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  1. #81
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    Quote Originally Posted by Veronika View Post
    I was supposed to see an MD today, but she cancelled on me--I saw an NP instead, and it was fine. It's still better than the dismissive MDs at urgent care.
    The only times I have ever been misdiagnosed were at urgent care--where the doctors ask all the questions about my medical history .

    I hate going to urgent care. I wish my body would cooperate with me on that one and stop falling apart on Friday nights.
    Trolling dates all the way back to 397 B.C. - People began following Plato around and would make fart noises after everything he said.

  2. #82
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    My last two visits to the ER were very specific and the diagnosis was a no-brainer. One was a textbook peritonsillar abscess (yuck) and the other, just over the weekend was a textbook otitis media. A first year medical student could have diagnosed that.

    You never want to be an "interesting" or "challenging" case.
    "Nature is a damp, inconvenient sort of place where birds and animals wander about uncooked."

    from Speedy Death

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    Quote Originally Posted by sailornyanko View Post
    Is that common in the US? I can understand why it would be important to know why someone is there THAT day if it's a simple thing like a diabetic that came to pick up his monthly presciption, but only a doctor is trained with the eye to ask the right questions. Taking a good medical history is one of the hardest things in medicine because asking the right question can direct you to the diagnosis. House's cases sometimes are very typical manifestations of a disease (like the episode where a guy got brucelosis by eating non pasteurized cheese), but by not making a good history they spend the whole episode running around in circles like idiots.
    Very true!

  4. #84

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    Quote Originally Posted by genevieve View Post
    I never pay attention to who is taking my stats at the doctor's. I only get annoyed when I give someone a complete history, they leave, and the doctor comes in and asks me all the same questions But I have no idea if the previous person is an MA, a NP, an LPN, or some joe off the street with a lab coat. next time I go I should see if I can tell (I don't even recall if people wear tags that would identify their position).
    IME most doctor's offices/clinic discourage the credentials listed on a name tag. In my internal doctor's office, there are no name tags worn - i just know what their credentials are because I ask. In my ENT office, I happened to have worked with a couple of the staff nurses so I know their credentials.
    The last time I was at my internal doctor's office, the CMA did measurements one of which was incorrect (the nurse came in to verify it as it was inconsistent with a measurement taken 5 weeks earlier). If you are doing a quick review of symptoms questionairne and quick measurements because you are sick - ok, go ahead.

    But when it comes to listing my medications with dosages and the frequency I prefer to talk to the RN. With my annual physical, I brought in the list of medications I am taking, the spelling, any otc medications and vitamins. The CMA was reading off the list from my chart. Which included an antibiotic that I had prescribed 3 months earlier, a solumedrol pack prescribed 3 months earlier and antibiotic ear drops prescribed 3 months earlier. When I said I wasn't taking those medications anymore, she said why not - the doctor will want to know why you quit taking them. Uh, they were prescribed for a specific illness and specific timeframe.

  5. #85
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    Quote Originally Posted by IceAlisa View Post
    My last two visits to the ER were very specific and the diagnosis was a no-brainer. One was a textbook peritonsillar abscess (yuck) and the other, just over the weekend was a textbook otitis media. A first year medical student could have diagnosed that.

    You never want to be an "interesting" or "challenging" case.
    I didn't think I was challenging at all. I had, after all, already diagnosed myself .

    Me: I have a lung infection.
    Doctor: Thank you for your input, Dr. Prancer. Now let's see what you really have. I would say you have a cold.
    Me: I have a lung infection. I have had at least six lung infections and I am positive this is a lung infection. Colds don't faze me at all; I don't even run a fever with a cold.
    Doctor: If you've had six lung infections, then you must not take very good care of yourself. What you have now is a cold, which is a virus, and there is nothing I can do for you. Go home--fluids, bedrest.

    I had a lung infection--which was very bad by Monday.

    Me: I have a rash that is spreading very quickly and it's itching horribly.
    Doctor: Wow, I've never seen anything like that before.
    Me: I think I need a steroid cream
    Doctor: Nah, it must be some kind of allergy. Put some Benadryl on it and wrap it in Saran wrap, so you don't rub it off.
    Me: I already tried Benadryl and it didn't help at all.
    Doctor: It will help if you use the Saran Wrap. Trust me.

    So I put Benadryl on it and wrapped it in Saran Wrap, and then on Monday went to the dermatologist, who was aghast at the Saran Wrap and gave me a whopping dose of steroids--shot, cream AND pills.

    I also think that Urgent Cares are staffed mostly by doctors who don't have sufficient social skills to have their own practices .

