Latest Likes For coast2coast

Latest Likes For coast2coast

coast2coast, MSN, NP 7,201 Views

Joined Jul 9, '10. Posts: 404 (42% Liked) Likes: 624

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  • Jul 16

    Quote from Anna S, RN
    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.
    he was severely hypothyroid due to med noncompliance due to mania ...

  • Jul 16

    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.

  • Jul 13

    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.

  • 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


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