Medicare Part C Can and Should Be Refocused for Zing, Zest and Zizzle: A New Role For Primary Care

Introduction

This article outlines a wellness initiative for health insurance companies offering Part C Medical Advantage programs under Medicare. While there are (as of 2014) 66,800,000 plus Americans on Medicare (53.8 million of whom are aged – the rest qualify as disabled), only 16.2 million participants have Medicare Advantage programs. So, this segment represents an attractive test population for an initiative that could in time be available for all Medicare recipients and, eventually, all Americans.

The proposed initiative begins with expanding the kind of data that will be collected and digitized for Advantage Plan members. The expanded data will be of exercise and other wellness-related activity. This initiative will expand and improve prevention-focused offerings now in use under the Advantage primary care programs. Existing efforts are almost entirely illness-focused, non-positive, not much fun and ask little to nothing of patients concerning steps to take to promote their own well being. The primary care is passive, not active with an emphasis on risk reduction. Currently, primary care visits are consumed by sickness/worseness measuring efforts, supplemented at times with traditional health education brochures and the like.

In short, Advantage programs have little or no ZZZ – zing, zest and “zizzle.” (“Zizzle” – my neologism for enhanced “sizzle,” but with the letter “z” added to enable the cool acronym)!

ZZZ will be under the control of plan doctors, despite the fact that, at present, doctors have limited time for, knowledge of or, in many cases, commitment to exercise and fitness – their own or their patients. However, they will embrace ZZZ because it will make them better doctors, improve patient health status and render coming to work more interesting. Furthermore, patients once aware of and engaged in ZZZ endeavors will be happier, as well as healthier.

The ZZZ model will get patients on board with active participation, praise and a positive focus. It will provide all patients with the realistic hope for a better, more effective way to live. It will feature a transfer of responsibility for life quality from the medical system or the doctor to every patient. This shift is desperately needed. Believe it or not, some health insurance wellness program descriptions still use the ghastly phrase, “preventive health.” For the record, no one, particularly a health care provider, should seek to prevent health! The use of this ill-considered phrase reveals the absence of thinking in terms of health and life enrichment, and its use should be considered a felonious offense, followed by a moment of shaming and then, rehabilitation of the offending medical miscreant. Without exposure to the ZZZ program, this excrescent term will never be heard again.

Elements Of The ZZZ Wellness Program

ZZZ initiatives will be expressed in upbeat, positive tones that emphasize the benefits and advantages of the program for doctors and patients. In making the case for ZZZ, it will be wise to minimize criticism of the poor record of the health care and fitness industry historically. This despite the fact that the medical system has ignored the myriad elements of genuine physical and mental well being, cultural support and meaning and purpose. This will change under ZZZ programming.

Instead of measuring and monitoring risk, ZZZ elements will feature the assessment of achievable benefit levels. Computerized data gathering for all patients will give medical providers a full picture of patient exercise habits. Doctors will, after conferring with patients, encourage specific exercise and overall well being targets/objectives for 3 month, six month and one year periods. Monitoring, evaluation and, when appropriate, celebration rituals will be conducted at each stage.

Initial Steps for Implementing ZZZ

* Enlist the participation of the medical community. Note areas of opportunity, intervention and programming at the three ZZZ stages.

* Involve specialists to work with the patient and primary care doctors. The ZZZ program is managed and conducted not only by primary care physicians but also available wellness practitioners (nurses, etc.) and fitness specialists.

* Rather than prescriptions, medical personnel will insist that short and long terms objectives be part of individual ZZZ wellness plans. These should be drawn by individual patients in collaboration with wellness center resource personnel.

* Aerobic fitness tests will be used to evaluate strength and flexibility, alignment and balance. No longer will standard medical exams and routine office visits overlook total-body health, fitness and wellbeing.

* Emphasize the integration of wellness elements with smart technology. The ZZZ model enlists tech devices (such as exercise apps, smart watches, iPhones, Bluetooth and cloud storage) to collect and transmit computer data to medical managers. These data are integrated with traditional medical apparatus (blood pressure machines, digital scales, blood glucose monitors and so on) to create comprehensive pictures of patient health status at varied points along the way.

* A wellness-focused website will be set up and promoted for continuing education. The sites will be used by personnel as resources for patients (e.g., it will contain articles on REAL wellness skill areas as well as the usual prevention topics). The site will be update with fresh information on a daily basis, in part in response to interests shown by Advantage primary care ZZZ participants.

Doctors will utilize these tools in initial and all subsequent encounters with patients, many if not most of whom will be initially be overweight, discouraged, stressed and without non-pharmacological coping skills.

Summary

With Medicare doctors linked to individual exercise history, patient/provider interactions will become more attuned to the importance of lifestyle, which is not the case at present. ZZZ will represent an historical advance, and boost the likelihood that care givers will attend to signs and symptoms of fitness, good diet and personal development and become more circumspect about destructive norms, lack of meaning in life and the value of finding added meaning from work.

With this linkage, symptoms such as metabolic dysfunction will not be signals for automatically prescribing drugs to lower high blood pressure or cholesterol, but rather as indicators for specific lifestyle initiatives. The doctors will confer with other office team members (nurses and varied specialists in lifestyle interventions) for exercise and meaning-related “prescriptions.”

With the ZZZ program, all health practitioners will have the tools, procedures and information they need to measure and monitor lifestyle patterns, and the training, intelligence and wisdom to use non-drug approaches to ameliorating problems. Most important, the focus will be upon turning patients away from the mediocrity of dwelling on ills and troubles. The ZZZ shift will instead channel their energies toward health and life enrichment.

