This document provides an outline and commentary for a presentation on writing in medicine. It discusses the importance of writing for documenting patient care, sharing information with other providers, and medico-legal purposes. It emphasizes treating writing like a medical procedure by taking time to document thoroughly and accurately. The second part analyzes Sylvia Plath's novel The Bell Jar using techniques of narrative medicine to understand Plath's perspective and mental state. Examples are presented of how the first-person narration and verb tense provide insights. The presentation aims to demonstrate how literature can enhance understanding in medicine.
The document summarizes a medical mission trip to Honduras by a Christian team from April 28th to May 4th, 2014. Over the course of 3 clinic days, the team provided intake, triage, medical care by providers, reading glasses, medications from the pharmacy, and care for burns and broken bones. The team was touched by helping the local community, especially the children, and they are grateful for the hospitality and friendship of the people of Honduras despite the poverty.
The document provides information from a student's health academy orientation and rotations. It includes summaries of guest speakers, thank you letters from rotations, presentations on hand washing at elementary schools, and blogs recapping experiences in different hospital units. Professional resumes, cover letters, reference pages, and reviews of lectures on various medical careers are also included.
Narrative medicine as a tool to detect the burden of illness: an application to myelofibrosis. Progetto realizzato da ISTUD per Novartis. Presentazione di Maria Giulia Marini.
This document provides a biography of poet Sylvia Plath. It details key events in her life, including her childhood in Massachusetts, education at Smith College where she struggled with mental health issues, marriage to fellow poet Ted Hughes, and career writing poetry. It notes her works were not widely appreciated until after her death by suicide in 1963 at age 30. She dealt with ongoing depression and mental health issues throughout her life that were reflected in her poetry dealing with themes of death, self-dissatisfaction, and troubled relationships.
Sylvia Plath was an American poet and author who committed suicide in 1963 at the age of 30. Some of her most famous works include the poems "Daddy" and "Lady Lazarus" as well as her only novel, The Bell Jar, which was published under a pseudonym and dealt with her own experiences with mental illness. Plath married fellow poet Ted Hughes in 1956, but they divorced in 1963 after he had an affair with another woman. Plath took her own life shortly after by putting her head in a gas oven, leaving her two young children. Her death and troubled relationship with Hughes have been topics of discussion and controversy among literary scholars.
The document discusses best practices for documenting patient history and exams, including:
- Recording the full date, time, demographics, and chief complaint for every exam.
- Asking follow up questions to the chief complaint using mnemonics like TADD, OPQRST, and OLD CARTS to fully understand symptoms.
- Documenting details of the history of present illness by addressing at least 4 of 9 symptom characteristics for comprehensive exams.
- Using "telegraphing" to shorten notes while maintaining meaning. The chief complaint should always be in the patient's own words within quotation marks.
Clinical signs in small animal medicineQuang Huy Vu
This document provides an introduction to a clinical signs textbook for small animal medicine. It discusses the value of visual learning and includes over 1,000 clinical images to complement written textbooks. The introduction describes the author's motivation and philosophy of clinical teaching. It also shares the author's "Mikey's Maxims" which are philosophical lessons learned over 37 years of practice. "Clinical Pearls" are also included, which are valuable clinical lessons. The introduction acknowledges those who contributed to the author's career and helped make this textbook possible. The goal is to provide a visual resource to enhance clinical learning and diagnosis.
The document summarizes a medical mission trip to Honduras by a Christian team from April 28th to May 4th, 2014. Over the course of 3 clinic days, the team provided intake, triage, medical care by providers, reading glasses, medications from the pharmacy, and care for burns and broken bones. The team was touched by helping the local community, especially the children, and they are grateful for the hospitality and friendship of the people of Honduras despite the poverty.
The document provides information from a student's health academy orientation and rotations. It includes summaries of guest speakers, thank you letters from rotations, presentations on hand washing at elementary schools, and blogs recapping experiences in different hospital units. Professional resumes, cover letters, reference pages, and reviews of lectures on various medical careers are also included.
Narrative medicine as a tool to detect the burden of illness: an application to myelofibrosis. Progetto realizzato da ISTUD per Novartis. Presentazione di Maria Giulia Marini.
This document provides a biography of poet Sylvia Plath. It details key events in her life, including her childhood in Massachusetts, education at Smith College where she struggled with mental health issues, marriage to fellow poet Ted Hughes, and career writing poetry. It notes her works were not widely appreciated until after her death by suicide in 1963 at age 30. She dealt with ongoing depression and mental health issues throughout her life that were reflected in her poetry dealing with themes of death, self-dissatisfaction, and troubled relationships.
Sylvia Plath was an American poet and author who committed suicide in 1963 at the age of 30. Some of her most famous works include the poems "Daddy" and "Lady Lazarus" as well as her only novel, The Bell Jar, which was published under a pseudonym and dealt with her own experiences with mental illness. Plath married fellow poet Ted Hughes in 1956, but they divorced in 1963 after he had an affair with another woman. Plath took her own life shortly after by putting her head in a gas oven, leaving her two young children. Her death and troubled relationship with Hughes have been topics of discussion and controversy among literary scholars.
