
4 weeks ago she developed a clear discharge which was blood-
tinged during the week of her visit. She denied any pain
associated with this bleeding.
As you are familiar with her past history and review of systems
these will not be reiterated at this time.
normal with normal female escutcheon. The introitis is parous.
normal. There is no significant cystocel or rectocel. The vaginal
mucosa is healthy in appearance. Direct visualization of the

cervix revealed a small cervical polyp at six o’clock, which was
removed. Bimanual palpation revealed the uterus to be retro-
displaced, symmetrical in contour and slightly enlarged. The
adnexal regions and the culdesac felt normal. As noted above,
the cervical polyp was removed.
July 17 2014
RE: Laverne Lampe
Page 2
This information was conveyed to Mrs Lampe, and the treatment
indicated is a curettage. While I doubt if she has a malignancy,
removal of all this hyperplastic tissue is indicated to make sure
she does not have an in situcarcinoma present. She is a very
apprehensive woman, and at this time, it is unknown whether
she will proceed with the recommended surgery. If she does
return for the curettage, I will see that you receive a copy of the
surgical dictation and the pathology report.
Thank you again for your kindness in referring Mrs Lampe and
for allowing me to assist with her care.
Very truly yours

Blues
188144.42
Files for Required Transcription Assignment 1/Transcription
Blues
103812.93
Files for Required Transcription Assignment 1/Transcription
Blues
101435.555
Graded Project
Medical Transcription 1
© PENN FOSTER, INC. 2017 PAGE 1MEDICAL
TRANSCRIPTION 1
Graded Project

CONTENTS
OVERVIEW 2
INSTRUCTIONS 2
HOW TO COMPLETE THE ASSIGNMENTS 2
GRADING CRITERIA 3
SUBMITTING YOUR PROJECT 4
TRANSCRIPTION 1
Graded Project
MEDICAL TRANSCRIPTION 1
OVERVIEW
It’s now time to complete yourgraded project. To complete and
submit your required
transcriptions, follow the instructions provided.
INSTRUCTIONS
You’re required to complete and submit the assignments below.
To access the recorded
dictations and transcribed reports, go to your student portal.
Next, click the Files for
Medical Transcription 1 Graded Project link.
1. Transcription Assignment 1: Letter 2
Access the recorded dictation as provided and prepare the
letter. Be sure to

transcribe the letter as dictated.
2. Transcription Assignment 2: Letter 7
Access the recorded dictation as provided and prepare the
letter. Be sure to
transcribe the letter as dictated.
3. Editing Assignment 1: Letter 11
Access the transcribed letter and audio
file, and edit the letter for errors in
spelling, punctuation, grammar, and letter format.
4. Editing Assignment 2: Letter 21
Access the transcribed letter and audio file, and edit
the letter for errors in
spelling, punctuation, grammar, and letter format.
HOW TO COMPLETE THE ASSIGNMENTS
1. Type or proofread each letter in the order given.
2. Review your work carefully. For the transcription
assignments, it’s a good idea to
replay your file and listen to it as you read
each report. You’ll be able to catch any
errors and reinforce your terminology at the same time. Don’t
rely on a computer
spell checker. For the proofreading and editing assignments,
reread the document to
find additional errors you may have missed. It may
also help to read the document
aloud to catch any mistakes you might have missed.

TRANSCRIPTION 1
Graded Project
3. Be sure to include your name, student number, Medical
Transcription 1 Graded
Project, and examination number (03983600). In addition,
include the title of the
assignment in the top right corner. For example, the titles of the
assignments you’ll
submit are as follows:
n Transcription Assignment 1: Letter 2
n Editing Assignment 1: Letter 11
4. Single-space the bodies of the reports to be submitted.
5. Follow the exact format provided in the dictated recording.
Use your initials and the
current year for submitted reports.
6. If you can’t understand a word or phrase in the dictation,
check your medical dic-
tionary and the terminology section of the corresponding
chapter in your textbook.
If a word has already been given in the terminology section of a
previous chapter,
it will be used again without being listed—once you use a word,
you’re expected
to remember it. You may have to check earlier

chapters’ lists to find the word. Also
check the lists of medical terms and the lists of drugs,
instruments, tests, and other
terms in the Appendix.
7. If you’re still unable to transcribe the word, make an
educated guess. If you can’t
transcribe a word, it’s better to leave a blank space on your
dictation and properly
flag the missing entrythan to guess and use the
wrong word. Please refer to your
textbook for information on proper flagging.
SUBMITTING YOUR PROJECT
You must submit these four letter assignments in ONE word-
processing document and
not as individual files in a folder. If you’ve
completedthe assignments as individual docu-
ments, you’ll need to copy and paste all assignments into ONE
word-processing document.
Acceptable formats for submitting your work include Microsoft
Word documents (.doc and
.docx) or Rich Text Format (.rtf). No other format is to be used
for submitting this project.
Each assignment is individually graded by your instructor and
therefore takes up to a few
weeks to grade.

