Most of my posts recently have been rather heavy, and personal. I thought I would trot out another attempt at medical humor that (actually!) happened to me on the job.
Everyday, before a Medical Assistant begins seeing patients, there’s a litany of things to take care of. Some mornings are busy, some run smooth; but, the ducks need to be in a medical row before showtime can begin and the first patient is seen. You’ve got to meet with your provider and pow-wow the day, make sure every room is stocked, make sure you’ve got equipment set aside for any special procedures that day, and gulp down about a gallon and a half of coffee.
Nearly every hospital or facility uses what’s called an EHR, or: electronic health record. This is essentially the operating system of the clinic. You can see all sorts of nifty PHI (patient health information) here, as well as the schedule for the day. Many facilities use an EHR known as Epic, although there are others. The days of paper system providers are practically an anachronism.
In February of 2009, President Barack Obama signed the HITECH act, or the: Health Information Technology for Economic and Clinical Health Act. The goal of this act was to compel ‘meaningful use’ of electronic health records; that is, to facilitate national healthcare information between different healthcare facilities, and to promote the safety of patients by digitally checking drug interactions, duplicate orders, unrecorded allergies, a current medication list, and a host of other measures.
There are, of course, drawbacks to this measure. Any electronic system of information can be hacked. If you’d rather not be discouraged, please do not read this:
To be fair, nearly all modern healthcare facilities use state-of-the-art electronic security systems for their internal network, with an army of techies constantly guarding it. The chances of someone cracking into a hospital’s system are extremely low. So please, do not follow this link:
But, by and large, your information is quite safe. Another criticism of the electronic health record system is the difficulty transmitting information from one facility to another. Within the same company, it’s not a problem. But if Epic goes to link a patient’s PHI from another healthcare company, the results can be quite variable. Sometimes, the information is linked immediately. Other times, the targeted EHR does not respond; or, in some cases, it does, but painfully slow. However, when it works, it’s a fantastic tool for healthcare practitioners.
Still another criticism is purely opinion, one I have heard from many in the industry, and not necessarily my own. The Department of Health contributed nearly $37 billion dollars to promote the adoption of EHRs. This was a worthwhile incentive for a worthy endeavor, but essentially, this all but rendered small, private practices extinct. It is extremely expensive for a small provider or a facility to convert from a paper records system to an electronic system, generally running over 6 figures per provider. Thus, the Amazon analogy applies.
Personally, I find the Epic EHR a great system, easy to use, very customizable, and a wealth of PHI. I could not imagine doing my work without it. In my opinion, the developers have done a fine job.
But, back to the matter at hand: the beginning of a Medical Assistant’s day. Within Epic, there is a schedule for the day feature, listing the patient, their pertinent information, the time and length of visit, and, at the click of a button, whatever else you need to know. Perhaps the most useful category on this list is: ‘reason for visit.’
It was early on in my healthcare career, while I was an extern at a primary care clinic, using Epic. My mentor, who had the grace and social skills of a rabid possum trying to do math, asked me what reasons patients were coming in for today. I glanced at the computer monitor showing Epic, looking under the reason for visit column. There is was.
At least 8 of the 14 or so patients coming in that day, for our provider, were listed as ‘ED follow up.’
My God, I thought. These poor patients. So many. One of them was only in his early 20’s…
Erectile dysfunction is no laughing matter. So go ahead, get it out of your system. Go ahead with your vienna sausage problem jokes. Yuck it up. But the truth is, erectile dysfunction can be a very debilitating, and alarmingly frequent condition. It affects over 30 million men in the United States. The causes can be quite varied: diets, medications, neurological disorders, psychological disorders, kidney disease, age, lifestyle habits, and many others.
Sadly, one of its main side effects, other than the ability for a male to perform during sex, is psychological. There are a myriad of of psychological reasons why this is important to men, a topic for another time. But erectile dysfunction can cause seriously debilitating psychological damage to a male. Self-esteem can take a massive hit, and depression can result. A male may feel woefully inadequate, a self-defeating thought which pervades other areas of the man’s life. It is an embarrassing condition, one which men don’t like to talk about, it sucks, it’s no fun, women laugh at you, you think you’re worthless, I hate myself, no one will ever love me again, I am only half a man, why does God hate me, I…. wait, who am I talking about, here? I wasn’t talking about me! WHAT?!? Anyway, I digress.
There are, of course, many treatments available for ED. Depending on the cause and severity, it may range from a simple medication or lifestyle change, all the way up to an unfortunate but life changing surgery. It can be fixed.
So, my mentor asked me the reasons for patient visiting that day. I really didn’t know what to say. I paused, turned to her, recalling that this is healthcare, and said to her: “It looks like we have a lot of patients coming in today for ED.”
She looked even more annoyed than usual, looked at her screen (with the same schedule pulled up), and scowled. Turning back to me, and said, with the tone and temperment of a ferret with a flamethrower: “Some of these patients are female!” Huh? I looked back at Epic. I hovered the mouse cursor over the reason for visit column. (Epic has this neat feature… hover to discover… you pull up more detailed info when hovering the cursor over the subject…) Further information was displayed in an expansion of the display.
“Emergency Department follow up for dog bite.” “Emergency Department follow up for sore lower back.” “Emergency Department follow up for transient tachycardia.”
Ah. Emergency Department follow up. E.D., not E.D. Well, egg on my silly face! I learned that day something very important: in healthcare, what is colloquially known as the ’emergency room’ or ‘ER’ is actually called the ’emergency department.’ Well, that’s good to know. Would have been nice if that had been in the classroom curriculum. Back to you, Jaimers!