The document discusses best practices for documenting patient history and exams, including:
- Recording the full date, time, demographics, and chief complaint for every exam.
- Asking follow up questions to the chief complaint using mnemonics like TADD, OPQRST, and OLD CARTS to fully understand symptoms.
- Documenting details of the history of present illness by addressing at least 4 of 9 symptom characteristics for comprehensive exams.
- Using "telegraphing" to shorten notes while maintaining meaning. The chief complaint should always be in the patient's own words within quotation marks.
Clinical signs in small animal medicineQuang Huy Vu
This document provides an introduction to a clinical signs textbook for small animal medicine. It discusses the value of visual learning and includes over 1,000 clinical images to complement written textbooks. The introduction describes the author's motivation and philosophy of clinical teaching. It also shares the author's "Mikey's Maxims" which are philosophical lessons learned over 37 years of practice. "Clinical Pearls" are also included, which are valuable clinical lessons. The introduction acknowledges those who contributed to the author's career and helped make this textbook possible. The goal is to provide a visual resource to enhance clinical learning and diagnosis.
Essay Assignments Topic (How Should I be Governed d.docxrusselldayna
Essay Assignments
Topic: (How Should I be Governed during Ancient Greek Era)
ERA/Civilization:
The Classical Greek Period (Greek Political Thought: Plato and Aristotle)
"Great Question" to be answered and analyzed in the essay:
How should I be governed?
- The paper will argue how the people of the era/civilization (Ancient Greek)
answered the particular great question (How should I be governed?).
- All papers must carry a working thesis. This is not simply a report of different
historical perspectives, but a careful analysis and synthesis of the research you
conduct.
- Your final essay will include a title page and bibliography. The essay itself should
be no less than 2400 words and no more than 10 pages.
Note: introduction and Bibliography is already written, please see
attached file. Please continue writing the paper using this file.
ALL WRITTEN WORK TURNED IN FOR CORE HISTORY MUST FOLLOW THESE
BASIC RUBRICS:
• Typed work (word processor), neat and legible, 81/2” x 11” paper 1” margins
all sides
• Times New Roman font, 12 pt.
• Use Footnotes as opposed to endnotes
• All citations must conform to the Chicago Manual of Style
• Use only permitted sources.
- Papers must cite no fewer than FIVE scholarly sources, including at least THREE
primary sources approved by the instructor.
- Permitted secondary sources: Printed works that are scholarly (that is, peer-
reviewed) are the only permitted secondary sources. Peer-reviewed print journals
that are available electronically through library databases are included among
permitted sources. NO OTHER ELECTRONIC SOURCES are permitted Your
instructor may, at his/her discretion, reject or fail any paper that has used one or
more non-permitted sources.
Evidence of academic dishonesty or plagiarism on any part of the assignments will
result in failure of the course and referral to the dean for expulsion.
Essay Grading Rubric
1. Strong Thesis Statement - Is argued coherently and forcefully throughout
the paper. Includes appropriate introductory and concluding paragraphs. The
entire body of the paper is argument driven.
2. Use of Appropriate Scholarly Secondary Sources and Primary Sources -
There is depth and breadth to the research. No false citations. N0 fluff added
to bibliography.
3. Correct use of historical facts and examples to further the argument -
Paper does not give incorrect information, all facts serve the argument and
are not used as mere filler, historical context is maintained.
4. Mechanics and Grammar - No grammatical or spelling errors, proper
formatting, formality of language.
5. Adheres to assignment instructions - Chicago Manual of Style, Word
Count, etc.
Complex Regional Pain Disorder
White Male With Hip Pain
BACKGROUND
This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the b.
Rare World: Towards Technology for Rare DiseasesHaley MacLeod
This document discusses opportunities for technology to help address challenges faced by those with rare diseases. It profiles people in rare disease communities who take on roles like patients, advocates, record keepers and more. Their experiences include struggling to communicate their unfamiliar conditions, facing denial from caregivers, and dealing with uninformed doctors. While rare and common chronic diseases differ in prevalence and awareness, they share experiences like coping with the disease and its impacts. The document suggests technologies could help expand care networks, embrace patients' whole lived experiences, leverage existing platforms, and improve patient-provider relationships. It calls for designs that allow slow information dissemination and supporting caregivers.
ISBAR is a structured communication tool used in healthcare:
I: Introduce yourself
S: Situation (describe the problem)
B: Background (patient history)
A: Assessment (current status)
R: Recommendation (suggested action)
It promotes clear and concise communication for better patient c
This document discusses 10 traits of great physicians as identified by Dr. John P. Higgins. The traits are: 1) having a detective-like approach to patients to fully understand their cases, 2) taking care of one's own health and practicing self-care, 3) being a master listener focused fully on patients, 4) finding passion in the work of medicine, 5) treating the whole patient including psychological and social factors, 6) having empathy for patients' experiences, 7) paying close attention to details, 8) developing resilience to handle stressful situations, 9) continuously learning and improving, and 10) relaxing and avoiding burnout. The document provides examples for each trait and tips physicians can adopt to enhance patient care.