TRANSCRIPTION 1
Graded Project
Be sure that your document contains the following information:
n Your name
n Your student ID number
n The lesson number (03983600)
n Your email address
To submit your exam online, follow these steps:
1. On your computer, save a revised and corrected version of
your exam. Be sure to
include your student number and exam number on your saved
document.
2. Go to http://www.pennfoster.edu and log in.
3. Go to your student portal.
4. Click on Take Exam next to the lesson you’re working on.
5. Enter your email address in the box provided. (Note: This
information is required
for online submission.)
6. Attach your exam as follows:

a. Click on the Browse box.
b. Locate the file you wish to attach.
c. Double-click on the file.
d. Click on Upload File.
7. Click on Submit Files.
Follow these steps to submit ONE word-processing document
(Microsoft Word or Rich
Text Format) containing all four assignments. Be sure to keep a
backup copy of the
document you submit to the school!
GRADING CRITERIA
The following errors will be marked in all of the transcription
exams.
n Missing paragraph—10 points
n Missing sentence—5 points
n Missing word error—1 point
n Misspelled word—3 points
n Missing word flagged appropriately—1 point
n Spelling or word usage error—3 points
http://www.pennfoster.edu

TRANSCRIPTION 1
Graded Project
n Format/appearance errors—No points are deducted but the
grader will indicate
format errors. Examples of format errors include the following:
1. An incorrect capital or lowercase letter
2. Word should have been abbreviated if it was typed out or it
should have
been typed out if it was abbreviated.
3. Incorrect spacing within the transcription
4. A new paragraph should have been started.
5. Incorrect indention under a heading, especially in numbered
lists
n Punctuation errors—No points are deducted
but the grader will indicate punctuation
errors such as a missing period (.), quotation marks (“ ”),
semicolon (;), colon (:), or
hyphen (-), or that a punctuation mark shouldn’t have been
inserted.
n Comment balloons are used by the graders as needed to
provide additional feed-
back for you to review.

Chapter 2
Health Care Ethics
LEARNING OBJECTIVES
• Describe the concepts of ethics & morality.
• Describe how an understanding of ethical
theories, principles, virtues, & values are
helpful in resolving ethical dilemmas.
• Explain the relationship between spirituality &
religion.
• Discuss situational ethics & how one’s moral
character can change as circumstances
change.
• Explain how one’s reasoning skills influence
the decision-making process.
I expect to pass through this world but once. Any
good therefore that I can do, or any kindness I can
show to any creature, let me do it now. Let me not
defer it, for I shall not pass this way again

−Stephen Grellet
Ethics
• Branch of philosophy that deals with values
relating to human conduct with respect to
rightness & wrongness of actions & goodness
& badness of motives & ends.
• Focus on rightness & wrongness of actions.
• Concerned with what is morally good & bad,
right & wrong.
Ethics – II
• Microethics
– individual’s view of right & wrong.
• Macroethics
– global view of right & wrong.

Ethics – III
• Philosophical Ethics
– involves inquiry into
– ways of life
– rules of conduct
• Religious Ethics
– a general pattern or“Way of Life”
• Professional Ethics
– a set of rules or moral code
Morality
• Code of conduct
• Guide to behavior
• Describes class of rules held by society to
govern conduct
• Moral dilemmas occur
– when moral ideas of right & wrong conflict
Morality Legislated

• Law is distinguished from morality in that
– law has explicit rules, penalties, & officials who
interpret laws & apply penalties.
• Laws created to set boundaries for societal
behavior.
– laws are enforced to ensure expected behavior
happens.
Moral Judgments
• Judgments are concerned with
– what an individual or group believes to be the
right or proper behavior in a given situation
• No Universal Morality
– right varies from nation to nation, culture to
culture, religion to religion, as well as from one
person to the next
Code of Conduct
• Prescribe standards of conduct

• States principles
• Expresses responsibilities
• Defines rules expressing duties of
professionals to whom they apply
Ethical Theories I
• Normative Ethics
– attempt to determine what moral standards
should be followed so that human behavior &
conduct may be morally right
– General Normative Ethics
– Applied Ethics
– Descriptive Ethics
– Meta-ethics
Ethical Theories II
• Consequential Ethics

