Medical Administration Careers: 3 Ways for Learning Medical Scribe Terminology and New Healthcare Definitions

Student Learning New Medical Terminology

by Walter Rodriguez, PhD

Passing medical certification exams and tests are one of the most challenging tasks you may encounter---even with seemingly adequate preparation! And, after passing the certification exams or tests, you must still keep current with the new medical terms and healthcare definitions. So, what can you do to stay current with the medical terminology and healthcare definitions?

Below are three authoritative (research-tested) ways you may use to learn current and new medical terminology:

1. Read Medical News and Blogs: One of the best ways to learn medical terminology is by reading articles in refereed journals and institutional blogs like this one. Reading the terms in the context of an article will help you retain the knowledge. After reading this blog, please scroll down to read sample articles written by Dr. Peter Reuter, an assistant professor in the College of Health Professions and Social Work at Florida Gulf Coast University and author of multiple medical encyclopedias & a web resource.

2. Review Electronic Flashcards: In preparation for a test, we tell our students to go to interactive resources, such as Quizlet. Please see an example at https://quizlet.com/11256201/basic-medical-terminology-scribe-flash-cards/. In addition, we provide numerous practice  quizzes on our Canvas Learning Management System (LMS).

3. Take a Diagnostic Exam: According to How We Learn: The Surprising Truth About When, Where, and Why It Happens by Benedict Carey, "taking a test before you know anything about it improves subsequent learning." In our Medical Scribe Program and courses, we have developed worry-free diagnostic tests that students take before they start learning some of the medical scribe and medical terminology materials. These types of exams help us (faculty) diagnose (identify and analyze) where we need to focus our teaching and learning efforts. And when we start our Medical Scribe courses and programs, we always provide at least one diagnostic test. The tests help us benchmark the students' learning progress.

Please visit again for additional hints on how to learn Medical Terminology to pass your Medical Scribe certification exams, even without registering for one of our online courses. For more information or to try one of the exams, please complete this form.

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Medical Administration Careers: Postoperative Delirium - A Potentially Serious Issue for Older Patients. [And a few terms* that Medical Scribes should be familiar with.]

Peter Reuter, MD, PhD

General anesthesia has been around since the mid-1800s, and every year millions of people undergo procedures that require general anesthesia. What may be surprising to most people is the fact that after using anesthetic drugs for approximately 170 years, we still don’t know how they act exactly. We can explain how they block or suppress pain signals, but we still don’t have a sufficient explanation as to how they induce unconsciousness that can be reversed. We have evidence that they act on nerve cells or neurons in a way that interferes with the regulation of sleep, attention, and memory, and there is speculation that they disrupt communication between different parts of the brain, which somehow causes unconsciousness.

Initially patients undergoing general anesthesia were mostly younger patients because of the risks associated with the procedure, especially the stress put on the cardiovascular and respiratory systems. However, over time anesthesia has become safer for all patients and surgeons started to perform elective procedures on patients that would have been excluded because of their advanced age in the first part of the last century. Combined with an increasing number of people living into their 70s, 80s, and 90s the number of older people undergoing general anesthesia has skyrocket in the last 50 years.

In the early 1980s reports surfaced that described patients going through a state of confusion, hallucinations and memory loss after general anesthesia. The patients couldn’t respond to normal questions, such as how they were feeling, and often replied with nonsensical answers. Over time this state was termed Postoperative Delirium. When doctors started to look into the cause for this state they couldn’t find a relationship to the kind of anesthetic used or the duration of the anesthesia. There were, however, first indications that the delirium wasn’t always just a transitional state that lasts a few hours only, but could linger for months and, in rare cases, even for years.