1) Charlie, a respected orthopedist and mentor of the author, was diagnosed with pancreatic cancer but refused all treatment and focused on spending time with family, eventually dying at home.
2) Doctors experience death differently than most - they are aware of medical limitations and options and generally have a serene acceptance when facing their own mortality, opting for minimal treatment and dying peacefully.
3) The author argues that the medical system encourages excessive treatment out of fear of litigation and desire to avoid blame, even when treatment provides only misery, and that doctors still refuse such treatment for themselves by focusing on dignity and quality of life over aggressive measures near the end.
This document summarizes a presentation given at the Third Annual Patient Engagement Summit on June 4, 2015 by R. J. Salus, the Director of Patient Experience at El Camino Hospital. The presentation focuses on predicting patient needs, empowering patients, and transforming healthcare transactions into meaningful relationships. It discusses challenges such as capturing accurate patient preferences and expectations. It also presents ideas and technologies for more personalized, convenient, and proactive patient-centered care.
This document provides an overview of physician ethics and legal issues. It discusses the Hippocratic Oath and codes of medical ethics. It describes how the law and ethics intertwine in areas like abandonment, compassion, and trust. It also covers topics like medical errors, patient assessments, misdiagnosis, informed consent, negligent treatment, and failure to properly review patient documentation.
PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com
Dr. Jon Siebert received his undergraduate degree in biology and medical degree from the University of Kansas School of Medicine. He did his 2-year residency in Atchison, Kansas and then took a job at the Atchison Regional Hospital system. His wife is from Atchison and knew of openings in primary care when he was in medical school. Dr. Siebert works in both a primary care office and an addiction clinic. He enjoys working with addiction patients. While personally against abortion, he will refer patients seeking one to another provider if he cannot dissuade them.
Treatment For Cancer - Alternative Cancer Treatment Options To Traditional Ca...Keith Loucks
This is a guide for those looking for alternative cancer treatment information. Treatment For Cancer - Alternative Options to Traditional Cancer Therapy
For this assignment, consider the following case and then using th.docxbudbarber38650
For this assignment, consider the following case and then using the internet, course materials, and the Library, compose reasoned responses to the questions that follow.
In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.
The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.
The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).
1. What, if anything, did the nurse do wrong?
2. Had she moved beyond her scope of practice?
3. Could the nurse's conduct be justified under the patient advocate portion of her role?
4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?
Support your responses with evidence and cite your sources.
Length 4 pages not counting the case. At least 4 references; scholarly sources
COURSE MATERIAL INFORMATION
: Ethical Principles and Dilemmas of Confidentiality, Veracity, and Fidelity
Health care .
The soul of medicine tales from the bedside pdfOctavio Alec
The document summarizes a book titled "Surgery: A Case Based Clinical Review" that is intended to help medical students prepare for surgery rotations and shelf exams. It uses a case-based approach to cover common surgical diseases. For each case, it includes a brief history, exam findings, differential diagnosis, workup, management, and questions. It also has algorithms, areas of controversy, and potential pitfalls. The book concludes with multiple choice questions. Reviews praise its organization, concise explanations, and preparation for oral exams and shelf tests.
Homeopathy - Personal Experience of a PhysicianChuck Thompson
Historical book on the medical practice of Homeopathy. A physician's personal experience. Christian based book. Gloucester, Virginia Links and News website. GVLN. Visit us for more incredible content.
Experts by experience 2014: A compilation of patients’ storiesInspire
Experts by experience 2014: A compilation of patients’ stories: A special report by Inspire, developed in cooperation with the Stanford University School of Medicine, featuring columns written by patients as part of a monthly series in Stanford University School of Medicine’s Scope medical blog.
Third Party Reporting of Patient Improvement.docxNelson Hendler
Reproting of outcome studies is often subjective. This collection of real leterrs, emails, and Facebook posting provides third party documentation and validation of the efficacy of treatment, without the subjective bias of the party doing the treatment.
The document is a paper written by H. Brittmann in 2014 about his experience fighting brain cancer. It provides an introduction to his diagnosis of a stage 4 glioblastoma multiforme brain tumor and median life expectancy of 18 months. It then lists 8 quick tips for coping with a cancer diagnosis, including asking for help, understanding treatments, challenging doctors, exercising body and mind, enjoying life, documenting the journey, and settling affairs. The document discusses treatment options Brittmann considered beyond the standard radiotherapy and chemotherapy, such as gene therapy, electrotherapy, and immunotherapy.
The document provides a sample of questions an attorney could ask a doctor during a deposition to expose flaws in a psychological evaluation report. It discusses how the doctor diagnosed major depressive disorder but the report lacked sufficient data to support this diagnosis. The questions probe where in the report the doctor described symptoms, observations during examinations, test results and validity. The doctor would not be able to point to evidence in the report validating the diagnosis.