– theory of ethics that emphasizes morally right
action is whatever action leads to maximum
balance of good over evil
• Utilitarian Ethics
– concept that moral worth of an action is solely
determined by its contribution to overall
usefulness
Ethical Theories III
• Nonconsequential Ethics
– Denies consequences of an action are only criteria
for determining morality of an action
• Deontological Ethics
– doing right thing is good
– might not always lead to or increase the good &
right thing sought after
Ethical Theories IV
• Ethical Relativism

– morality is relative to the norms of one’s culture
Principles of Ethics – I
• Ethical principles
– universal rules of conduct, derived from ethical
theories that provide a practical basis for
identifying what kinds of actions, intentions, &
motives are valued.
• Autonomy
– Life or Death: the Right to Choose
Principles of Ethics – II
• Beneficence
• Nonmaleficence
• Justice
– Distributive Justice
Virtues & Values

• Virtue
– normally defined as some sort of moral excellence
or beneficial quality.
• Moral value
– relative worth placed on some virtuous behavior
• What has value to one person may not have
value to another.
• A value is a standard of conduct.
• Values used for judging goodness or badness of
an action
Pillars of Moral Strength - I
• Courage
• Wisdom
• Temperance
• Commitment
• Compassion
• Conscientious

• Discernment
• Fairness
Pillars of Moral Strength - II
• Fidelity
• Freedom
• Honesty/Trustworthiness/Truth-Telling
• Integrity
• Kindness
• Respect
• Hopefulness
• Tolerance
Spirituality & Religion
• Spirituality
– in the religious sense implies that there is purpose
& meaning to life; spirituality generally refers to
faith in a higher being

• Religion
– serves a moral purpose by providing codes of
conduct for appropriate behavior through
revelations from a divine source
Religions – I
• Judaism
• Hinduism
• Buddhism
• Taoism
• Zen
• Christianity
• Islam
Secular Ethics
• Based on codes developed by societies that
have relied on customs to formulate their
codes

– Code of Hammurabi
• Atheism
Situational Ethics - I
• Outcome or consequences of an action in
which ends can justify the means
• Moral values & moral character can be
compromised when faced with difficult
choices
Situational Ethics - II
• Good people behave differently in different
situations.
• Good people sometimes do bad things
• One’s moral character sometimes change as
circumstances change
– thus the term situational ethics

Sustaining Life
Situational Ethics
• Decision not to use extraordinary means to
sustain life of an unknown 97 year old “may”
result in a different decision if the 84 year old
is one’s mother.
Reasoning
Decision-Making – I
• Reason includes the capacity for logical
inference and the ability to conduct inquiry,
solve problems, evaluate, criticize, and
deliberate about how we should act and to
reach an understanding of other people, the
world, and ourselves.
Reasoning
Decision-Making – II
• Partial reasoning involves bias for or against a
person based on one’s relationship with that
person.
• Circular reasoning describes a person who has
already made up his or her mind on a

particular issue and sees no need for
deliberation.
Reasoning
Decision-Making – III
• Ethics in decision-making involves the process
of deciding the right thing to do when facing a
moral dilemma.
• Ethical dilemmas occur when ideas of right
and wrong conflict.
Review Questions – I
1. Discuss the concept of morality.
2. Describes the various theories of ethics.
3. Describe the various principles of healthcare
ethics.
4. Describe desirable virtues and values in the
healthcare setting.
5. Given an example of situational ethics.
6. Discuss the importance of reasoning in the

decision-making process.
Chapter 1
Government, Law, and Ethics
“Laws are the very bulwarks of Liberty; they
define every man’s rights, and defend the
individual Liberties of all men.”
J.G. Holland (1819-1881)
LEARNING OBJECTIVES
• Discuss 3 branches of government, & importance of
separation of powers.
• Describe organization structure of Department of
Health and Human Services.
• Explain development of case law & how it differs
from statutory & administrative law.
• Describe function of various government ethics
committees herein presented.