    I've had some very bad experiences in Urgent Cares.
    Trolling dates all the way back to 397 B.C. - People began following Plato around and would make fart noises after everything he said.

  6. #86

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    We've had good luck with urgent care, but ours is staffed by MDs and NPs who are part of the regular practice teams within the medical group. Every MD and NP in the group does a rotation at least once a month. They have full access to the medical records, and will contact the PCPs or treating specialists if they need to. They use a "call first" system, so they actually call up your records before you come in and are ready to take you if you're really sick. It's really nice, but I realize that most folks don't have access to such large groups.
    AceOn6, the golf loving skating fan

  7. #87
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    Quote Originally Posted by Aceon6 View Post
    We've had good luck with urgent care, but ours is staffed by MDs and NPs who are part of the regular practice teams within the medical group. Every MD and NP in the group does a rotation at least once a month. They have full access to the medical records, and will contact the PCPs or treating specialists if they need to. They use a "call first" system, so they actually call up your records before you come in and are ready to take you if you're really sick. It's really nice, but I realize that most folks don't have access to such large groups.
    I used to go to a practice that had an after hours urgent care. If you were a patient of the practice, they treated it like an office visit. That was REALLY nice while it lasted, but then the doctors had a fight and all of them left but one--and he was the one I just couldn't stand. I kept going to him for a while, but one day he told me my blood pressure was really high and I heard myself say "It's only high when I am seeing you."

    And I realized that was true and left.
    Trolling dates all the way back to 397 B.C. - People began following Plato around and would make fart noises after everything he said.

  8. #88
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    Quote Originally Posted by IceAlisa View Post
    Where I work ROS stands for Review Of Systems.
    It does where I work too, unless I'm not paying attention to what I type...

  9. #89
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    My guess is that urgent care docs wade through hundreds and hundreds of viral colds a day fighting off patients demanding antibiotics. So to them Prancer is the boy who cried wolf #146 but in her case she turned out to be right and there was a wolf. Not that it's a good excuse for not being more careful; and certainly it's not Prancer's fault that so many people go to the doctor with a cold asking for antibiotics.

    I've read that low levels of vitamin D are linked with frequent colds but am not sure where I saw this or how good the research was. May be I should try it.
    "Nature is a damp, inconvenient sort of place where birds and animals wander about uncooked."

    from Speedy Death

  10. #90

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    Quote Originally Posted by numbers123 View Post
    The last time I was at my internal doctor's office, the CMA did measurements one of which was incorrect (the nurse came in to verify it as it was inconsistent with a measurement taken 5 weeks earlier).
    At my recent visit to the primary care doc, the medical asst measured my height and weight before I saw the doc. She informed me I was 4'9" - which was wrong unless I had suddenly shrunk a few inches. I told her it was 4'11" and she said she'd try again. So she pulls the measuring stick up and then says "Look". I stepped off and turned around and pointed out to her that it was on 59 1/2". She said "Right, four-nine." I explained to her that no, 60 inches would be 5 feet and 1/2 inch less is 4'11 and 1/2". She didn't even react and I'm quite certain she didn't change what she wrote down - why the feck she didn't just write the number of inches and leave it at that, I don't know.

    I told my doc about it, b/c I was so annoyed, but she didn't have the chart with the measurements with her so she couldn't check. And with everything she has to do and think about, she probably forgot what I said the minute she walked out of the room. So my med records are now incorrect b/c of a stupid med asst. Hopefully, the next time I'm there, I'll get someone who knows how many inches are in a foot. Or just writes down the inches w/o trying to convert them into feet.

    And at the end of my visit, the brilliant med asst came back into the room to give me my tetanus booster. Sorry if this offends anyone here, but I wasn't too thriled about having my arm stuck with a needle by someone who can't even do 2nd grade math. Not that I had a say. My arm hurt like hell afterward, which I don't remember after my last booster, but that was 10 years ago so I may have forgotten.

  11. #91

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    ^ Might I say that there are very incompetent people that are overemployed and very competent people that are underemployed. This does not reflect the job title or function of "medical assistant" but the labor market as a whole.

    There are some that miscalculate the height of a person. There are some that miscalculate the rewards of prolonged military commitments. The difference is that one went to vocational school, because that is what their resources allowed, so now they calculate incorrectly in inches while the other was a legacy admit at prestigious schools, because that is what their resources allowed, so miscalculated in Trillions of Dollars.

    Conversely, there are some that were doctors in their homeland, but now they are self-employed as convenience store owners. There are some that are middle aged that had no opportunity for higher education although they were very bright, so they are now construction workers.