The ZZZ Program will give new meaning to the term “prescription.” Instead of a permission slip for gaining a drug from a pharmacy, the patient/doctor follow-through memo will be a pathway for more zing, zest and zizzle from life. The affirmative goal will be to create and carry out a simple wellness plan. This will be patient-authored, with assistance from the ZZZ doctor group. It will culminate with improved exercise patterns and fitness results, and new initiatives in diet adjustments and attention to personal development. All this will be reviewed by the health insurance provider and the patient on a yearly basis.

The World Healthy Organization has shown that human lifespans more than doubled over the course of the 20th century, mainly because of the triumph of science over disease, particularly diphtheria, measles, whooping cough, polio, tetanus, typhoid and smallpox, among others. Perhaps a similar gain might be achieved in the course of the 21st century. This, too, will be enabled by science but focused not only on eradication and control of infectious diseases, but on enhanced life quality and longevity. Such would come about by a dramatic reduction in the incidence of diseases of choice, that is, lifestyle and environmental “contagions” passed along by cultures that make uninformed, destructive behaviors seem normal and convenient. Warnings against such patterns of self-abuse will never be as effective as opportunities to experience the liberating power of personal advances. Improved energy levels, better appearance and greater feelings of well being, all and more occasioned by exercise, good diet, effective management of stress and other skills taught in ZZZ-like endeavors will follow primary care that focuses upon exercise, responsibility, exuberance and the joys of self-empowerment.

Such a shift will be the ultimate form of an Advantage-based health insurance programs, initially for a relatively small group of Medicare enrollees and, perhaps, eventually for all the American people.

Be well, look on the bright side and always insist of a good measure of wellness-related conversation with your friendly neighborhood primary medical doctor.

See how phonecases made a real revolution in the industry.
Posted in Uncategorized | Comments Off on Medicare Part C Can and Should Be Refocused for Zing, Zest and Zizzle: A New Role For Primary Care

Educational Community Employees Can Get Discounted Auto Insurance

Check out what your state says about insurance company policies. In select areas, the regulators permit carriers to utilize employee status as a basis for establishing insurance quotes!

This is why teachers and school employees can take advantage of specific auto coverage that those states promote. Some companies have slashed rates for car insurance and given the educational community free benefits along with a faster response in the event of claim compensation.

If you are fortunate enough to belong to this group, do the leg-work by researching who can offer a specialized plan. Be sure to compare quotes in relation to the type of coverage you are offered.

More about the Teachers’ Auto Insurance Discount and Benefits

Question: Which auto drivers are invited to participate?

Answer: If you are presently are an employee of an accredited educational institution or a retired worker and you are a resident of the state that allows coverage by occupation, you can benefit from the program.

Question: Can you list examples of employees?

Answer: Sure. Employees of the teaching community include:

• Supervisors
• School library workers
• Early childhood teachers
• Teachers’ association members
• Current school board associates
• State-licensed school staff-members
• School nursing staff
• Guidance counselors or psychologists
• Substitute teachers

Question: Can you outline the benefits of this insurance plan?

Answer: You will love the included benefits of one such program:

• Extra roadside assistance that involves car towing, tire changing, boosts for vehicles, along with other modes of assistance. In general, the benefits can be similar to those offered from a pricier roadside assistance program.

• Elite comprehensive and collision deductible waiver for accidents that happen on an educational institution’s property, as well as up to $1,000 protective coverage for school property loss or damage due to a liability episode with your car.

• Special services to policyholders that include van pick up and claim service that helps with your needs.

Question: Can you give me some tips on how to find an agency that will provide an auto insurance quote on a customized plan?

Answer: First-off make sure to go to an independent insurance agency who partners with the leading insurance providers, especially one that offers this type of select coverage. You’ll want to go to an established operation that employs agents that will take the time to discuss all particulars to you, while answering any pertaining concerns you may have. After all, customer service begins with the broker you are dealing with. All this helps you become the educated consumer that makes the wise decision that produces the good results you want: protective coverage at excellent discounted rates that come along with the all of the benefits you have learned about.

Posted in Uncategorized | Comments Off on Educational Community Employees Can Get Discounted Auto Insurance

Graduate Nurses and the Experienced Nurses They Work With – Do’s and Don’ts

Graduate Nurses

You’ve just graduated from nursing school and have begun your first job. You are so excited! You can’t wait to apply all the knowledge you’ve worked so hard to gain and share it with your fellow nurses. Then bam! Reality shock. They don’t want to listen to what you have to say. You don’t understand. Why don’t the experienced nurses you work with want to learn all the latest nursing information you have to share? You don’t care, you say. Stop! Change your thinking or risk driving a wedge between you and your coworkers that will be difficult, if not impossible, to remove.

Here are two ways to be successful in your first nursing position.

1. Don’t be a know it all

Not everyone will want to learn what you have to teach. Many of the nurses you work with consider experience far more important than what is learned from a book or in school. If you constantly lecture to them, you will be seen as condescending or showing off. It’s better not to teach unless asked. Bide your time. As you establish yourself as a competent nurse, you will be respected. Then your knowledge will be recognized and valued.

2. Do let the experienced nurses teach you

They may not have all the latest knowledge you do, but the seasoned nurses you work with have practical experience you don’t have. This is invaluable and cannot be found in textbooks. Listening and taking in what they have to share will help you forge good relationships with them. They will be more willing to hear what you have to tell them if you show appreciation for what they know.