Essay Assignments Topic (How Should I be Governed d.docxrusselldayna
Essay Assignments
Topic: (How Should I be Governed during Ancient Greek Era)
ERA/Civilization:
The Classical Greek Period (Greek Political Thought: Plato and Aristotle)
"Great Question" to be answered and analyzed in the essay:
How should I be governed?
- The paper will argue how the people of the era/civilization (Ancient Greek)
answered the particular great question (How should I be governed?).
- All papers must carry a working thesis. This is not simply a report of different
historical perspectives, but a careful analysis and synthesis of the research you
conduct.
- Your final essay will include a title page and bibliography. The essay itself should
be no less than 2400 words and no more than 10 pages.
Note: introduction and Bibliography is already written, please see
attached file. Please continue writing the paper using this file.
ALL WRITTEN WORK TURNED IN FOR CORE HISTORY MUST FOLLOW THESE
BASIC RUBRICS:
• Typed work (word processor), neat and legible, 81/2” x 11” paper 1” margins
all sides
• Times New Roman font, 12 pt.
• Use Footnotes as opposed to endnotes
• All citations must conform to the Chicago Manual of Style
• Use only permitted sources.
- Papers must cite no fewer than FIVE scholarly sources, including at least THREE
primary sources approved by the instructor.
- Permitted secondary sources: Printed works that are scholarly (that is, peer-
reviewed) are the only permitted secondary sources. Peer-reviewed print journals
that are available electronically through library databases are included among
permitted sources. NO OTHER ELECTRONIC SOURCES are permitted Your
instructor may, at his/her discretion, reject or fail any paper that has used one or
more non-permitted sources.
Evidence of academic dishonesty or plagiarism on any part of the assignments will
result in failure of the course and referral to the dean for expulsion.
Essay Grading Rubric
1. Strong Thesis Statement - Is argued coherently and forcefully throughout
the paper. Includes appropriate introductory and concluding paragraphs. The
entire body of the paper is argument driven.
2. Use of Appropriate Scholarly Secondary Sources and Primary Sources -
There is depth and breadth to the research. No false citations. N0 fluff added
to bibliography.
3. Correct use of historical facts and examples to further the argument -
Paper does not give incorrect information, all facts serve the argument and
are not used as mere filler, historical context is maintained.
4. Mechanics and Grammar - No grammatical or spelling errors, proper
formatting, formality of language.
5. Adheres to assignment instructions - Chicago Manual of Style, Word
Count, etc.
Complex Regional Pain Disorder
White Male With Hip Pain
BACKGROUND
This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the b.
Rare World: Towards Technology for Rare DiseasesHaley MacLeod
This document discusses opportunities for technology to help address challenges faced by those with rare diseases. It profiles people in rare disease communities who take on roles like patients, advocates, record keepers and more. Their experiences include struggling to communicate their unfamiliar conditions, facing denial from caregivers, and dealing with uninformed doctors. While rare and common chronic diseases differ in prevalence and awareness, they share experiences like coping with the disease and its impacts. The document suggests technologies could help expand care networks, embrace patients' whole lived experiences, leverage existing platforms, and improve patient-provider relationships. It calls for designs that allow slow information dissemination and supporting caregivers.
ISBAR is a structured communication tool used in healthcare:
I: Introduce yourself
S: Situation (describe the problem)
B: Background (patient history)
A: Assessment (current status)
R: Recommendation (suggested action)
It promotes clear and concise communication for better patient c
This document discusses 10 traits of great physicians as identified by Dr. John P. Higgins. The traits are: 1) having a detective-like approach to patients to fully understand their cases, 2) taking care of one's own health and practicing self-care, 3) being a master listener focused fully on patients, 4) finding passion in the work of medicine, 5) treating the whole patient including psychological and social factors, 6) having empathy for patients' experiences, 7) paying close attention to details, 8) developing resilience to handle stressful situations, 9) continuously learning and improving, and 10) relaxing and avoiding burnout. The document provides examples for each trait and tips physicians can adopt to enhance patient care.
1) Charlie, a respected orthopedist and mentor of the author, was diagnosed with pancreatic cancer but refused all treatment and focused on spending time with family, eventually dying at home.
2) Doctors experience death differently than most - they are aware of medical limitations and options and generally have a serene acceptance when facing their own mortality, opting for minimal treatment and dying peacefully.
3) The author argues that the medical system encourages excessive treatment out of fear of litigation and desire to avoid blame, even when treatment provides only misery, and that doctors still refuse such treatment for themselves by focusing on dignity and quality of life over aggressive measures near the end.
This document summarizes a presentation given at the Third Annual Patient Engagement Summit on June 4, 2015 by R. J. Salus, the Director of Patient Experience at El Camino Hospital. The presentation focuses on predicting patient needs, empowering patients, and transforming healthcare transactions into meaningful relationships. It discusses challenges such as capturing accurate patient preferences and expectations. It also presents ideas and technologies for more personalized, convenient, and proactive patient-centered care.