So, there you have it. If you need to go to the ER, it’s just fine to call it that. Let’s say you go in for a bad bee sting or something. Then, the staff there will advise you to follow up with your regular provider. When you schedule that follow up appointment, behind the scenes, Epic will list the reason for your visit as an ED follow up. But don’t worry. You don’t have ED. Especially those of you coming in for gynecological exams.
As an aside, my mentor turned out to be a very cool person. She and I keep in touch, years later, as she was very instrumental to my success. Although, I remember more than a few times, while I was turning an exam room (cleaning it and restocking it after a patient’s visit), I overheard her say: “Having an extern rules. He has to do whatever I tell him. I love that!” Heh. She was a great mentor, and a great Medical Assistant, and very much part of my education. Thank you again, KK at Wedgewood.
Well, there you have it! Take care of yourselves! Wash your hands! Get vaccinated! Be good to each other! Bye for now.
In healthcare, there are, of course, procedures that are gender specific. That is, a woman will get a breast exam, while a male will get a prostate exam. For the most part, as patient comfort is paramount, a practitioner of the same gender as the patient will be assigned to the procedure. This is not always the case, and, in my experience, I have found that most patients, of either gender, as long as the procedure is not terribly invasive regarding sensitive areas, are perfectly okay with a practitioner of either gender carrying out the procedure or examination.
No one particularity likes going to the doctor, anyway, so many patients have ‘do what you have to do and get it over with’ kind of attitude. Fair enough. If practitioners are performing professionally, there is an air of confidence about them, of speed, that conveys to the patient that they have done this process countless times, and this is just another day at work to them.
Indeed, we’ve seen it all. Nothing shocks us. Nothing embarrasses us. It is extremely difficult to gross-out or disgust a healthcare practitioner. I helped an MD remove a cyst slightly larger than a golf ball from a patient’s leg once. She had the cyst out of the patient’s leg, grasping it tightly but delicately in a large pair of surgical grips, so that it would not burst. It was still connected to the patient by a thin strand of tissue, and she asked me to cut the connection just inside the abscess pocket in the patient’s leg. No problem. Kinda cool. Please don’t burst that cyst, doctor. These are new scrubs.
However, all of us in the industry are well aware (or damn well should be) that this is not just another day at the office for the patient. From day one, in whatever training you take, the abstract and highly important skills of empathy and compassion are drilled into your head. We may move confidently and business-like, but patient comfort, to the best the procedure allows, is always on our mind. We cannot sympathize, but we do, often heavily, empathize. There is a difference. We hate pain and suffering. We don’t show it, but it kills us when we see it in a child. That’s why I and thousands of others joined this industry. You may not be able to nauseate or embarrass a practitioner, but even the most seasoned MD can be emotionally moved by the site of suffering. But we carry on. The tears are for later, often alone.
But, back to the matter at hand. As I said, whatever procedure a patient is going through, it is often new to them, or, at best, they are somewhat familiar with it. However, an invasive, gender specific procedure can put a patient on edge if the person performing it is of the opposite gender. We are always aware of that potential.
Take, for instance, the common work a Medical Assistant will do. Give injections. Perform a lavage. Dress a wound. Take vitals. Draw blood. And: the EKG.
Allow to me to switch tracks for a moment. The human body is an amazing machine. Simply put, your body has two command systems that boss your other organs around: the endocrine system, which uses hormones to carry out instructions; and the central nervous system, which uses electricity. Both of these systems, frequently in concert with each other, tell the rest of your organs what to go do with themselves.
The tireless, all-important, paramount, primary organ known as the human heart receives it’s commands via electricity, from the CNS. This tireless, muscular organ is the centerpiece of human existence. It’s role is simple; it keeps your blood flowing through your vascular system. Sounds like an easy workload, but the movement of your blood, which, among many other things, carries needed oxygen throughout the body and removes things it does not need, gives us substance that we cannot do without. Your all-important brain can suffer severe trauma, one can become nearly brain-dead, really, and you might still live, most likely with the aid of machines. If your heart takes enough damage, and it is not tended to in time… well, head for the big light. We’ll see you in the whatever comes next.
As an embryo, the heart is the first functional organ to develop , and starts to pump blood in the developing human in about 3 weeks. However, the brain begins to slowly develop afterwards, around 7 weeks of pregnancy, so pain is not an issue, before anyone turns this fact into an abortion diatribe. That’s between a woman and her doctor.
As a human being, the heart is well protected, encased in the mediastinum, a chamber inside the thoracic cavity (upper torso), protected by the rib cage. Makes sense; it’s important, put it someplace well protected. Which is the opposite of the human brain, which is protected by a thin skull and sits, like an easy target, in the head, which sticks out prominently from the top of your body. Not the best spot for it. Just my opinion; I didn’t design the mess called the human body.
Anyhoo, the heart itself, receiving its constant instructions to contract and relax from the CNS, is about the size of an adult fist. It consists of 4 chambers, the upper atria and the lower ventricles. It will beat about 115,000 times a day, pumping roughly 2,000 gallons of blood everyday. This tireless, dedicated organ is truly the running back of the human body.
As I mentioned, the heart is controlled by electricity, from the CNS. It’s a fascinating combination: a grouping of muscular tissues, a collection of cells, really, that responds to a jolt of internal juice. Neato.
Let me run through this quickly: the vagus nerve, from the brain, carries electricity to the top of the right atrium, to a ‘node’ called the sinoatrial node (good Jeopardy fact, there), which then carries the spark through the rest of the heart, stopping briefly at other nodes to ensure that the chambers contract and relax. Contraction is known as systole. Relaxation is called diastole. So, when you get your blood pressure measured, the top number is the systolic, how hard the heart is contracting, and the bottom number is the diastolic, how well the chambers are relaxing. Now you know that.