If you follow these suggestions when you start your first nursing job, you will find it much easier to get along with the nurses you work with. Those relationships will be critical to your success and happiness in your job. Together, with their experience and the latest knowledge you have learned in school, you and your fellow nurses can provide the highest quality nursing care to your patients. After all, isn’t that what nursing is all about?

Experienced Nurses,

“Oh, no, here comes the new nurse who just graduated from nursing school. Full of energy and enthusiasm. Thinks she/he knows everything and can’t wait to share it with anyone who will listen. Soon she/he will realize that what is learned from textbooks is not the same as the real world of nursing.”

If you’ve ever said or thought those words, you’re not alone. Nurses who have been practicing for years know that graduate nurses (GNs) often don’t realize how much they have to learn. It takes a lot of time and patience for experienced nurses to teach GNs. And orienting GNs isn’t easy. They don’t always want to listen. But can they talk! They want to tell the nurse with years of experience the “right” way of doing nursing procedures. Sometimes the GNs’ behavior seems outright obnoxious.

Here are two ways to help GNs make the transition from students to practicing nurses.

1. Don’t feel threatened

See this as an opportunity to teach and learn. Teach what you know and learn the most up to date nursing information. Let graduate nurses know that you value their knowledge and want to hear what they have to say. Just not all the time. Help them see when it is appropriate to introduce new ideas and when it is not. Show them how to share information without offending the rest of the nurses. Share your nursing background and expertise. Emphasize how you can help each other.

2. Do role model assertive communication and conflict resolution

If GNs do something wrong or offend nursing staff, let the GNs know. If a nurse comes to you to talk about one of the GNs, suggest this nurse talk directly with that GN. There are many benefits to this approach. The GNs will learn what not to do and hopefully, not do it again. You will be forming good relationships. And best of all, you will stay out of the deadly triangle. Back stabbing never helps anyone.

Why should you make it easier for GNs? Maybe no one made it easier on you when you started out in nursing. All the more reason to help the GNs. Eventually, they will become your peers. The GNs can either help you or hurt you during critical times as you deliver quality patient care. Wouldn’t you rather work with nurses who know what you know than nurses who do not have the advantage of your experience?

Nancy Banfield Johnson,RN, MSN, ANP, the Nurse Mentor, offers speeches and workshops to teach nurses clinical knowledge and managerial skills to balance life and work, enhance productivity and to develop and achieve professionally. Her down-to-earth approach is highly motivational as she gives practical, creative solutions to help you solve problems in your nursing practice. Nancy helps organizations recruit and retain nurses by improving their work environment and increasing collaboration among nurses and with other health care professionals.

Nancy’s blog covers clinical problems and career issues for graduate and experienced nurses peppered with stories from her 35 year nursing career.

Posted in Uncategorized | Comments Off on Graduate Nurses and the Experienced Nurses They Work With – Do’s and Don’ts

Are Nurse Practitioners Just As Trustworthy As Doctors?

There are approximately 200,000 licensed Nurse Practitioners (“NP”) in the United States, making it likely that you will run into one at some point. Contrary to popular belief, for the average person’s normal needs, NPs may be just as helpful as regular doctors, and are often easier to schedule an appointment with.

Are Nurse Practitioners Trustworthy?

Like medical doctors, Nurse Practitioners are trained in all areas of primary care, including diagnosis, treatment, prevention, health education, medication prescription, and medication management. They have completed registered nursing school as well as graduate-level or doctoral-level educations that include didactic and clinical coursework, and are licensed to diagnose and treat patients without supervision from a medical physician. Their Master’s programs may take up to three years while their Doctorate programs can take up to six years. You may find them working in a private practice, a school, a nursing home, in the emergency room, or in public health departments. Over 50% work in family or adult practices, but others also specialize in gerontology, neonatology, oncology, pediatrics, psychiatric-mental health, women’s health, and acute care. Every two years they are required to show proof of continuing medical education to renew their license to practice in all 50 states. They also work collaboratively with medical physicians, especially if faced with a new or unfamiliar situation.

The American Association of Nurse Practitioners recently published a study summarizing evidence that compared patients under NP care with those under the care of regular physicians. The study found that patients under NPs had higher satisfaction, fewer readmissions to the hospital or visits to the emergency room, and higher rates of avoiding unnecessary hospitalizations. Additionally, they may also be a more cost-effective alternative to doctors, due in large part to lower educational costs – approximately 25% that of medical school.

What Are The Benefits Of Seeing A Nurse Practitioner Instead Of A Doctor?

NPs provide almost all of the services that doctors provide, such as:

– Examining and diagnosing patients
– Treating short-term issues and prescribing medications or other treatments
– Treating long-term issues like diabetes or high blood pressure
– Providing healthy lifestyle counseling and education on disease prevention
– Managing consistent, overall care for patients (like primary care physicians)

In addition, NPs tend to focus more on preventative care, as they may often be less busy with appointments than regular physicians and have more time to listen and discuss preventative issues such as quitting smoking, maintaining a healthy diet, and keeping regular exercise habits. Depending on where you live, they may also be more readily available than a primary care physician, especially if you are not located in an urban metropolis. The United States has a shortage of primary care providers, so the convenience of scheduling with a Nurse Practitioner may be crucial if you have a pressing need to be seen by a healthcare professional.