This document provides an overview of physician ethics and legal issues. It discusses the Hippocratic Oath and codes of medical ethics. It describes how the law and ethics intertwine in areas like abandonment, compassion, and trust. It also covers topics like medical errors, patient assessments, misdiagnosis, informed consent, negligent treatment, and failure to properly review patient documentation.
PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com
Dr. Jon Siebert received his undergraduate degree in biology and medical degree from the University of Kansas School of Medicine. He did his 2-year residency in Atchison, Kansas and then took a job at the Atchison Regional Hospital system. His wife is from Atchison and knew of openings in primary care when he was in medical school. Dr. Siebert works in both a primary care office and an addiction clinic. He enjoys working with addiction patients. While personally against abortion, he will refer patients seeking one to another provider if he cannot dissuade them.
Treatment For Cancer - Alternative Cancer Treatment Options To Traditional Ca...Keith Loucks
This is a guide for those looking for alternative cancer treatment information. Treatment For Cancer - Alternative Options to Traditional Cancer Therapy
For this assignment, consider the following case and then using th.docxbudbarber38650
For this assignment, consider the following case and then using the internet, course materials, and the Library, compose reasoned responses to the questions that follow.
In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.
The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.
The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).
1. What, if anything, did the nurse do wrong?
2. Had she moved beyond her scope of practice?
3. Could the nurse's conduct be justified under the patient advocate portion of her role?
4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?
Support your responses with evidence and cite your sources.
Length 4 pages not counting the case. At least 4 references; scholarly sources
COURSE MATERIAL INFORMATION
: Ethical Principles and Dilemmas of Confidentiality, Veracity, and Fidelity
Health care .
The soul of medicine tales from the bedside pdfOctavio Alec
The document summarizes a book titled "Surgery: A Case Based Clinical Review" that is intended to help medical students prepare for surgery rotations and shelf exams. It uses a case-based approach to cover common surgical diseases. For each case, it includes a brief history, exam findings, differential diagnosis, workup, management, and questions. It also has algorithms, areas of controversy, and potential pitfalls. The book concludes with multiple choice questions. Reviews praise its organization, concise explanations, and preparation for oral exams and shelf tests.
Homeopathy - Personal Experience of a PhysicianChuck Thompson
Historical book on the medical practice of Homeopathy. A physician's personal experience. Christian based book. Gloucester, Virginia Links and News website. GVLN. Visit us for more incredible content.
Experts by experience 2014: A compilation of patients’ storiesInspire
Experts by experience 2014: A compilation of patients’ stories: A special report by Inspire, developed in cooperation with the Stanford University School of Medicine, featuring columns written by patients as part of a monthly series in Stanford University School of Medicine’s Scope medical blog.
Third Party Reporting of Patient Improvement.docxNelson Hendler
Reproting of outcome studies is often subjective. This collection of real leterrs, emails, and Facebook posting provides third party documentation and validation of the efficacy of treatment, without the subjective bias of the party doing the treatment.
The document is a paper written by H. Brittmann in 2014 about his experience fighting brain cancer. It provides an introduction to his diagnosis of a stage 4 glioblastoma multiforme brain tumor and median life expectancy of 18 months. It then lists 8 quick tips for coping with a cancer diagnosis, including asking for help, understanding treatments, challenging doctors, exercising body and mind, enjoying life, documenting the journey, and settling affairs. The document discusses treatment options Brittmann considered beyond the standard radiotherapy and chemotherapy, such as gene therapy, electrotherapy, and immunotherapy.
The document provides a sample of questions an attorney could ask a doctor during a deposition to expose flaws in a psychological evaluation report. It discusses how the doctor diagnosed major depressive disorder but the report lacked sufficient data to support this diagnosis. The questions probe where in the report the doctor described symptoms, observations during examinations, test results and validity. The doctor would not be able to point to evidence in the report validating the diagnosis.
1. Morbidity and Mortality:Writing what’s wrong Rick Mansfield, MD MS Feb 3, 2010 The Dying Narrative The Case Example of Sylvia Plath and The Bell Jar
3. A history of Mansfield M+Ms P4P is Changing MeMansfield, R. Journal of Medical Economics. 5/4/07. p.56-60. (Winner of Young Physcian’s Writer’s Award) Patient flow in primary care (10/07 – 10/08): presented as a poster at the VA National Primary Care Conference in Arlington, VA July 7/29/08. Medicine and the Arts: Ethics: [Excerpt] by Dietrich Bonhoeffer: Mansfield, R. Academic Medicine. 84(7):908-9, July 2009. Virginia Woolf and PTSD:Mansfield, R. Accepted for publication in Journal of Academic Medicine: slated for 3/10. Proofs Finalized yesterday. The Dying Narrative in the Bell Jar by Sylvia Plath: Mansfield, R. Presentation at Literature and Culture since 1900 Conference pending 2/18/10.