Okie-dokie, let’s come back around to the EKG, one of the many procedures a Medical Assistant will perform. The electrocardiogram is a fascinating machine. It’s concept is simple; as the heart runs on electricity, the EKG measures this electrical process, allowing practitioners to ‘see’ how the old ticker is doing. Many of us have undergone this procedure.
That the body is manipulated by electricity was first proven in 1790 by Luigi Galvani, who made a dead frog’s legs dance by electrical stimulation. Physicians at the time were… shocked. It was an interesting trick, but Galvani was also obviously kind of warped, to conduct this experiment. Why is the poor frog always taking the brunt of medical research? Frogs are cool. Anyway.
In the mid 1880’s, two researchers named Ludwig and Waller developed their ‘capillary electrometer’ that showed the heart’s rhythmic electrical stimuli could be monitored from a patient’s skin. They were on to something, and they didn’t even have to slaughter a poor frog.
In 1901, Dr. Willem Einthoven, using magnetic poles and silver wire, and a whole lot of ‘let’s try this,’ finally invented what became known as the EKG. The device continued to develop, into the EKG that you will see in a clinic or hospital today.
Healthcare is very pompous and traditional. The device is called the electrocardiogram. However, as healthcare honors tradition more than major league baseball, Einthoven used the Greek ‘kardio’ as his invention was very, very important, and maybe now Dad might like him. Thus, the acronym ‘EKG’ is used.
Here’s a mind-bender for another time, that took me a while to figure out: the EKG uses 10 electrodes, placed across a patient’s upper body. These are the little sticky pads, connected to wires. The electricity is only measured; no current is carried to the patient. Many of us who have had the procedure often find electrodes later on in the shower that the practitioner forgot to remove. Be that as it may, these 10 little sticky electrodes give 12 ‘leads,’ or views, of the heart’s electrical activity. That’s 12 views from 10 electrodes. That explanation is for another time, but as a student, it took me a bit of time to wrap to my head around that one.
These 12 leads, interpreted by a computer, which render a wave-like display, can tell a great deal about how a patient’s heart is performing. Many, many problems with the heart can first be detected with the EKG. It is an invaluable diagnostic tool in healthcare.
There’s a little more to it, and some instruction in its use is needed. I was trained how to use the EKG when I spent a year in Medical Assistant school.
So, let’s bring it back around, to finish, with my opening: gender specific procedures. The EKG itself is not gender specific, but the procedure of using one can be.
The role of Medical Assistant is heavily female dominated. Only about 15% of Medical Assistants are male. Of our class of 9, I was the only male, other than our wise instructor, a patient, erudite veteran. To protect his anonymity, let’s use the name ‘Jaimers.’
We were trained in the EKG early on in our program. We were not quite yet a team, and the group-trust, while growing, was not there yet. As I mentioned, the EKG is not gender-specific. However, with a female patient, it does involve her removing much of her upper clothing, while lying on her back, putting her in a vulnerable and perhaps uncomfortable feeling state. Not every women getting an EKG feels this way, but I can see how one might.
Jaimers asked my fellow 8 female students if any of them would have an issue if I, the only male, practiced the EKG on them. Several of my classmates said they would. I took no offense. However, one particular classmate had absolutely no problem with this.
This classmate and I clicked early on in the program. She was intelligent, driven, and, like myself, determined to bury the program into the ground and come away with a cumulative 4.0 gpa. She has had quite an accomplished life, and I could see her determination. In school, always get a smart friend. Anyway, to protect her anonymity and dignity, let’s call her ‘Heidie.’ As an anecdote, had I been born a female, my name would have been the same, only my parents would have spelled it correctly. And even weirder, had I been born a male, my name would have been Tom. Inside joke!!!
Anyway, Heidie did not give a rat’s ass who worked on her; like me, she just wanted a 4.0. So, I had the honor. Even though she is older than I am, Heidie is quite beautiful, but that did not enter my mind at all when she was lying down on the exam table, her scrubs up, just exposing the bottom of her bra. Like I’ve mentioned, it’s just another day at the office for a practitioner.
But, I ran into trouble. The first two electrodes of the EKG go to just the right and left of the patient’s upper sternum. Heidie had decided to be Pamela Anderson that day. I hope you can see the logistical problem I was having. I needed my 4.0, but Heidie’s damn hooters were in my way. Heidie and I have gone on to be great friends, to this day, but at that moment, Dolly Parton there was annoying me. I needed to place the first two electrodes, but I did not want to molest my classmate. I was frustrated, trying to delicately place the first two electrodes at the sides of Heidie’s sternum, without touching her silicone work. Impossible.
Jaimers, our seasoned, knowledgeable instructor, noticed I was having trouble. He came over to assist me, and briefly instructed me on how to delicately and professionally, explaining what you are doing to the female patient, move her bazingas out of the way so that you can place the electrodes. His advice was spot-on, of course, but at that point, I was ready to just heave the annoying hooters out of the my way and use duct tape to hold them until I was finished. Jaimers and I got the electrodes hooked up, but, of course, Her Majesty happened to be wearing a bra with an underwire that day. This can cause AC interference in the EKG’s reading. I eventually had to move on to another willing female patient. This was the only time in our friendship that Heidie has annoyed me. Of course, she got the last laugh, when she performed an EKG on me. My family is mostly Swiss, with a fair amount of Sasquatch thrown in. That is to say, I am a hirsute man. I shed. It sucks. Whenever I have a girlfriend, the lights have to be off. So the process then, the humility reversed, is that the Medical Assistant has to shave, with a razor, the locations where the electrodes go. Actually, I probably disgusted Heidie. I hate being part Bigfoot.
