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Jolie 33,179 Views

Joined: Oct 17, '01; Posts: 9,619 (48% Liked) ; Likes: 14,059

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  • Jun 2

    Quote from Nurse Beth
    I've seen this done at Cedar Sinai with a doctor present at all times. The clinic is run like an efficient, safe outpatient surgery clinic. Consents are signed, NPO prior is confirmed, allergies checked. IVs are started on patients for sedation and emergency access. Discharge instructions are given. A crash cart is nearby as are ACLS trained staff.

    I'm just surprised at what you are describing.
    Beth, might you be confusing TMS with ECT?

    What you are describing is typical of out-patient ECT, where an efficient, well-run clinic can admit, treat, recover, and discharge an experienced patient about 1-1/2 or 2 hours.

    TMS does not require a patient to be npo, there is no IV or sedation, and no recovery time. Most patients drive themselves to and from treatment, often before or after work, or even possibly on a lunch hour. Max time in the chair is about 40 minutes.

    I have become familiar with this procedure recently, accompanying a family member. The clinic is part of a multi-specialty psychiatric practice, with MDs, NPs, therapists, RNs and psych. techs.

    The initial mapping of each patient is conducted in 2 steps, first by the RN and tech working in tandem. Once they determine the ideal coordinates, the procedure is repeated by the physician, and then results are compared to those generated by the machine itself. The first treatment is conducted by the physician. Mapping is repeated approximately 1/2 way thru the course of treatment.

    Each session is conducted by either the RN or psych tech, with a second professional present in the office. The person conducting the treatment uses the time to converse with the patient, present educational information, etc. This isn't a therapy session, but is useful in assessing the client's mood, activity level, motivation, behavioral plan, side effects, etc. It is not acceptable in this practice to plug in earphones and "chill" during the treatment.

    To Curious MD, As a business owner myself, I understand the challenge of starting up a new business and realize that personnel represent the biggest expense, by far. Though it may be tempting to cut corners to save on this expense, I implore you NOT to do so. Give up your own salary first. (Like many entrepreneurs, we went for a few years without paying ourselves.) It is necessary, and will pay dividends down the line when your business thrives because of the quality and commitment of the front-line people interacting with your patients.

    Best of luck to you.

  • May 15

    Quote from shak95
    I will accept all notes tips and advice.
    Except the candid, accurate advice offered by Sour Lemon, RN.

    Please help us understand why you believe notes taken by strangers on the internet would be superior to your own work, or tips and advice from anonymous posters better than those from your instructor.

  • May 8

    In my experience, WHNPs work primarily in the office/clinic setting caring for well women, or addressing acute or on-going care needs. When I moved to my current home 12 years ago, I started seeing a Women's Health NP and have never looked back. She does my yearly exams, contraceptive care, and is available for other care needs that can be met within the confines of an OB-GYN practice. For example, she treats minor illnesses and manages my migraines but won't address orthopedic injuries.

    I maintain a relationship with my family practice doctor, but rarely see her anymore because her practice has grown so much that it is hard to get an appointment with her. She also has an NP in her office who sees a full range of patients from infant well and sick visits to elderly folks. That office will address virtually any health issue, so it is indeed "one stop shopping" for our family. Unfortunately, I don't care for the NP, so I only go there if there is an issue that I know the WHNP in the OB-GYN practice won't address, like my Achilles Tendon injury.

    I think your answer will lie in the range of patients you desire to see and treat.

  • May 6

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • May 6

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • May 3

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • May 2

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • May 2

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • Apr 30

    Quote from Nurse Beth
    I've seen this done at Cedar Sinai with a doctor present at all times. The clinic is run like an efficient, safe outpatient surgery clinic. Consents are signed, NPO prior is confirmed, allergies checked. IVs are started on patients for sedation and emergency access. Discharge instructions are given. A crash cart is nearby as are ACLS trained staff.

    I'm just surprised at what you are describing.
    Beth, might you be confusing TMS with ECT?

    What you are describing is typical of out-patient ECT, where an efficient, well-run clinic can admit, treat, recover, and discharge an experienced patient about 1-1/2 or 2 hours.

    TMS does not require a patient to be npo, there is no IV or sedation, and no recovery time. Most patients drive themselves to and from treatment, often before or after work, or even possibly on a lunch hour. Max time in the chair is about 40 minutes.

    I have become familiar with this procedure recently, accompanying a family member. The clinic is part of a multi-specialty psychiatric practice, with MDs, NPs, therapists, RNs and psych. techs.

    The initial mapping of each patient is conducted in 2 steps, first by the RN and tech working in tandem. Once they determine the ideal coordinates, the procedure is repeated by the physician, and then results are compared to those generated by the machine itself. The first treatment is conducted by the physician. Mapping is repeated approximately 1/2 way thru the course of treatment.

    Each session is conducted by either the RN or psych tech, with a second professional present in the office. The person conducting the treatment uses the time to converse with the patient, present educational information, etc. This isn't a therapy session, but is useful in assessing the client's mood, activity level, motivation, behavioral plan, side effects, etc. It is not acceptable in this practice to plug in earphones and "chill" during the treatment.

    To Curious MD, As a business owner myself, I understand the challenge of starting up a new business and realize that personnel represent the biggest expense, by far. Though it may be tempting to cut corners to save on this expense, I implore you NOT to do so. Give up your own salary first. (Like many entrepreneurs, we went for a few years without paying ourselves.) It is necessary, and will pay dividends down the line when your business thrives because of the quality and commitment of the front-line people interacting with your patients.

    Best of luck to you.

  • Apr 30

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • Apr 29

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • Apr 29

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • Apr 29

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • Apr 28

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • Apr 28

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........


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