Of course, whether you choose an NP or a medical physician, you should be mindful of their communication style and the natural rapport you develop with them. Always follow your intuition about whether or not you trust that person with your healthcare.

Posted in Uncategorized | Comments Off on Are Nurse Practitioners Just As Trustworthy As Doctors?

Nursing Career – Ensuring Job Security

Job security is one of the things that people look for when they search for a job. It is so hard to find a career path that will ensure job security. It depends on the consumers whether companies continue to produce these services. When there is no demand, then it is pointless to create a supply. It totally makes sense, right? These usually apply to business concerning home decor, restaurants, cars, vacation, spas and even housekeeping services. You may now think that there is no single career that may provide job security these days. This makes job hunting a more difficult thing to do.

You need to think deeper. There is one career that will be able to provide you with job security. Nursing is always in demand that is why it so hard to lose your job with a nursing career. People are getting sick all the time this is why nurses are always needed. Even if the country is experiencing economic crisis, people will still continue to hire nurses. Keep in mind that no one is guaranteed of immunity from getting sick. This is why even if there are a lot of nursing schools which have emerged and more and more people are taking up nursing, they say that there is still a lack of supply for them. The demand for nurses is really high this is why more people prefer to get into a nursing career rather than the corporate world.

The U.S. Bureau of Labor Statistics has included some predictions on the nursing career in the Occupational Outlook Handbook. By the year 2016, registered nurses will have a faster employment rate. It will become the fastest growing industry beating all the other sectors. By this time, home health care will be expected to grow provide more nursing jobs available. This should be monitored since the aging Baby- Boomers of nursing may decide to retire soon. They may retire in batches and provide a faster rate of decreasing the workforce compared to the increasing nurses in this field. If this is monitored and provided with a solution, then there is nor problem. According to the current situation, nursing is heading for an improving course with more job opportunities available in the future.

What is good about being a nurse is that you get to have a job immediately after you graduate. Whether you have taken the licensure exams or not, you will still be able to practice nursing. But do not make yourself stay in that position. There are so many opportunities for nurses and usually these are given to nurses who have more qualifications. Those who benefit from these are the nurses who have their license, a Master’s Degree or even more job experience. Nurses often switch from one profession to another allowing them to be versatile as a nurse. Nurses may work in hospitals, rehabilitation centers, doctor’s office, nursing homes and even manage their own nursing agency. The number of choices that nurses have ensures them that they can go on in any field that they want to. All you need to do is to check out the requirements that are needed to work in the different field and you are good to go. This is why nursing has been the most appealing job there is for most people.

The pay that nurses get can reach up to about $100,000 annually plus the benefits that they enjoy. Depending on the facility where they work, they can have free medical service for them and their family members. They can even have free tuition if they decide on taking up a Master’s Degree in Nursing and eventually a Ph.D. in Nursing. What is good about this is that nurses can still work while they are studying so they do not lose their job. This allows them to gather up all the training that they can get in order to improve their nursing skills.

If there are cases when nurses are forced to leave their old job because they need to move to another place, they do not need to worry because they will be sure that they will find a new job there. You can even have the privilege of working in the same department as where you worked before. Especially if the job you want is somewhere where the supply of nurses is not enough to fill the positions there. This is one of the reasons why you should increase you credibility as a nurse. The more you become qualified for a position the more chances that you will get your dream job. But the bottom line is that being a nurse will get you a job no matter what happens.

If you are thinking of taking up a nursing career, make sure that you have made the decision whole – heartedly. Do not base your decision solely on the fact that nursing provides job security for you. You need to make sure that you have the qualities and the skills to be a nurse. If you do not love your job, it will only lead you to quit it and you are left with no job at all which is not good. On the other hand, deciding to become a nurse because you love what you are doing is a good choice for you.

You need to remember that the nursing career will continue to increase in their demand. This will provide you with the security that no matter what happens; you will have a job waiting for you. This is no excuse for you to quit your job and apply for a new one later because you are sure that you will get hired. Remember that nursing is all about service and you need to make sure that you give it to the people who need it the most. Nursing is not a seasonal job but a round-the-clock service that must be provided for all those who need their care. Good luck in your nursing career and make sure that you do your best!

Posted in Uncategorized | Comments Off on Nursing Career – Ensuring Job Security

Nursing Staffing Agency: Keeping Your Clients Once You Secure Contracts

The challenge facing many new or existing nursing staffing agencies is keeping your contracts with hospitals, nursing homes or long term care facilities once you secure a contracts. A lot of time and money is spent securing contracts so the last thing you want is to lose the business you worked so hard to do to acquire.

Losing a contract may be tied directly to your actions or to the actions of employees. Whatever the reason is that you lost the contract at the end of reasoning is just the fact that you lost potential income and future relationships with this facility. Getting these contracts back is one of the most difficult things to do, if you can ever get the contract back once you have lost it.

That is why I really believe in creating a public relations campaign with the contracts you have and to keep the contracts by making the client feel they are the most important thing to you. The reasons why this is critical is that when you have issues that arise, those issues hopefully will not be the reason why you are dropped from future business.

Back in my early years of my career I was working as an x-ray technologist for a large medical staffing agency. I always performed excellent in my assignments and tried to make happy the clients I dealt with. I was the type of employee that many of the hospitals were glad I showed up to help them cover the shift for the day.

It was not until I was promoted to a salesperson that I realized how important it was that employees represent the company well because those employees will make or break your company. But, we cannot always control how employees interact with our clients and therefore we will find out problems once we get a call from the facility that had a negative interaction with our employees.