After class, when everyone was leaving, Jaimers said his daily: “Andrick, may I talk to you for a moment?” I really got tired of hearing that. But that day we spent a good 20 minutes talking, staring out the window down onto Seattle’s downtown, a typical misty day. All we needed was some armchairs, soft jazz, and lower lights. He was quite informative that day. He imparted the (extremely useful) wisdom on how a male patient performs an EKG on a female. You explain what you are doing, politely and professionally, asking for permission, and use the back of your hand to briefly raise the female patient’s breast to place the electrode. It was an informative, bonding chat. So, please don’t miss the next episode of Hooter Talk, with Jaimers and Andrick, Sunday nights at 9:00 PM on your local PBS station. Won’t you donate now, to keep this quality program going? Hooter Talk with Jaimers and Andrick is brought to you by viewers like you, the Corporation for Public Silliness, and the National Endowment of Andrick Smarting Off Again.
All kidding aside, let me finish up this essay with my original opening: gender-specific procedures. I have indicated that the EKG is not gender-specific, but it can be to the patient. On my externship, my mentor tasked me with performing and EKG on a female patient. I asked her if we had checked with the patient to make sure that a male performing this procedure was comfortable with her. My mentor blew it off, saying that it shouldn’t matter. Oh well, I thought. She’s the boss. I grabbed the EKG kit, and entered the exam room.
I could tell there was a problem as soon as I entered the room. The woman looked scared and nervous. I used a soft voice, and politely introduced myself, telling her I was there to perform her EKG. She began to cry. I told her that it’s okay; what’s troubling you? She tearfully asked if a female could perform the procedure. I have no idea if I caused her concern, or something prior. Perhaps abuse, anxiety, or a troubling potential diagnosis. It did not matter. Empathy and compassion. I told her that that would be just fine, no trouble at all, and that I would find a female Medical Assistant. I excused myself.
I went back to my mentor and told her what happened. She seemed surprised. Whatever…
It can also work the opposite way. People are all unique individuals. I was working at a community clinic, and was asked to perform an EKG on a female patient. I entered the exam room and introduced myself. Bam! Off went her gown, off went her bra, she laid down flat, and said: “Okay!” Well! My kind of patient! Who gives a crap? Just do your thing, MA!
None of that EKG encounter with that patient bothered me. Her unabashed style made things quite easier. There is a little dead space in the EKG process, when the MA connects the electrodes, straightens the lines, and ensures that the computer is correctly connected. So she and I talked about Star Trek. It was quite the memorable EKG experience.
So, my final points. You never stop learning, even after school is over. When you practice on real patients, it’s a brand new world. The procedures we do in healthcare may all be similar, but each patient is unique. You never know the full story of what brought them to this place. Empathy and compassion. Most people are fighting a battle you know nothing about. The other thing I learned was: if you are a female patient, and going to the clinic or hospital, please don’t wear a bra with an underwire. We’d appreciate it.
Thanks for reading, everybody! Happy Thanksgiving!
Hey everybody! It’s been a while. I thought it would be good to post again.
I’ve got a little time; I’m on a medical leave right now to take care of a sudden and troublesome condition. I’m hoping to return to work in January. So, I’m using the time for research and writing. Good time for a new post.
My time as a Medical Assistant has not been terribly long, but I have learned a few things. The world of healthcare is full of drama, intrigue, gossip, strong emotions, and downright assault. They didn’t exactly prepare me for that in school. But, many veterans of the industry are a bit burned out these days, so I joined the ranks just in time for the rampant profanity and frayed nerves. Good times!
But, all that’s for another time. Today, I’d like to write about broken male genitalia, hearing aids, and a federal government that just continues to annoy the crap out of me.
Okay, bear with me, because this is sort of round-about.
Older males can develop a condition called Peyronie’s Disease. Simply put, this a pronounced curvature of the ding-dong when it becomes ready for the old hoo-hoo cha cha with a nice lady. Many illnesses and conditions in medicine are eponymous; that is, they are named after the scientist or physician that first identified them. I have done no research, nor do I wish to, of who Peyronie was, and why he chose this area of study. Well, I suppose someone had to do it?
Anyway, this curvature of the little fella can be quite debilitating, preventing regular sexual intercourse. Please, please, please do not follow this link:
I warned you. Anyhoo, Peyronie’s Disease is generally caused by a buildup of scar tissue and plaque in Mr. Johnson. This is typically due to a number of various medical conditions, but most often due to penile trauma. What happens is, the old timer really, really wants to do the bang-bang dance with the pretty lady friend. However, along with age can often come another unfortunate condition, erectile dysfunction. ED, as it’s known, can be varied in its severity. If it is not too bad, the gentleman will do his darnedest to guide the not-so-stiffy into the nice lady’s fun zone. This invariably does not work, and is probably not all that fun for the female partner. I’m guessing. But, this continued practice will cause physical trauma, damage, to Mr. Johnson. This often results in Peyronie’s Disease. Oh, the tragedies of man…
But wait! Hope abounds! Modern modern medicine triumphs! There is a medication known as Xiaflex (triumphant music sounds) that can cure this condition!
Xiaflex is a medication that breaks down the plaque buildup in a shlong with Peyronie’s Disease.
It is injected directly into the affected area of the penis. You are reading that correctly. A needle, made of metal, is inserted right into a crooked penis. In my practice as a Medical Assistant, I have seen Peyronie’s Disease, and I have seen it corrected by an injection of Xiaflex into the affected area of the male member. It cannot be unseen. I am different now.