4. outline Part one: Writing is the procedure of the pcp Intro and terms Typos and the ‘cut and paste’ [the afib/coumadin case] Timeliness and location of documentation – it’s not all medical [the BMI case] Treat writing like a procedure [the synthroid case] What our writing says about us – (a transition to the main case of the day) Part two: Narrative medicine with examples the dying narrative of Sylvia Plath
5. Health care providers are writers Patient care depends (in part) on what is written in the chart. If you don’t finish your notes – you will be hounded until you do. “If it wasn’t documented – it didn’t happen…even if it did.” Conversely, if it was documented – it happened…even if it didn’t Clinical follow up among numerous providers Billing and coding Medico-legal Performance evaluations Writing is the ‘procedure’ of the pcp
9. One letter! “…tests indicate his lover has also been affected…” ‘we are waiting for the cultures…”
10. One letter! “…tests indicate his lover has also been affected…” ‘we are waiting for the vultures…”
11. Case example: Mr. TIA-the cut and paste error. Please don’t do this! *med review/chart review: A) the chart records this item in the history: “Atrial fibrillation… Recently converted to normal sinus rhythm after a course of anticoagulation with Warfarin (off Warfarin for approximately 3 weeks now)." THIS ITEM FIRST APPEARED IN A CARDIOLOGY NOTE DATED 1/7/02 - AND HAS BEEN COPIED VERBATIM AS RECENTLY AS 11/9/09. - MEANING THE CHART RECORDS HIM AS BEING "OFF WARFARIN FOR APPROXIMATELY THREE 3 WEEKS NOW" FOR THE PAST SEVEN YEARS…THis is relevant today as my approach to a TIA would have been different if a possible TIA occurred in the setting of just having stopped coumadin. B) many notes record the patient as taking ASA qd - he states he does not. His wife confirms this. This is also relevant since he should not be considered an aspirin failure for possible TIA.
12. If you’re going to cut and paste… Use hard dates Do not say ‘symptoms started three weeks ago…”. If you cut and paste this later – it will be wrong. Say “symptoms started on 1/15/09…”. If you cut and paste this later – it remains true. Another example: “Abx day 4” vs. “14 day course of abx started on 1/1/10 to end on 1/15/10” – more words up front; but can be cut and pasted accurately for the duration of the course. Make cut and paste work efficiently to your advantage – but make it true.
13. Cut and paste (Be a writer) Reference your source: e.g., “PMH as per Dr. J’s note of 1/21/10…[then cut and paste the PMH]” Not medical knowledge It’s technology to which we have to adapt Let’s use it to our advantage. Let’s make sure the medical record is complete and accurate. Do they teach this in med school or residency now?
14. Who else reads our writing? Letter received from patient: “Dear Doctor, Thank you for honoring my request for a copy of my medical records. I was quite pleased to see myself referred to as a ‘pleasant elderly gentleman’ in your notes. Most people refer to me as an ‘irascible old bastard’.” (thanks to Dr. Berman….that’s not Dr. Berman)
15. the BMI example: timeliness and location of documentation Evaluations and outcomes are not always based on what we actually do – evaluations and outcomes can be based only what we document and when we document it.
16. the BMI example: timeliness and location of documentation Some recent email communications: “Rick you missed 6 out of 11 patients this week for the BMI Reminder. Please call the below patients and satisfy the reminder- thanks” “This is not true! – These patients were all seen within the last 72 hours – I just haven’t finished my notes yet. All my notes prior to this are completed. These notes will be finished promptly. This is a research design flaw – this data captured is confounded by its dependence on note status – and therefore is not always an accurate measure of whether or not I addressed BMI with patients.” “Glad to hear you are completing the BMI reminder. Please finish your notes on the same day as the visit.”
17. 375 37.5 375 The Synthroid case: treat writing like a procedure
18. The Synthroid case: outcome After one month of taking the wrong dose – the pt felt his PTSD flare and the need to ‘shoot back’. Root Cause Analysis Tort case against the VA VHA NATIONAL DUAL CARE POLICY: (VHA DIRECTIVE 2009-038 - August 25, 2009) I meet with VA regional counsel at 10:00 AM today
19. The Synthroid case: treat writing like a procedure If we can’t write it – it won’t be done. If we don’t make the time to write – how can we expect things to be done correctly? What if a surgeon practiced surgery the way we write notes and orders? What have I done? I treat my admin time with equal importance to my clinic time. I don’t see two patients at once during my clinic – why should I allow interruptions while writing my notes…and orders?