This negative interaction at times will leave a negative impact for the client, especially if it’s the first time you send someone, or if the client has experienced one negative candidate after negative candidate and we do nothing to fix the issue. The key to keeping contracts is dealing with issues as they arise and reminding the candidate you are here to fix the issues.

I have found that building a relationship with your clients from the very beginning won’t eliminate problems, but will help them dumping you the moment you do have a problem. Hospitals greatest frustration with staffing agencies is the lack of perceived eagerness from employees, they at times view us as we just want to get paid for the warm body. Your job is to make your clients feel that you are creating a relationship with them for a long lasting approach to your company’s mission.

I realized early on that it is less expensive to talk to your clients at the beginning once you secure contracts, than it is to try to regain a contract you lost. It is easier to change the candidate than it is to try to regain a contract once you lost it. Talking and communicating constantly with your clients is critical and crucial to the success for your staffing agency.

You will work very hard to secure contracts, you will spend money to secure contracts, and you will communicate with perspective clients and have meetings telling your story to secure contracts. You will spend a lot of energy, the last thing you want it to lose business for misunderstandings. Very simple rule of thumb I have to keeping contracts, talk to your clients.

Keeping contracts and securing contracts is the lifeblood of your staffing agency.

Posted in Uncategorized | Comments Off on Nursing Staffing Agency: Keeping Your Clients Once You Secure Contracts

Misdiagnosis of Schizophrenia & Other Mental Disorders

Abstract:

In this article we will examine why clinicians diagnose serious mental illnesses and why misdiagnosis is a common factor in the process. Looking at the definitions of schizophrenia and labelling as an incidence of laziness, misunderstanding, poor training and guidance from the psycho-pharmaceutical industry to sell powerful money making drugs for life. To remind ourselves as clinicians that mental illness labels are not real, but a cluster of symptoms, that describe a persons perception of reality to enable directed treatment and internal psychiatric discussion with familiar terms that mean something to the treating doctors.

Introduction:

Schizophrenia like many other mental illness labels describe a cluster of symptoms that can explain the mental state of the person presenting to a mental health profession such as a psychiatrist, clinical psychologist and psychiatric nursing. When a potential patient arrives at the hospital for initial consultation some predisposing information arrives with them. These can be the family story, (what has been happening) the police story, (why they were detained), the social worker story, (their history of social breakdown) and in all these stories is the bias of the referring agency, as they have to justify the reasons they are asking the mental health professional to see the person in the first place. Armed with this background the mental health professional will begin the process of trying to identify from reported behaviour what label is appropriate for this individual from the DSM V manual of mental health statistical classification. (1. ICD 9 in the EU) This book of coding labels as numbers is meant to help mental health professionals to claim insurance payments and give a convenient depersonalising number to a mental health disease so that professionals can agree on a method of treatment, usually a chemical straight jacket in the form of several psychiatric drugs, confinement and even surgery. (ECT and Lobotomy).

To understand what exactly schizophrenia actually is in terms of everyday language we can consider the following extract – is a severe form of psychopathology in which a personality seems to disintegrate, in thought and perception which are distorted and emotions are blunted (2. 2010, Psychology of Life). This catch-all statement is the common idea of being insane or madness in which a persons reality is distorted by delusions that corrupt their everyday concepts of normality.

In order to understand this process we need to know more about Schizophrenia in the first instance. According to the DSM manual (constantly being revised by psychiatry to include more definitions) there are several subtypes of the condition. The number is 295 plus an additional number to identify type. So 295.30 is paranoid schizophrenia, 295.10 is disorganised, 295.20 is catatonic, 295.90 is undifferentiated, 295.60 residual type, then additional numbers can identify particular presenting problems such as 295.40 schizophreniform disorder, 295.70, schizoaffective, 297.1 delusional, 298.8 brief psychotic, 297.3 shared psychotic, 293.81 with delusions, 293.82 with hallucinations with an additional idea of substance induced psychotic disorder, finally, 298.9 psychotic disorders NOS (no obvious reasons). (1. 1994 – DSM IV Classifications)

With all these sub-types of the labelling of schizophrenia the clinician has to research with the patient the length and severity of the symptoms being expressed. This is usually a self report from and initial interview with the patient about their experience of their own behaviour. This can be very subjective as the patient is suffering from confusion and may not have a clear idea of their own mental state. Let alone know the common word parlance of mental illnesses to explain their situation. Time as a factor so is specified as suffering for two months or more from delusions., hallucinations, disorganised speech, gross disorganisation or catatonic behaviour (turned to stone) negative symptoms such as affective flattening ( dead like response) alogia (without speech) or avolition (failure to engage). These basic requirements can be a mixed bag not requiring all states in order to label the person schizophrenic. The diagnosing mental professional will through experience judge the severity of the case by the amount of symptoms being expressed or reported. In order to extend the label to the other subcategories, for example, paranoid there would have to be additional evidence to support the patient being diagnosed as such by statements that indicate a paranoid belief in that their delusions include persecution from imaginary third parties. Along with schizophrenia may be episodes of depression, anxiety or bipolar (mood swings between both states), this leading to additional diagnosis of schizoaffective disorder for example.

As you can see the process of identifying exactly what the diagnosis should be is quite complex and needs sufficient time in order to be sure of the exact condition of the patients mind. In this case the law takes over giving the psychiatrist considerable power over individuals under the guise of care, such as, is the person considered a danger to themselves or others, as a catch all for confinement over a 24 to 78 hour period with no representation of a third party. In other words the power to arrest and detain a person with out trial, legal protection or any form of protest. In place are panels to review that decision after the initial period of observation but rarely go against the psychiatrists recommendation and so uphold any confinement decisions.