Xiaflex is not inexpensive. Depending on the severity of the Peyronie’s Disease, it can take up to 12 injections of the medication. Each administration of Xiaflex costs roughly $3000.
Okay, so my 87 year old mother, who I love dearly, is nearly deaf. I know that there was no segue there, but bear with me. This all comes around. Nevertheless, I hope my Mom is not reading this.
Charlsia Schall is still very sharp mentally, and I inherited her wicked sense of humor. Physically, she’s doing okay for someone who is 87, but she needs to use a walker and she desperately needs hearing aids.
You can still speak with her, but it is usually best to speak directly in front of her, in a louder, clearer voice. Being that her cognitive acumen is still strong, it is easy to carry on a conversation with her. At her age of 87, I am truly lucky. Not many people have such a luxury. Again, I hope you’re not reading this, but I love you, Mom.
My mother and late father, through living frugally and saving as much as they could, did okay for themselves. You know, living within your means and saving as much money as you can. Like you’re supposed to do. Sheesh. Old people, wise with their money… I tell you… Anyway, though she could definitely afford it, Mom is not keen on making large purchases. On some level, I don’t blame her at all. Hearing aids are profoundly expensive, with decent ones starting at at least 4-5 thousand dollars. As my Mother is not entirely deaf, this is an economic button she is just not comfortable pushing.
Social Security was signed into law by President Franklin D. Roosevelt in 1935. Again, I got no segue here, but trust me, this is all going to come together. Hopefully. If this is a good day. Anyway, Social Security was part of the rescue package intended to mitigate the Great Depression. Apparently, economies occasionally need medication and therapy as well. The Great Depression had ravaged the United States. A recap of history is not needed here.
The government, at all levels, has always taken a strong interest in the American healthcare system. This can be a good thing, as government oversight can ensure the safety of patients and the efficacy of treatments, strengthening out healthcare system. (How we go about paying for this masterpiece is another story entirely). Federal agencies exist to oversee healthcare at all levels, ostensibly to protect the American patient: the FDA, the CDC, the DEA, the Joint Commission, etc. Occasionally, these departments can become weaponized for political reasons, as we are human, all of us flawed, and humans run the government.
My education and professional experience is in medicine. I dislike talking politics, as people can easily get all yelly-shouty-pissy. I know only the basics of our political system, and I hold opinions based on what I see. There is a branch of philosophy (I have dabbled, but am not educated) known as epistemology. This school of thought seeks to differentiate between what is fact and what is opinion. In today’s era of social media, it is quite easy for anyone, from any ideological camp, to loudly shout an opinion, with scarce facts backing it up, until, in this era of blatantly partisan media, their opinions are reinforced enough to become, in their world, facts. A nice twist of logic. It is difficult to speak of politics these days, as we live in a largely binary political belief system, with inflexible, unyielding opinions (not facts), and people quickly get emotional and confrontational. You cannot have a rational discussion with someone in that state. Hence, I avoid politics.
Anyway: back to politics nonetheless, the federal government, and Social Security. Over the years, the government has changed, tweaked, and adjusted Social Security, but the basics of the original intention still stand. All taxpaying Americans pay into it, and our senior citizens can enjoy an easier way of life, as medical bills mount with age. Be that as it may, there are certain things Social Security still will not pay for.
My beloved mother could really use those hearing aids. Hearing aids are not covered by Social Security.
Xiaflex, the medication that treats Peyronie’s disease, is covered by Social Security.
Let that sink in for a moment.
Hearing aids? Up to $7,000 or $8,000 dollars.
Xiaflex? Up to $36,000 dollars.
Yup. No hearing aids, no new glasses, no covered dental work for my Mom.
Bent weener? No problem. Got you covered.
I was a little stunned when I heard about this. Surely, I thought, the powers that be in Congress would have rectified this by now. An RN I was working with at the time gave me his opinion:
RN: Andrick, who do you think makes the laws in the Senate?
Me: Uhh… Well, for the most part, mostly older white males.
RN: And who do you think they have staffing their offices?
Me: Usually insanely hot 35 year-old women.
RN: Okay then, do the math.
Me: Aw, crap!
Joe Biden and the slim majority of Democrats in Congress have recently tried to stabilize the country and give long-needed help to the working class. Again, I hate speaking politics, but two of his Republican predecessors did the same thing. But, because half the country believes Joe Biden lost (dude… people… really?), the opposition is suddenly concerned about all this money we’ve been throwing around.
Initially, Biden’s rather largish spending plan included adding hearing aids, vision, and dental to Social Security recipients. Sounds like the right thing to do. But people balked at it. Biden has scaled his ambitions back. Recently, Congress at least passed an infrastructure spending bill. There is more work to be done. Biden and the Democrats are still trying to pass legislation that would help the needy. After much yelling, the plan was scaled back, as far as Social Security benefits go. Vision and dental are out, but hearing aids would be included. At least my Mom could finally hear again.
However, the opposition is again balking at this one. Along with them are two Democratic obstructionist Senators. One is a cranky old man, with an 85 year old body and 500 year old face,a Republican dressed as a Democrat, who doesn’t like spending money at all. He wears sensible shoes. He represents the state of Virginia. I had to Google Virginia; evidently it’s a suburb of West Virginia or something. East Virginia was infamously destroyed by the Cloverfield monster. The other Democratic obstructionist Senator is a woman from Arizona, who’s really pulling off the naughty-behind-closed-doors school librarian look. I’ve been to Arizona. Head south to the deserts of SoCal, go east, and stop where all the retired people are. Anyway, this Senator is rather hard to read. She doesn’t seem to stand for anything, and dislikes speaking to reporters, her constituents, or the clerk who asks paper or plastic. Maybe she’s just there collecting a paycheck. She certainly does not need the Viaflex. So, there is a good chance that the aid package that includes hearing aids in Social Security will not pass.