    ETA: Sometimes it is a clinic's policy to adjust certain measurements to compensate for added height by shoes and added weight by clothes. However, an inch or pound or two or even three will not changes a person's BMI calculation much.
    Last edited by bardtoob; 02-11-2011 at 06:53 PM.

  12. #92

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    Quote Originally Posted by bardtoob View Post
    ^ Might I say that there are very incompetent people that are overemployed and very competent people that are underemployed. This does not reflect the job title or function of "medical assistant" but the labor market as a whole.
    I don't think I said anything about "medical assistants as a whole." I was responding to Numbers' post with a similar story from my experience.

    There are some that miscalculate the height of a person. There are some that miscalculate the rewards of prolonged military commitments. The difference is that one went to vocational school, because that is what their resources allowed, so now they calculate incorrectly in inches while the other was a legacy admit at prestigious schools, because that is what their resources allowed, so miscalculated in Trillions of Dollars.
    I'm not sure what the Bush administration has to do with the training of medical assistants, but as far as this particular person goes, you (and I) don't know what her "resources" were or why she went to vocational school. If you are suggesting her education background prior to vocational school was lacking (and you may be right), even if that's true, it doesn't give her a free pass to screw up - shouldn't a vocational training program in the health care field make sure the people it certifies know basic measurement rules? That is kind of important in health care - mistakes can have scary consequences. How do I know that she correctly measured the amount of vaccine to put in the syringe? Hopefully, she's done it enough (and the amount isn't person-specific) that she knew how to do it right. And I'm still alive, so that's a good sign.

    ETA: Sometimes it is a clinic's policy to adjust certain measurements to compensate for added height by shoes
    I took my shoes off before I stepped on the scale.

  13. #93

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    Quote Originally Posted by bardtoob View Post
    ETA: Sometimes it is a clinic's policy to adjust certain measurements to compensate for added height by shoes and added weight by clothes. However, an inch or pound or two or even three will not changes a person's BMI calculation much.
    It is a big deal as women age. if ones height begins to shrink, my physician is concerned about bone density and back/spine issues. And reputable clinics would use accurate measurements, not "compensate for added height of shoes." And unless I am carrying rocks in my sweater or sweatshirts, I don't believe that weight should be that different. Unless your clinic weighs you with your winter coat, platform shoes, etc. My doctor's office always has you remove your shoes and coats before weighing.

    Urgent Care clinics have not weighed or measured my height for the very reason you mentioned. Medication dosages are pretty standard for adults. Now when my kids were little, they always were weighed because of the mg/kg dosage recommendations.

  14. #94

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    Quote Originally Posted by numbers123 View Post
    It is a big deal as women age. if ones height begins to shrink, my physician is concerned about bone density and back/spine issues. And reputable clinics would use accurate measurements, not "compensate for added height of shoes." And unless I am carrying rocks in my sweater or sweatshirts, I don't believe that weight should be that different. Unless your clinic weighs you with your winter coat, platform shoes, etc. My doctor's office always has you remove your shoes and coats before weighing.
    I don't approve of it either. Doing something the right way does not take that much more time.

    Quote Originally Posted by numbers123 View Post
    Urgent Care clinics have not weighed or measured my height for the very reason you mentioned. Medication dosages are pretty standard for adults. Now when my kids were little, they always were weighed because of the mg/kg dosage recommendations.
    To those setting the policies and procedures, relevance is everything.
    Last edited by bardtoob; 02-11-2011 at 11:13 PM.

  15. #95

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    Quote Originally Posted by Debbie S View Post
    And at the end of my visit, the brilliant med asst came back into the room to give me my tetanus booster. Sorry if this offends anyone here, but I wasn't too thriled about having my arm stuck with a needle by someone who can't even do 2nd grade math. Not that I had a say. My arm hurt like hell afterward, which I don't remember after my last booster, but that was 10 years ago so I may have forgotten.
    Not trying to excuse the MA you saw, but tetanus shots always hurt in my experience. Good thing we don't have to get them too often!

  16. #96
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    Quote Originally Posted by numbers123 View Post
    With my annual physical, I brought in the list of medications I am taking, the spelling, any otc medications and vitamins.
    I love people who do this. I can't tell you how many patients I get who say "well, I take a little white pill every morning and a littler white pill every night. No, I don't know what they're for. Why don't you know what it is? It's just a simple white pill." It's worse when it's a new patient and we have no records on them whatsoever...