Causes of Schizophrenia:

The problem with causes is that at the moment in psychological science there is a lot of ideas, conjecture and discussion but no clear answer. Biologically, some patients will clearly have brain damage, brain dysfunction i.e. the process of neurological communication or neurotransmitters maybe dysfunctional or low in production, such as serotonin (linked to mood) etcetera. However cause and effect in any correlation means which causes what? Does brain damage occur because you are delusional or are you delusional because your brain is damaged? The only evidence is xrays from differing processes and post-mortum examination of someone diagnosed in their lifetime. Both clearly not definitive in providing real evidence that have many scientific validity problems. The second is twin studies or family studies both with huge validity problems as most evidence is from meta analysis (this means many small studies to combine into one big study) again modelling may explain much of this evidence – if a child witnesses a family member or their twin behaving oddly they will think this is actually normal and so model that behaviour as sound, to be learned from, so a new schizophrenic is developed from the existing schizophrenia within the family or from a twin / sibling. This is not a big surprise to many as we often see similar traits in family members even if they have lived apart for long periods of time. Any clinical psychologist can tell you when treating family issues that often the new mother has revelations about becoming just like her mother in her raising of her subsequent children. As one mother said, “I looked in the mirror and saw my mother staring back at me” What she is expressing is not looking like her mother but in fact acting like her and talking like her as an adult. (Research, Transactional Analysis functional PAC model). So even if there is lots of statistical evidence that schizophrenia runs in families this has no effect on why the disease develops in the first place. Modern genetics again tries to answer the problem by saying it is inherited, however despite mapping the genetics of humans and other species we know very little about how genes actually express themselves and only have a broad ideology that informs us that genes can express themselves in many forms later in life according the to the environment they are exposed to from every day events. Our genetics are like a time bomb that given the right stimulus will create a response in our behaviour, developing disease and longevity of life in general. In other words nothing is specific and nothing is for sure. So as in schizophrenia the biological, genetic and family approach are still full of validity problems from the type of research conducted and are full of bias’s from the very science that seeks the answers they wish they could have. The most likely cause of schizophrenia is still stress and the problem of living in a complex world full of conflicting ideology and purpose, where the disease can be seen as a form of mental escapism from the pressures of life. Better to live deluded than have to deal with the reality of failure, disappointment, lost expectations plus a lack of real love and affection from others. (4. 2011 Abnormal Psychology Core Concepts)

Misdiagnosis:

The most controversial part of any mental illness is being labelled with schizophrenia or any other mental problem and have no power over that decision. A very famous study by Rosenhan (1973) showed that students who were asked to present themselves as hearing voices (auditory hallucinations) could after a few minutes be admitted to a psychiatric ward and be kept for sometimes days and weeks as patients, when reporting soon after arrival, that they no longer hear the voices and felt well – they were still seen as having schizophrenia in remission, when in fact all were perfectly well. Could this still happen today after 40 years – the answer is yes and even more frightening as we never learned anything from the study about the fact psychiatrists are easy to fool! (3. 1973 Rosenhan) A true modern case is given below:

A young woman wanted a medical sick certificate to have some time off work. She was exhausted by her life in general but other than that was not depressed or anxious about everyday life. Her brother suffered from a mental disorder mainly around being dysfunctional, backward and idle. He was on medication for schizophrenia. The girls father took her to the mental hospital where her brother attended and informed the doctor of the family history and his girls exhaustion. The psychiatrist within five minutes of the consultation labelled her as schizophrenic. The psychiatrist went on to register as an out-patient, gave her several types of psychotic drugs, and her sick certificate for work. The young women having left the hospital became extremely anxious about showing the sick certificate to her employer as this might lead to her losing her employment. On a friends advice she sought a second opinion from a clinical psychologist. The psychologist was amazed at the diagnosis but never the less completed a thorough examination of the patient. After an hour his diagnosis was perhaps mild reactive anxiety brought on most probably by the misdiagnosis of the psychiatric doctor.

To understand what happened the psychologist interviewed the young woman, the father and observed the brother. It was clear that the diagnosis was heavily influenced by circumstances, family and by the time element in making a decision about her condition. It would be nice to imagine this as an isolated case but in fact this is the norm. Quick diagnosis based on very little evidence. None of the criteria for schizophrenia existed, she had no delusions, she was not disorganised, she did not report any bizarre affect, she was coherent in speech and manner. So how did such a clear misdiagnosis be allowed to happen? Luckily with budget cuts in mental health and lack of facilities the young woman was not severe enough to be confined to a mental ward. She discarded the medication and sought out a general practitioner who having re-assessed her gave her a sick certificate for exhaustion and no medication was needed. (4. Myler 2016)

The above case is only one example of how misdiagnosis can happen, so what are the main elements that lead to such a dangerous practice by psychiatrists in general.