So, there you have it. Penny-pinching senior citizens can’t rely on Social Security for hearing aids, but senior citizen males, no matter what their station, can afford Xiaflex to fix their bent ding-dongs. Makes perfect sense to me!
Back in early 2020, when the world began to unravel, when I had just finished my first quarter of school, the lock-downs across the country had begun. My parents, I had both at the time, were considered vulnerable (right… remember when it only infected elderly people or people with compromised immune systems? It’ll go away in April! Like a miracle! Drink bleach!) and they were living in an assisted living facility. In fact, it’s only recently that restrictions have been relaxed, and I’ve been able to regularly visit my mother.
Anyway, I was having such a great time in school; I was particularity blown away by anatomy and physiology. The human body is an amazing machine. When our instructor first started lecturing about the roles that the cardiovascular and pulmonary systems play together, I devoured his words, scribbling furiously in my notebook. I read through the relevant chapters in our massive textbook. I was fascinated.
I wanted to tell my parents what I had learned, but that’s hard to do over the phone. So, I scribbled together these following pages and mailed my attempt to understand the human body off to them. They got a real kick out of it!
Needless to say, I was a green student, and I got plenty of things wrong in my notes. I think I got the actions of the diaphragm mixed up. I left out the other semilunar valve, the aortic valve. I did my best with the white blood cells, but I’m no biochemist. I got the test tube of blood wrong; white blood cells and platelets are actually in the middle, in a thin layer called the Buffy coat (seriously). There are also plenty of spelling and grammatical errors, and a few pages have this evening’s PB&J on them. Sorry about that.
If you manage to make it through my mangled scribbles of a new student barely understanding, and get to the part where I talk about platelets, you might notice something interesting. Platelets, the cells in your blood that form a mesh to stop bleeding, use serotonin in this process. This is the same serotonin that rattles around in your brain, affecting your mood, and are the primary target of most antidepressant medications. Huh. The human body’s kinda weird like that… Anyway, enjoy!
It is a well known fact that the healthcare industry does not speak English. Sure, when you’re talking to your doctor, or any practitioner, you’ll use layman’s terms, the ones we all know. Relatable, common sense terms. However, behind the scenes, healthcare has a needlessly complicated language. It’s like a strong tradition, a superstition almost. As if only the initiated can use this sacred tongue.
Typically, after any visit to a clinic or facility, you are given a sheet of paper, sometimes emailed, summarizing what your experience there was. It’s usually called an After Visit Summary, or a Visit Information Sheet. Depending on your facility, if you read the summary in-depth, you might see some of this obscure language pop up.
Much of the language of healthcare is derived from ancient Greek and Latin, when the smart people of the time began to (very slowly, often incorrectly) figure out how the human body works. The Latin work for uterus is ‘hyster,’ derived from hysteria, as the Greeks thought women could be overly emotional, as they did not understand that a woman ovulating can have her hormones thrown off. How charming of them. ‘Tomy’ means to cut, or remove. Thus: hysterectomy.
Today, much of the modern healthcare lexicon is an alphanumeric code, a relatively recent development. This eases communication between different languages, and it is also a common way for clinics to communicate with insurance companies.
Perhaps the most intriguing healthcare term of all is the eponym; that is, a procedure or discovery named after the person who pioneered it. The PAP smear was invented by Georgios Papanikolaou. The cruel disease of Alzheimer’s, an illness as old as humanity, was first pathologically described by Alois Alzheimer. Crohn’s disease was first identified by Burrill Crohn.
Now, considering anatomy, that is, the parts of the human body, there are many eponymous terms that, when first read, are downright silly. Here now, is a list of the most ridiculous sounding names for parts of your body:
Purkinje fibers: These are located near the bottom of the heart, and aid in the pumping action of the heart muscle and blood. They are named after Jan Evangelista Purkyně.
Bundle of His: (Actually pronounced bundle of HISS) These are fibers in your heart that help conduct the electrical impulse that keeps the heart beating. They were discovered by Wilhem His Jr.
Islets of Langerhans: These are parts of the pancreas that aid in the metabolism of glucose. They are named after researcher Paul Langerhans.
Cowper’s glands: These aid in the transmission of male semen from point A to point B. They are named after William Cowper. Mama Cowper must have been proud.
Pouch of Douglas: This is the pouch between the rectum and the uterus of the female body. Anatomist James Douglas took his work very seriously.
Golgi apparatus: This cellular substance aids in protein packaging. They are named for the Italian Scientist Camillo Golgi.
Loop of Henle: This handy little structure aids in the production of urine. It is named after German anatomist Freidrich Gustav Jakob Henle. Dr. Henle liked to study how we pee.
Little’s plexus: This is part of your nasal septum. It was first discovered by American surgeon James Little. I don’t know much about him, but judging by his name, he was probably 6’4″ and 280 lbs.
Crypts of Lushka: These are the mucous membranes on the inside of the gallbladder. They are named after German anatomist Dr. Hubert Von Luschka.
Zonule of Zinn: This is a suspensory ligament in the eye. They are named after Johann Gottfried Zinn.
Spiral valves of Heister These are valves in the cystic duct, connecting the gallbladder to the bile duct. They are named after German anatomist Lorenz Heister.
Wormian Bones: These are structural bones in the skull. They are named after Ole Worm, professor of anatomy at Copenhagen. Cool name.
