coast2coast, MSN, NP 7,201 Views
Joined Jul 9, '10.
Posts: 404 (42% Liked)
I don't understand this one- I thought that elevated TSH always indicated hypothyroid. Can someone explain this to me?
The highest TSH I've ever seen before was 157. Pt very fatigued, low heart rate, low B/P, overweight, and so on.
Chronic hgb in the 3.5-4.0 range. Dying of metastatic probably rectal dancer, survived almost a year.
a1c 16.9, very alive and one of my best-behaved diabetics now.
TSH 490. Manic but definitely alive
a1c's of 15, systolic BPs in the 200s, and trigs of 3000 sadly become very mundane very quickly in community practice. It's amazing how resilient the human body can be.
Personally have seen a good job market for a range of specialties. Graduated from a direct entry program and had a job 2 months prior to graduation, across the country, in one of the worst job markets in the US (California). All my classmates (30+) were hired within months of graduation as well. Never worked as an RN and this has not been a barrier to getting interviews and offers.
I see this frequently with psych patients - they want you to engage in a power struggle. Drives me nuts, every single time.
There's no way you will see 25+ patients/day and leave at 3pm if this is family practice/primary care. The 'productivity' bonus is a joke, as is lack of benefits. Keep looking.
No offense was intended, I was merely trying to counter what I see as a widely-held belief that things like legal status are not a routine part of healthcare delivery.
An acute care example would be someone needing dispo to rehab or skilled nursing. Sure, a patient can come in emergently and by EMTALA be treated, and immigration status I would agree does not impact that emergency treatment, in general. But what do you do with someone who ends up profoundly disabled, but without the income or health insurance to be accepted into some level of rehab? Like any inpatient who overstays their welcome in acute care, the barriers to dispo become a matter of common knowledge and therefore, at times, judgment. It shouldn't impact care but the potential is there.
I apologize if my original comment seemed to negate your personal experiences, on re-reading I can see how it could come off like that. I just want to engage in a discussion on a topic that I am obviously quite passionate about, not looking to cause offense.
I'm not aware of any healthcare facility that makes any sort of determination of the immigration status of individuals presenting for care. Everyone has been treated the same and no one has asked about immigration status, in my experience.
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