Time – less than 10 minutes average time to make a diagnosis.
Depending too much on third party reports – police, social workers, family.
Lack of resources – such as second opinions, team lead discussion, clinical psychologists (who have more training in mental health than any psychiatrist).
Lack of training – most have less than 18 months after graduation from medical school and most of this is spent on drug therapy.
DSM V and preceding publications that promote mental illness instead of mental health.
Depersonalisation of medical practitioners by their very training regimes at University.
Time – constraints via patient over-load and lack of administrative support.
Lack of knowledge about other professionals in the field, such as clinical psychology and counselling therapists.
Arrogance – pure and simple – the I know best syndrome – grandiosity (a form of schizophrenia in itself ironically).
Governments around the world who think mental health is a low priority to health budgets that in the same time have enormous hidden costs to the global economy.
Tendency of the patient to over exaggerated symptoms in order to receive a diagnosis.
Other professionals trying to remove responsibility for care.
Family seeking to distance themselves from troubled family members.
Conclusions:

The misdiagnosis of schizophrenia and other mental illness problems in the general population cause major distress and depression to millions of people around the world. While there are clearly many genuine cases of schizophrenia, that may benefit from the help and support of the community, in the form of hospitalization and confinement this is clearly not the case for the majority of patients who after five minutes and other peoples reports find their world turned upside down forever. Once labelled, the stigma of being a mental health patients can last for life and push the patient into acting out an illness they do not actually have. You label someone something and their instinct is to become the very label you gave them and so a self fulfilling prophecy is enacted and they can all pat themselves on the back and say – see I told you so!

References:

1994 – DSM IV American Psychiatric Association publication.
2010 – Gerrig, Zimbardo – Psychology and Life, pg. 465 – Pearson Publications.
1973 – Rosenhan – On being sane in insane places – pg179 Science Publications
2011 – Butcher, Mineka, Hooley – Abnormal Psychology Core Concepts 2nd Ed. – Pearson Publications. General background information on schizophrenia.
2016 – Myler – Case Notes – unpublished

Posted in Uncategorized | Comments Off on Misdiagnosis of Schizophrenia & Other Mental Disorders

Nurse’s Attitude and Patient’s Recovery

I was on my summer clinical in medical surgical ward. That was my first day of the clinical and I was assigned in Semi private ward. It is expected from a staff nurse to do the head to toe assessment of every patient to whom she has been assigned. Being a student nurse my initial responsibility is to help out the staff in her routine work and care for the patients as well. I started my work by helping the staff nurse in head to toe assessment of patients. It was going smoothly. We both did assessments of eight patients together and I was now feeling comfortable in doing the assessments.

As we went near to room 5, I smelled some obnoxious odor. We went inside the room. There was no patient on bed no 5-A. The nurse told me to wear gloves, gown and mask as the patient was on airborne and as well as on contact precaution. I obeyed her. When we removed the curtain from bed no 5-B, we were shocked to see a female patient who was bombarded with skin blisters all over her body. There wasn’t any skin on her body and her body was bleeding too. She was lying on a sterile Drape sheet and her body was covered from cradle, then again the drape sheet was covering the cradle.

That nurse and I left the room without any further inspection as that odor was unable to tolerate. Our rejected behavior was certainly inhumane and was not appreciated at all (Be it that patient or the Head nurse). Then we went to our TL and she told us all about that patient. I was surprised to know that she was suffering from a very fatal autoimmune Blistering Disorder- Phemphigus Vulgaris. She explained that out act did not represent a Nurse’s role. Then that day TL looked after that patient. For the next few days, TL kept me in the same area. Then slowly with the passage of time I came familiarized with that patient, and started taking care of her. After two weeks the patient recovered much better and faster and was shifted to another hospital in Quetta due to some financial reason.

Initially, I was so reluctant to deal with her because I never came across such a thing in my life, but then I gave this situation a second thought being a nurse so I felt ashamed and then I started feeling affiliated for her and got happy being with her.

Dr. IIeen Craven of Honor Society of Nursing states that all nurses, no matter how they practice, are there to ensure safe, effective, and empathetic patient care. They place the patients in the center of care and work with other healthcare professionals to ensure the outcomes of care which will be best for every patient.

O’Baugh et al conducted a study in a clinic in Sydney, Australia in 2003. The objective of this study was to determine how patients and nurses view ‘being positive’ and identify the different factors that influence this state of being. From this study it was stated that the overall attitude of the health care providers affects a patient’s general attitude and desire or will power

Let’s understand it with an interesting analogy between a nurse’s attitude and the environment by taking an example of going shopping. If you go into a shop to buy something and someone is there and they have a sad look on their face and you don’t get a word (out of them) so they are so negative in their attitude, it has a terrible effect on you. You don’t go back to the shop. Same is the scene with the patients and the healthcare professionals. Now when I look back, I realize that how childish I was in my behavior. If I were in her place I would have certainly felt so embarrassed because from a nurse (a caretaker) no one can expect such things.

A negative behavior is always the reason to mistrust of patients not only towards nurses and medical staff, but towards all the health care providers’. Being positive is very essential when dealing with patients. It not only helps in better recovery, but also establish a trusting attitude towards all health care providers.

Posted in Uncategorized | Comments Off on Nurse’s Attitude and Patient’s Recovery

An Overview of a Prolactin Blood Test

Prolactin is a hormone produced by the pituitary gland of the body. A pea-sized organ that’s found at the base of the brain, pituitary gland helps in controlling the metabolism, growth and sexual development of the body. Though prolactin is found in both men and women in small quantities, it’s majorly found in females who are pregnant and about to deliver a baby. The main purpose of this hormone is to stimulate lactation i.e. production of milk amid women during pregnancy and to maintain its supply post-delivery of the baby. A prolactin blood test helps in diagnosing problems caused by the hormone as well as measures the levels of this particular hormone in the bloodstream. The test also aids in the determination of the presence of a tumor called prolactinoma in the pituitary gland.