Artemis Schlong: After centuries of debate, a name was finally settled on the name of the male reproductive organ in 1692, by Costa Rican anesthesiologist Artemis Schlong.
All human beings, gender dependent, have within them these anatomical parts with unusual and odd sounding names. There are of course, many more. And still… more to be discovered.
Well, let’s take another look under the hood of healthcare.
Healthcare, the practice thereof, confuses many people. That’s understandable. I wish that I had more time to explain to my patients what I was doing, because it’s incredible stuff. Another thing that confuses many people is health insurance. In fact, it makes them quite angry. Understandably. But that leads to my next topic. Let’s confuse things even more with the riddle of modern healthcare that is billing and coding.
In a moment, we’ll take a look at the ICD. But first, some context. Just about everything that happens in healthcare has a number attached to it. It’s really more simple than it sounds, but here we go: HCPCS (Healthcare Common Procedural Coding System) was established by the Centers for Medicare and Medicaid Services in 1978. Though it is in the purview of the CMS, it applies to all healthcare coding. There are three levels to it, but the first level is the most common, and it contains what are called CPT codes, or Current Procedure Terminology codes. These are the codes for what the physician does to you: evaluation, surgery, lab work, prescriptions, tells you to lay of the bacon cheeseburgers, etc. Pretty straight forward.
Then there are the ICD codes, or International Classification of Diseases. These are the codes for what exactly is wrong with you, and why you came to see the Doctor in the first place. A broken arm has a code. A flu has a code. A dog bite has a code.
Ostensibly, the ICD codes were implemented to track diseases across a population. Since illness has no respect for political boundaries, these codes are also used to communicate to physicians across the planet. Researchers and physicians who may not speak English can at least decipher the ICD code.
This concept has been around for a long time. Some medical historians place the origin of the ICD codes as far back as 1763, when a French physician named François Bossier de Sauvages de Lacroix developed a classification of 2400 diseases. (https://pubmed.ncbi.nlm.nih.gov/20978452/) The list continued to grow and develop, and by 1898, the United States was using the International List of Causes of Death. (https://pubmed.ncbi.nlm.nih.gov/9082128/). More twists and turns of the list followed, until the establishment of the United Nations and its subsequent organizations.
In 1948, the World Health Organization took over the ICD listing. The various lists used across the world were compiled, and the first official list, number 6, was published in 1949.
Again, these codes are used to track illnesses across populations and for better communication between the healthcare infrastructure of nations. However, these codes have taken on another role. These are the codes that are sent to insurance companies when a facility needs authorization for treatment, along with the CPT code mentioned above. The insurance company will plunk these codes into their computer, mull in over, and respond with how much they will cover, which 11 times out of 10 is slightly south of zero.
In my training, I was taught to look up ICD codes the old fashioned way. Our instructor handed us each a large book, the latest ICD code book, with more pages than War and Peace in large print, and we were to track down a patient’s ailment. These days, the code is simply generated when I enter it into the computer. If I enter ‘back pain,’ the code is automatically generated, with the option for further detail, should the physician think it warranted. My instructor loved to make us work for it.
Bear in mind, the ICD code book is not to be confused with the Diagnostic and Statistical Manual of Mental Disorders. That’s a whole different list of problems. I’ve got about half of them. Work is underway to integrate the DSM with the ICD, but that will probably take some time.
In 1979, the ICD-9 was published. The codes are alphanumeric, five -seven digits long, and have the option for modifiers. There were over 13,000 different codes.
In 2015, the United States adopted the ICD-10. It was greatly expanded: there are over 70,000 different codes.
The theory was, the massive increase in entries allowed for greater specificity of the ailment, and did away with the need for modifiers. You ask me, someone had a little too much time on their hands, and probably started the day a great big bowl of amphetamine flakes. Nom nom!
Yeah, the ICD-10 may have taken it a little too far. The following are actual entries from the massive list:
W61.33:Pecked by a chicken
W5921: Bitten by turtle
R46.1:Bizarre personal appearance (Oh, I got that one, for sure…)
Z63.1: Problems in relationship with in-laws (What? When does that ever happen?)
V97.33:Sucked into jet engine
Y92.253: Injured at Opera House (Hey, it happens…. Over 6 people a year succumb to this tragedy)
Y92.241:Hurt at the library
Y92.146:Swimming-pool of prison as the place of occurrence of the external cause of injury
Y93.D1: Stabbed while crocheting
V9107XA :Burn due to water-skis on fire, subsequent encounter (I really don’t know what to say…)
V9542XA: Spacecraft collision injuring occupant (Eyes front, Major Tom!)
And my personal favorite: Y.34: Unspecified event, undetermined intent (Well, sure! That works!)
I’m making none of these up. The ICD-11 is set to published in 2022. It is said to be almost five times as large as the ICD-10.
To end on a serious note: occasionally, the ICD will need to be quickly amended. In April of 2020, a new code was added. U07.1: Covid-19.
Wash your hands! Social distance! Wear a mask! Get vaccinated! Avoid Florida! We’re not through this yet!
DISCLAIMER: I HAD NOTHING TO DO, AT ALL, WITH THE FOLLOWING STORY. I AM LICENSED TO PRACTICE ON HUMAN BEINGS. THIS STORY AND PICTURES WERE RELATED TO ME BY… A FRIEND OF MINE. AGAIN, I DID NOT DO THIS.
Peafowl are common birds of the phasianidae family, related to the pheasant. They are found in warm, tropical regions of the world. The male of the species, the peacock, is known for its resplendent display of tail feathers, the peacock train. They are some of the most beautiful birds on Earth.