Government Organization
• Legislative Branch
• Executive Branch
• Judicial Branch
Branches & Powers of Government
Legislative Executive Judicial
Write laws Implement &
Enforce Laws
Interpret Laws
Enact, amend,
or repeal Laws
Veto Laws Apply Laws
Declare War
Confirm Justices
Commander-in-
Chief Armed
Forces

Declare laws
unconstitutional
Enact Taxes &
set the budget
Appoint Justices Compel
Testimony
Scarcely any political question arises
in the United States that is not
resolved, sooner or later, into a
judicial question.
−Alexis de Tocqueville (1805–1859)
Judicial Branch
• When government bureaus & agencies go
awry, which are adjuncts of the legislative or
executive branches, the people flee to the
third branch, their courts, for solace & justice.
Federal Court System
• District Courts
• U.S. Circuit Court of Appeals

• Supreme Court
U.S. District Court
• Trial courts of the Federal System
• 96 Courts
• Jurisdiction over all categories of federal cases
– including civil & criminal matters
U.S. Court of Appeals
• Created to help reduce workload of U.S.
Supreme Court
– 12 Regional Court
– 1 Judicial Circuit in DC
• Reviews
– District court decisions
– Administrative agency decisions
U.S. Supreme Court

• Highest federal court
• Only court created by federal constitution
• Comprised of 8 Associate & 1 Chief Justice
“As I have said in the past, when
government bureaus and agencies go
awry, which are adjuncts of the
legislative or executive branches, the
people flee to the third branch, their
courts, for solace and justice.”
−Justice J. Henderson, Supreme Ct. of
S. D.
Separation of Powers
Model for Government
• Under this model government is divided into
branches
• Each branch
– has separate & independent powers

– areas of responsibility
– each branch is also able to place limited restraints
on the power exerted by the other branches.
Dept of Health & Human Services
• Centers for Medicare & Medicaid
Public Health Service includes
• National Institutes of Health
• Centers for Disease Control and Prevention
• Substance Abuse & Mental Health Services
Administration
• Health Resources & Services Administration
• Agency for Healthcare Research and Quality
• Agency for Toxic Substances & Disease Registry
• Indian Health Service

Laws
• Govern the relationships between private
individuals and organizations; and between
both of these parties and government.
Categories of Law
• Public Law
– Deals with the relationships between government
and individuals.
• Private Law
– Deals with relationships among individuals.
Sources of Law
• Common Law
– derived from judicial decisions.
• Statutory Law

– written laws
• Administrative Law
– public law, rules & regulations issued by
administrative agencies to direct the enacted laws
of the federal and state governments.
Common Law in U.S.
• Body of principles that has evolved and
expanded from judicial decisions.
• Origins in English Common Law.
Common Law Principles
• Precedent:
– a judicial decision that may be used as a standard in
subsequent similar cases.
• Res Judicata:
– means the thing is decided—refers to that which has been
previously acted on or decided by the courts.
• Stare Decisis:

– common-law principle meaning let the decision stand.
– based on similar cases and fact patterns.
Statutory Law
• Written law emanating from a legislative body.
– Hierarchical Order
– U.S. Constitution: highest in hierarchy of laws
– State Constitution
Constitution: Article VI
• This Constitution and Law of the United States
. . . Shall be the supreme Law of the Land; and
the Judges in every State shall be bound
thereby . . . .
Administrative Law

• Extensive body of public law issued by
administrative agencies to direct enacted laws
of federal & state governments.
Administrative Procedures Act - I
• Describes different procedures under which
federal administrative agencies must
operate.
• Prescribes procedural responsibilities &
authority of administrative agencies.
Administrative Procedures Act - II
• Provides legal remedies for those wronged by
agency actions.
• Rules & regulations established by
administrative agency must be administered
within scope of authority delegated Congress.
Conflict of Laws

• When state & federal laws conflict
– Resolution sought in appropriate federal court.
GOVERNMENT ETHICS
• Office of Government Ethics
• U.S. House of Representative Committee on
Ethics
• U.S. Senate Select Committee on Ethics
• Office of Congressional Ethics
Political Malpractice
• Failure of to act when there is a duty to act.
The tragedy of society is not the
noisiness of the so-called bad
people, but the appalling silence of
the so-called good people.

−Martin Luther King, Jr.
Review Questions – I
1. Define the term law and describe the sources
from which law is derived.
2. Define the legal terms:
a. precedent
b. res judicata
c. stare decisis
d. original jurisdiction
e. appellate jurisdiction
Review Questions – II
3. Describe the function of each branch of
government.
4. What is the meaning of separation of powers?
5. What is the function of an administrative
agency?

6. Describe the responsibilities of the DHHS.

© 2014 Jones and Bartlett PublishersChapter 3Refle.docx

Recommended

Recommended

More Related Content

Similar to © 2014 Jones and Bartlett PublishersChapter 3Refle.docx

Similar to © 2014 Jones and Bartlett PublishersChapter 3Refle.docx (20)

More from budbarber38650

More from budbarber38650 (20)

Recently uploaded

Recently uploaded (20)

© 2014 Jones and Bartlett PublishersChapter 3Refle.docx