Symptoms of prolactinoma

Common symptoms of prolactinoma in women are as follows-

  • Unexplained headaches,
  • Visual Impairment,
  • Galactorrhoea or lactation outside of the childbirth or nursing,
  • Pain or discomfort during sex,
  • Abnormal ache, etc.

Common symptoms of prolactinoma in men are as follows-

  • Unexplained headaches,
  • Reduced sex drive,
  • Erectile dysfunction,
  • Visual impairment etc.

Why is the test done?

A prolactin test is done to check the following:-

  • Find out the reasons behind atypical discharge from a woman’s nipples or if she is unable to conceive (infertility).
  • Prolactin level is tested in males when a pituitary gland problem is suspected. The test is also performed to check the prolactin levels in men if they seem to lack sexual desire or face trouble in erection (called the erectile dysfunction). The test helps to rule out Hypothalamus in men as well.

How to prepare?

  • Before the test, one should avoid drinking or eating for a certain number of hours.
  • The prolactin blood test is usually performed 3 hours after one wakes up in the morning.
  • Any emotional stress or strenuous exercise should be avoided as it can raise the prolactin level in the blood. One is also asked to rest for 30 minutes before having the blood drawn.
  • One should avoid nipple stimulation for 24 hours before prolactin test as it can increase the prolactin level in the bloodstream.

How is it done?

  • An elastic band is encircled around the upper arm to stop the flow of blood. This makes the veins look larger and hence, easier for a nurse or a technician to draw blood.
  • The needle site is fist cleaned with an alcohol swab and then a needle is injected into the vein.
  • A small quantity of blood is extracted from the vein.
  • Once enough blood is collected, the band around the arm is removed.
  • A cotton and bandage are tied on the punctured site to stop the outflow of blood.

Results

The normal values of a prolactin test in-

  • Non-pregnant women should range between 4 and 23 nanograms per milliliter.
  • Expectant mothers should range between 34 and 386 nanograms per milliliter.
  • Men should range between 3 and 15 nanograms per milliliter.
  • Children should range between 3.2 and 20 nano grams per milliliter.

High levels of prolactin in the blood indicate the presence of a tumor in the pituitary gland. It also means that pituitary gland is making excess prolactin for some unknown reason like – idiopathic hyperprolactinemia, etc. Other severe conditions that can cause high prolactin levels in the blood include liver disease (Cirrhosis), kidney disease and hypothyroidism.

Treatment

Treatment against pituitary tumour typically includes taking medications such as bromocriptine, complete removal of the pituitary gland and radiation therapy. The type of treatment given to a patient is based on the size of the tumour, health and the age of the person being treated.

Posted in Uncategorized | Comments Off on An Overview of a Prolactin Blood Test

Nurses – Be Prepared for On The Job Challenges

Nurses that work like saviors, put in their heart and emotions to standby to their jobs and responsibilities to save lives and cure the infected without compromises or disinterest. Their patient-centric attitude and commitment to serve relentlessly often put them into situations and environment that are tiring, have risk of infections, exposure to hazards and testing their limits.

The key challenges that are frequently faced by healthcare workers and medical attendants are shared below. Moreover, there are ways to tackle and crossover the hurdles in such circumstances, if followed by the books can save you from the outcry.

Working Hours – Longer it gets, tiring it becomes.

Nurses work in extended shifts that keeps on rotating and scheduling as per the demand. Working in back-to-back shifts in day and night cause extreme fatigue and tiredness. The job is exhausting and calls for physical endurance, emotional stability along with empathetic attitude towards patients.

Being a nurse, you need to take charge of many things from assessing patient to administering medications, from keeping patient record to medical paperwork and lot more, this becomes psychologically draining too.

However, healthcare organizations and hospitals ensure convenient and flexible working conditions for nurses, until there is critical demand or manpower crisis.
Exposure to Hazards – Medicines, Drugs or Test Samples can be Fatal.

Harmful chemicals, body fluids, medications and drugs, radiations, equipment sterilizing chemicals and strong cleaning agents are things that come across every day in a nurse’s work profile. This constant exposure is detrimental for the health of nursing professionals.

To safeguard and protect themselves, nurses should wear a face mask and gloves whenever they get in such situation or come in contact of harmful substances. To ensure good health of nurses and other medical staff, hospitals and medical centers provide sufficient number of protection gears and ensure the safest way for the disposal of used materials.
Risk of Infections & Diseases – They are Plenty

Nurses and other medical staff involved in providing patient care, surgeries and medications makes them vulnerable to various infections and diseases. Since, they regularly come in contact with patients, there are chances for even the fittest of them to get affected.

To overcome this, it is imperative that nurses must take adequate vitamins to keep their immunity strong and keep themselves protected with necessary vaccinations. It is quite essential that nurses should adopt better health and safety practices in their day-to-day lives.
Unbalanced Nurse-to-Patient Ratio-That is the Testing Times.

With the increasing cost in retaining medical staff and the shortage of registered trained nurses, healthcare facilities are facing a tough time. It has been observed that hospitals are spending more for keeping pace with the advanced technology rather than recruiting required nursing staff and this resulted in an unbalanced nurse-to-patient-ratio.

To address this challenge, there are initiatives and policies with exclusive privileges and benefits to increase the supply of nursing professionals.

Posted in Uncategorized | Comments Off on Nurses – Be Prepared for On The Job Challenges