My friend, who told this story to me, has a friend who owns a no-kill farm out in the country. The place is fantastic; friendly goats, peafowl, war-like geese, chickens, and even the last remnant of the dinosaur, the emu.
Though they may be vastly different than human beings, the peafowl can succumb to very similar ailments and conditions. This story, related to me and not done by me, is the story of a peacock with a very bad cyst.
My friend’s farmer friend had purchased a peacock. At first, he paid no mind to the cyst on the side of the animal’s face. But the cyst grew quite large, and was causing the poor bird problems with its vision and breathing. As you can see, its left eye was nearly useless, as the pressure of the cyst was pushing it out of its socket. It also had a rasp to its breathing, as the cyst was putting pressure on throat. This animal needed help.
My friend, who told this story to me, is quite familiar with cysts. However, he is not a veterinarian. Be that as it may, this appeared to be a sebaceous cyst, a very common growth. They are non-cancerous, and generally filled with semi-liquid or dead tissue. They are formed when the sebaceous gland, which produces sebum to coat skin and hair (or feathers) becomes damaged or blocked. They are typically not a problem, unless they are in a troublesome part of the body, such as this poor bird. Cysts grow slowly, and this beautiful animal would have continued to suffer.
Well, my friend, who is not me, has removed cysts before. It’s really quite simple. A shot of lidocaine, an incision, and then you scoop the gunk out. A course of antibiotics is then in order.
But, my friend had no lidocaine. This would have to be done Viet Nam style. He did, however, have two brilliant surgical assistants who were invaluable in this surgical procedure.
So, in my friend went. My friend did not know this, but a scalpel designed to cut human flesh barely works on a peacock. It took a little slicing. My friend was concerned that the animal would recoil in terror and pain, but it was quite cooperative throughout the entire procedure. More so than any human, actually, and without any lidocaine. Cysts are full of material that has no nerve endings; once you cut through the skin, you’re working with dead tissue. Also, my friend’s farmer friend told me that an animal will frequently settle down in a mixture of calmness and fear once it realizes it has no choice.
After just a few cuts, there it was: a disgusting mass of dead, crumbling, moist material. I will spare that picture. My friend scooped a lot of it out. It was… rather repulsive.
Withing minutes, the peacock’s left eye began to descend into its proper place, and the milky material in the lens all but disappeared. It’s breathing became less labored. Amazing what can happen when you release a little pressure.
Unfortunately, my friend got a little too ambitious when digging out the core of the cyst, and severed an artery. Again, my friend is no veterinarian, but he was confident that there was no major artery in that part of the animal. With some constant pressure applied with sterile gauze, the bleeding stopped.
My friend cleaned out the wound with saline, and applied some animal antibiotics. Every farmer has a bottle lying around: Tylan 200.
The bird looked much better after the surgery, but a little rough. It’s eye had returned to a normal state, and its breathing became better. My friend’s farmer friend kept up with the antibiotics, and I’m happy to say that the bird is doing just fine.
The cyst had been with the animal for quite some time, so it was unused to using its left eye. However, the little peacock brain has returned to normal use of its vision as its vision neurology has healed as well.
So, a happy ending. Again, I had nothing to do with this. It was related to me by a friend. The peacock has returned to his ostentation, and is living a happy life. This is what healthcare is all about. All life is precious.
Well, the third quarter is underway, and so far it’s going great! I’m taking 2 courses; one is Pharmacology and Medication Administration (this is what the chemical is, this is how I will inject you with it) and Administrative/Clinical review (this class is a lot of fun – the instructor basically sets up exam rooms, and we practice on-boarding patients; the instructor, playing the MD, then gives us a procedure to carry out with the patient), which ties together everything I’ve learned so far. We are also studying medical terminology, and where it comes from. Not sure why that wasn’t covered in the first quarter; perhaps they just wanted us to get familiar with the jargon before we closely studied the etymology.
Everything in healthcare seems to have a needlessly fancy name, but there’s a good reason for that. Just about every bit of terminology a practitioner uses is either Greek or Latin in origin. There is also the occasional eponymous term, a word named after the person who discovered/invented it (Pap test, Alzheimer’s, Tommy John surgery). I’m oversimplifying the history a bit, but a long time ago, when Hippocrates and his colleagues figured out that illnesses and diseases were actually environmental and not divine punishment (although that unfortunate concept still exists today), and began to actually study the human body, the ‘English’ of the day was either Greek or Roman. Many people in the known world (which was much smaller then, than our own) spoke one of these two languages; much like a good portion of the known world speaks English today. This way, a physician in Rome could correspond with a physician in Roman occupied England, who perhaps spoke a local dialect, and they would know what they were talking about. The practice continues today.
The word ‘doctor’ comes from the Latin ‘docere,’ which means: to teach. It also shares its roots with the word ‘docile.’ The thinking here is that one cannot properly learn and absorb information if one’s mind is not calm and focused on the matter at hand.
But, as it turns out, the ancient Romans could be a little flippant. The word ‘hyster’ comes from the Latin ‘hystera,’ the word they used for uterus (think: hysterectomy). The Romans believed that women got moody and emotional because of their menstrual cycle; therefore, the word ”hystera’ shares a root with the word ‘hysteria.’ Well, that’s charming. Sure, some women do occasionally get a bit out of sorts on their menstrual cycle, but that is not a character flaw or an indication of a psychological or psychiatric disorder. A woman’s endocrine system is simply in overdrive, if you will, forcing an ovum into the uterus. So there you have it. The etymology of medical terminology is fascinating, but glib, dismissive opinions are nothing new.