Latest Likes For coast2coast

Latest Likes For coast2coast

coast2coast, MSN, NP 6,721 Views

Joined Jul 9, '10. Posts: 404 (42% Liked) Likes: 621

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  • Feb 13

    Quote from Farawyn
    So...it's working?
    every d*mn time! We all have our kryptonite!

  • Feb 8

    I see this frequently with psych patients - they want you to engage in a power struggle. Drives me nuts, every single time.

  • Feb 7

    I see this frequently with psych patients - they want you to engage in a power struggle. Drives me nuts, every single time.

  • Feb 7

    Quote from Farawyn
    So...it's working?
    every d*mn time! We all have our kryptonite!

  • Nov 27 '15

    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.

  • Nov 26 '15

    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.

  • Nov 25 '15

    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.

  • Nov 24 '15

    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.

  • Nov 19 '15

    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.

  • Nov 19 '15

    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.

  • Nov 18 '15

    Quote from elkpark
    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.
    interestingly enough, this is not actually true. Having worked for multiple FQHCs,I can tell you that determination of eligibility for medi-caid/obamacare takes place on site and is an integral part of the workflow of community clinics. Specifically, you need a social security number to apply/ enroll.

    If I see an uninsured patient who needs specialty care, I need to know if that patient will EVER be eligible for insurance - it impacts course of treatment. Patients in DKA, with potential DVTs, or even with plain old chronic abdominal pain - I need to know if you have a (valid) social security number to decide how much I'm willing to try to treat in-house. It's not about denying care, but you have to frank and realistic about what you can offer them. The outcome of this is typically 1 of 2 extremes: cowboy medicine, where you treat patients w serious disease despite incomplete testing/eval, or no treatment at all for chronic but non-life-threatening conditions. So we will try to treat your lupus, even though we aren't rheumatologists and have very few treatment choices, but you are SOL when it comes to chronic back pain, frozen shoulder, or most mental health issues.

    OP, both LA county and the state of California have expanded pieces of medi-caid to cover individuals without legal status. LAC as late as spring 2015 was talking about opening up medi-caid enrollment regardless of status. The reality is the county pays for that healthcare whether or not you grant people eligibility to enroll. So eligibility/enrollment is at least a way of trying to count and characterize that shadow population. I would look for resources out of Cali, possibly also Kaiser which coincidentally is trying to take over the medi-cal market.

    pm me if you would like to know more about the impact of legal status on individual healthcare ... I have war stories

  • Nov 17 '15

    Quote from elkpark
    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.
    interestingly enough, this is not actually true. Having worked for multiple FQHCs,I can tell you that determination of eligibility for medi-caid/obamacare takes place on site and is an integral part of the workflow of community clinics. Specifically, you need a social security number to apply/ enroll.

    If I see an uninsured patient who needs specialty care, I need to know if that patient will EVER be eligible for insurance - it impacts course of treatment. Patients in DKA, with potential DVTs, or even with plain old chronic abdominal pain - I need to know if you have a (valid) social security number to decide how much I'm willing to try to treat in-house. It's not about denying care, but you have to frank and realistic about what you can offer them. The outcome of this is typically 1 of 2 extremes: cowboy medicine, where you treat patients w serious disease despite incomplete testing/eval, or no treatment at all for chronic but non-life-threatening conditions. So we will try to treat your lupus, even though we aren't rheumatologists and have very few treatment choices, but you are SOL when it comes to chronic back pain, frozen shoulder, or most mental health issues.

    OP, both LA county and the state of California have expanded pieces of medi-caid to cover individuals without legal status. LAC as late as spring 2015 was talking about opening up medi-caid enrollment regardless of status. The reality is the county pays for that healthcare whether or not you grant people eligibility to enroll. So eligibility/enrollment is at least a way of trying to count and characterize that shadow population. I would look for resources out of Cali, possibly also Kaiser which coincidentally is trying to take over the medi-cal market.

    pm me if you would like to know more about the impact of legal status on individual healthcare ... I have war stories

  • Nov 11 '15

    Quote from traumaRUs
    I think there is a lot of misunderstanding between RNs who perhaps are not familiar with the APRN role.
    I've been an APRN for 9+ years and I did absolutely love bedside nursing. However, I equally love my roles as provider and prescriber. Like other APRNs have mentioned, I do help pts. My pts are for the most part seriously ill with a much shortened lifespan. I discuss end of life issues almost daily.

    I do provide a service but mostly I provide care.
    this. Any goober with MD behind their name can fling scripts. TLC (which oh by the way might mean the difference between compliance and noncompliance, life and death) is where NPs impact both quantity and quality of life.

    (Name-calling only in the spirit of troll-ish-ness which we seem to have high tolerance for lately)

  • Oct 16 '15

    Never. I have also stopped giving out my direct extension at work and am now directing patients to the receptionist or nursing line.

    99% of my calls and messages could/should be handled by someone else. I found that by my being involved they generally took much longer to resolve and wasted a great deal of time.

    You REALLY, SINCERELY, URGENTLY need to speak to me and only me? You know where I work every day ... If it's not worth making an appointment to you, why on earth should I give you my time off the clock?

  • Sep 10 '15

    Brava, brava!



    Quote from GrnTea
    Pediatric Emergency Care:
    January 2013 - Volume 29 - Issue 1 - p 63–66
    doi: 10.1097/PEC.0b013e31827b5427
    Original Articles

    Comparison of Rectal, Axillary, Tympanic, and Temporal Artery Thermometry in the Pediatric Emergency Room

    Batra, Prerna MD; Goyal, Sudhanshu MBBS


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