20. Another Synthroid case: treat writing like a procedure "To Dr. Mansfield, I am increasing, after talking c Mr. X today, levoxyl from .025 mg to .075 mg #90 daily. Disregard note from 1-22-10." *************************************** date TSH VA dose of synthroid recommend dose by nonVApcp 8/26/09 3.00 0.025mg 0.025mg 10/23/09 0.025mg 0.05 mg (never received) 1/22/10 0.025mg 0.10 mg (received after 1/26/10) 1/26/10 0.025mg increase from 0.025 to 0.075 mg. non VA rec's for change in levoxyl are inconsistent. I have no further labs since 8/26/09. he needs to see me (with labs) before I change his dose… [this took >20 minutes to read/enter non-VA correspondence – track VA data, construct a table, make a decision, order labs, and communicate this to scheduling…20 minutes without an H+P evaluation]
21. Memorable quote from Med school: Good surgeons… Great surgeons… …Make good INcisions …Make good DEcisions
22. Patient satisfaction: “the customer is always right?” Switzer walked back into the room, having been called by the nurses. Ms. Rydel recognized him, “You again?” she tried to sit up when she said this but it hurt – she moaned and laidback down. “I want a second opinion. No one is telling me anything… I want Dr. Barr.” She pointed a finger at Switzer, “Haven’t you heard the ‘customer is always right?!’” …He pulled a chair up beside the bed; sat down so that as he looked at her, he wasn’t looking down, they were on the same level. He was calm when he spoke, “Ms. Rydel, this is a hospital, you’re not a customer, and I’m not here to sell you anything. I’m here to do everything in my power to help you as a doctor-” “Then why don’t you listen to me and do what I want? I have rights you know.” Her voice was at least a little softer. “Yes you do. You have your rights, and I have my obligation as a physician to provide for you the best care possible. I won’t deviate from that. I know you’re in pain. And I can’t cure you. It’s not that I don’t have the time to explain all this to you, it’s because you don’t have the time for me to explain it to you. You need to have surgery soon, now. Head Games: by Rick Mansfield p. 67
23. Now – more about writing… What is writing? Narrative medicine (and psychobiography) – Rita Charon Part Two: The case of Sylvia Plath and the Bell Jar
24. Strumpf and Douglas: The Grammar Bible. (p. xv) “Communication is the essence of the human condition.” The human condition is the subject matter of medical practice The medical record is our medium of communication, (dare I say, ‘essence’ of our communication?) “…even if his or her knowledge is unconscious.”
25. Strunk and White: the Elements of Style (p. 67) “All writers, by the way they use the language, reveal something of their spirits, their habits, their capacities, and their biases. This is inevitable as well as enjoyable. All writing is communication: creative writing is communication through revelation – it is the Self escaping into the open. No writer long remains incognito.”
26. Ex/ who is this writer? End stage metastatic pancreatic cancer He’s an old friend This is sad He’s lived a good life Request of the team: please give epo 14,000 U SC q wk Might make him feel better. J.O.
27. Ex/ who is this writer? Cc: …vague symptoms… HPI: …nothing specific… PE…CTA…RRR…. a/p: …symptoms treated in the ED…ok for d/c… …will check TSH…he can f/u with me in endo clinic A.B.
28. Zinsser: On Writing Well. (p. 5) “[writers]…are driven by a compulsion to put some part of themselves on paper…The problem is to find the real man or woman behind all the tension. For ultimately the product that any writer has to sell is not his subject, but who he is.
29. Stephen King: On Writing. (p. 101) It starts with this: put your desk in the corner, and every time you sit down there to write, remind yourself why it isn’t in the middle of the room. Life isn’t a support system for art. It’s the other way around.
30. Narrative Medicine: Rita Charon Definition: “medicine practiced with the narrative competence to recognize, interpret, and be moved to action by the predicaments of others.” (2 January 2001 Annals of Internal Medicine Volume 134 • Number 1) “With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care.” (JAMA 2001; 286: 1897-1902)
31. Rita Charon Writing and humanities studies produce better physicians…because doctors learn to coax hidden information from patients' complaints When Medicine Meets LiteratureBy Marguerite Holloway Scientific American Magazine - April 25, 2005.
32. Sylvia Plath: The Bell Jar. “People were made of nothing so much as dust, and I couldn’t see that doctoring all that dust was a bit better than writing poems people would remember and repeat to themselves when they were unhappy or sick and couldn’t sleep.” P. 57 “So maybe doctors and writers could get along fine after all.” P55
33. The Bell Jar: 1st Paragraph It was a queer, sultry summer, the summer they electrocuted the Rosenbergs, and I didn’t know what I was doing in New York. I’m stupid about executions. The idea of being electrocuted makes me sick, and that’s all there was to read about in the papers – goggle-eyed headlines staring up at me on every street corner and at the fusty, peanut-smelling mouth of every subway. It had nothing to do with me, but I couldn’t help wondering what it would be like, being burned alive all along your nerves. I thought it must be the worst thing in the world. (p.1) 1st person/past tense
34. The Bell Jar: 1st person/present! It was a queer, sultry summer, the summer they electrocuted the Rosenbergs, and I didn’t know what I was doing in New York. I’m stupid about executions. The idea of being electrocuted makesme sick, and that’s all there was to read about in the papers – goggle-eyed headlines staring up at me on every street corner and at the fusty, peanut-smelling mouth of every subway. It had nothing to do with me, but I couldn’t help wondering what it would be like, being burned alive all along your nerves. I thought it must be the worst thing in the world. (p.1)
35. Electrocution vs. Electroconvulsive therapy. Context text The Rosenbergs. 1950’s McCarthyism. 1st U.S. citizens to be condemned to death for espionage. Executed by electrocution. “down the hall between two nurses,… with dignity, like a person coolly resigned to execution.” P.211 ECT Tx is the climax of the book.