    Quote Originally Posted by Debbie S View Post
    At my recent visit to the primary care doc, the medical asst measured my height and weight before I saw the doc. She informed me I was 4'9" - which was wrong unless I had suddenly shrunk a few inches. I told her it was 4'11" and she said she'd try again. So she pulls the measuring stick up and then says "Look". I stepped off and turned around and pointed out to her that it was on 59 1/2". She said "Right, four-nine." I explained to her that no, 60 inches would be 5 feet and 1/2 inch less is 4'11 and 1/2". She didn't even react and I'm quite certain she didn't change what she wrote down - why the feck she didn't just write the number of inches and leave it at that, I don't know.
    OK, now that's just wrong.

    And at the end of my visit, the brilliant med asst came back into the room to give me my tetanus booster. Sorry if this offends anyone here, but I wasn't too thriled about having my arm stuck with a needle by someone who can't even do 2nd grade math. Not that I had a say. My arm hurt like hell afterward, which I don't remember after my last booster, but that was 10 years ago so I may have forgotten.
    Did you get a solo tetanus shot or a DPT? At least in my experience with the DPTs, it's a thicker mix than some others so it tends to hurt more.

  17. #97
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    Quote Originally Posted by bardtoob View Post
    ^ Might I say that there are very incompetent people that are overemployed and very competent people that are underemployed. This does not reflect the job title or function of "medical assistant" but the labor market as a whole.
    In general, I think competence tends to be systemic. Frankly, if I had an MA who wasn't competent, I wouldn't be worried about the MA; I'd be worried about the practice overall. If the MA is incompetent, why is the MA still there? Either the doctor doesn't know the MA is incompetent, which is one problem, or the doctor is willing to accept that kind of incompetence for whatever reason, which is another.

    Either way, the MA isn't the problem.

    I will say that I think a lot of people are quite unreasonable in the way they determine competence. But I still wouldn't go to a practice where I thought the staff was incompetent.

    Quote Originally Posted by mkats View Post
    I love people who do this. I can't tell you how many patients I get who say "well, I take a little white pill every morning and a littler white pill every night. No, I don't know what they're for. Why don't you know what it is? It's just a simple white pill." It's worse when it's a new patient and we have no records on them whatsoever...
    My current doctor's office has all the new patient forms online, so I downloaded them and filled them out before I went in. I know how to list my meds, but I took them along anyway because I knew they wouldn't trust me. Sure enough, the MA started asking me suspicious questions about my medication and I dumped them all out of my purse. And I had a fistful of labs from my last doctor to boot. It's amazing how little things like that so obviously raise other people's opinion of your IQ.
    Trolling dates all the way back to 397 B.C. - People began following Plato around and would make fart noises after everything he said.

  18. #98

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    Quote Originally Posted by mkats View Post
    Did you get a solo tetanus shot or a DPT? At least in my experience with the DPTs, it's a thicker mix than some others so it tends to hurt more.
    I can't speak for DebbieS, but mkats is probably correct. The Tdap recommendations are as follows:
    • Adults younger than age 65yrs who have not already received Tdap.
    • Adults of any age, including adults age 65yrs and older, in contact with infants younger than age 12m (e.g., parents, grandparents, childcare providers, healthcare personnel) who have not received a dose of Tdap should be prioritized for vaccination.
    • Healthcare personnel who work in hospitals or ambulatory care settings and have direct patient contact and who have not received Tdap.
    • Adults age 65yrs and older without a risk indicator (e.g., not in contact with an infant) may also be vaccinated with Tdap

    Since this is a newer vaccine, it is probable that the injection site feel different. But please everyone as your HCP about the Tdap.

  19. #99

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    Quote Originally Posted by IceAlisa View Post
    My guess is that urgent care docs wade through hundreds and hundreds of viral colds a day fighting off patients demanding antibiotics. So to them Prancer is the boy who cried wolf #146 but in her case she turned out to be right and there was a wolf. Not that it's a good excuse for not being more careful; and certainly it's not Prancer's fault that so many people go to the doctor with a cold asking for antibiotics.

    I've read that low levels of vitamin D are linked with frequent colds but am not sure where I saw this or how good the research was. May be I should try it.
    You want vitamin D3 2000 IU plus vitamin K2 20mg. The magic bullet. We sell a ton of it in our office. It's nickname is K2 D3.
    "awwww....shades of Janet Lynn" - Dick Button on anyone who makes more than one mistake in their program.

  20. #100
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    Is this the brand name? Thanks, I know very little about vitamin supplements.
    "Nature is a damp, inconvenient sort of place where birds and animals wander about uncooked."

    from Speedy Death

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