38. Next present tense example: For a long time afterward I hid them away, but later, when I was all right again, I brought them out, and I still have them around the house. I use the lipsticks now and then, and last week I cut plastic starfish off the sunglasses case for the baby to play with. (p. 3)
39. Change in verb tense? For a long time afterward I hid them away, but later, when I was all right again, I brought them out, and I still have them around the house. I use the lipsticks now and then, and last week I cut plastic starfish off the sunglasses case for the baby to play with. (p. 3)
40. Does she give away the ending? For a long time afterward I hid them away, but later, when I was all right again, I brought them out, and I still have them around the house. I use the lipsticks now and then, and last week I cut plastic starfish off the sunglasses case for the baby to play with. (p. 3)
41. The baby? For a long time afterward I hid them away, but later, when I was all right again, I brought them out, and I still have them around the house. I use the lipsticks now and then, and last week I cut plastic starfish off the sunglasses case for the baby to play with. (p. 3) How easy having babies seemed to the women around me! Why was I so unmaternal and apart?...If I had to wait on a baby all day, I would go mad. (p.222)
42. …that after I had children I would feel differently, I wouldn’t want to write poems anymore…when you were married and had children it was like being brainwashed, and afterward you went about numb as a slave in some private, totalitarian state. P.85 “I’m never going to get married.” p.93..p.26;83 Children made me sick. P.117 I didn’t want to give my children a hypocrite for a father. P. 119 More on Babies
43. Next example: the Bath and Baptism Whenever I’m sad I’m going to die, or so nervous I can’t sleep, or in love with somebody I won’t be seeing for a week, I slump down just so far and then I say: “I’ll go take a hot bath. I meditate in the bath…I’m never so much myself as when I’m in the hot bath…I don’t believe in baptism…but I guess I feel about a hot bath the way those religious people feel about holy water. (p. 19-20) The longer I lay there in the clear hot water the purer I felt…I felt pure and sweet as a new baby.” (p.20)
44. Baptism – the very last page! There ought, I thought, to be a ritual for being born twice – patched, retreaded and approved for the road.” (p.244)
45. Plath’s Only Novel “Secretly, in studies and attics and schoolrooms all over America, people must be writing.” P. 102. “Then I decided that I would spend the summer writing a novel. That would fix a lot of people.” P.121 A feeling of tenderness filled my heart. My heroine would be myself, only in disguise. She would be called Elaine. Elaine. I counted the letters on my fingers. There were six letters in Esther, too. It seemed a lucky thing. (p. 120) There are six letters in Sylvia, too. (It seems a lucky thing.)
46. The Bell Jar I saw [these girls] on the sunroof, yawning and painting their nails and trying to keep their Bermuda tans, and they seemed bored as hell…bored with skiing in Switzerland at Christmas and bored with the men in Brazil. Girls like that make me sick. I’m so jealous I can’t speak. (p.4) …Those girls, too, sat under bell jars of a sort. (P. 238)
47. The Bell Jar To the person in the bell jar, blank and stopped as a dead baby, the world itself is the bad dream p. 237. I would be sitting under the same glass bell jar, stewing in my own sour air. p. 185. I felt surprisingly at peace. The bell jar hung, suspended, a few feet above my head. I was open to the circulating air. P. 213. How did I know that someday…the bell jar with its stifling distortions wouldn’t descend again? P. 241.
48. She uses the present tense to: Compare ECT to electrocution Discuss babies/children Desire for new life/baptism Writing Understand other people Depression: The Bell Jar.
49. Conclusions: Writing matters It is the procedure of the pcp What we write says something about who we are ‘Write what you know’ – the age-old writer’s adage is just as true for the health care provider writing in the chart. Narrative Medicine: Understanding the patient’s story IS caring for the patient. (present tense)
50. Upcoming installments Heisenberg : The Uncertainty Principle (as it applies to health services research) Ben Franklin: Autobiography (cognitive behavioral therapy) Edgar Allen Poe: The Raven (psychosis) Robert Louis Stevenson: Jekyll and Hyde(alcoholism)
If you don’t take the time to write it – it won’t be done. If you don’t have the time to write it, how can you have the time to do it. Why do we not allot time to write notes. Why aren’t we given the time to do it. Traditionally it is always after clinic, end of the day, may
Address the “Bell Jar”: When the bell jar descends – she is ‘isolated’; and the bell jar distorts her view of the world around her.
The book is one of an unreliable narrator speaking in the past tense. An omniscient narrator is an option – who could speak in the present tense – but this is not the theme of the book….The very first paragraph includes a change in verb tense – this changes the voice. Normally this would have been caught by the editor (Think about the Lovely Bones…This is an omniscient narrator)
(In her real life – she wrote this book in between her 1st and 2nd child (i.e., at a time when she actually had a baby. (Perhaps at a time when she felt ‘all right’?)