What makes it difficult to identify the underlying cause, if the anesthetic isn’t to blame, is the fact that the stress of the general anesthesia is just one of many stresses the patients are under during their time in the hospital. Just being hospitalized for an acute or chronic ailment and the changes that come with that, such as loss of privacy, inability to sleep properly, changes to the diet or having to change or take new medications, can sometimes cause patients to become confused, depressed, irritable or even delusional. Two factors that have been isolated by various researchers are age and the type of surgery performed. We now know that patients above 70 years of age are more prone to develop Postoperative Delirium. The risk increases even more if they already suffer from mental deficits, such as dementia, before the anesthesia. Even patients who had just mild symptoms, such as forgetting appointments or to take their medication on time, were shown to be more likely to go through the delirium. Major surgeries that sometimes last for hours and that require the patients to stay in the hospital overnight or longer, also carry an increased risk for developing the syndrome. Studies have shown that half of patients older than 60 go through a state of confusion and disorientation after heart bypass or heart valve replacement surgery. Hip replacement surgery, which is usually faster and an elective procedure that can be done when the patient is physically and mentally ready, has a far lower incidence for the same age group.

Studies have also shown that some type of regional anesthesia can increase the risk for Postoperative Delirium as well. Normally, regional anesthesia uses an anesthetic drug to block nerve signals from a certain area of the body, such as the legs, from reaching the spinal cord. The patient loses feeling in the area, but is of course alert. However, patients are often given a sedative drug, such as propofol, to calm them down and reduce the stress of the situation. If the amount of those sedative drugs is sufficiently high patients go through a state of general anesthesia during at least some part of the procedure without them, and often the anesthetist, being aware of that.

Not only are older patients more susceptible to developing Postoperative Delirium, it often lasts longer and is more severe. Having older patients show signs of a mental slowdown (performing poorly on word recall test for example) three months after major surgery is not uncommon, with the time until complete recovery easily stretching to six to twelve months. One of the reasons could be that the nerve cells in older patients get more easily overwhelmed by anesthetic drugs and take a much longer time to recover their preoperative function. There is also speculation that some of the connections between different parts of the brain that get disrupted by general anesthetics, may take longer to be restored in older brains or may not be restored completely leading to lingering aftereffects.

One way to lower the risk for Postoperative Delirium is to make sure the patients are well nourished and especially well hydrated before surgery. Chronic dehydration, due to an aging thirst center that doesn’t alert the older patients any more of a lack of water, is a common problem among older people and can on its own lead to mental confusion. A more surprising find was that family and friends can play an important role in preventing and minimizing Postoperative Delirium. Patients that are accompanied by relatives or friends or who receive visits from them postoperatively have lower rates of confusion and better outcomes overall than patients that are unaccompanied and don’t have visitors. How these social interactions help prevent and treat Postoperative Delirium is unclear, however, the benefits are so tangible that more and more hospitals encourage relatives to stay with older patients before and after general anesthesia.

* Note for Medical Scribe students: Please see definitions below.

© Peter Reuter 2015

Video links:

General anesthesia: https://www.youtube.com/watch?v=vRlk73BbQ8o

Delirium: https://www.youtube.com/watch?v=hwz9M2jZi_o

Definitions

Anesthesia: The word itself means lack of feeling or freedom from pain, but is generally used to describe a method that reduces pain and feeling in a certain area (local anesthesia), region of the body (regional anesthesia) or the body as whole (general anesthesia). It is based on the application of substances (anesthetics) that interfere with the transmission of signals in nerves to the central nervous system (brain and spinal cord). Because of the lack of sensation and numbing of pain doctors can operate on patients using one of those techniques.

Unconsciousness: A state during with a person is not consciously aware of stimuli from the environment or its own body and is unable to respond. It can be a reversible state, such as coma or general anesthesia, or a permanent stage with no recovery.

Cardiovascular System: Consists of the heart (cardio-) and blood vessels (vascular). Its task is to supply sufficient amounts of blood to any part of the body at any time and under any conditions. To do that it has to pump a sufficient amount of blood, which can be 4-5 times more under physical stress than at rest, while generating an adequate blood pressure to push the blood through 50,000 miles or more of blood vessels.

Respiratory system: Consists of upper and lower airways that transport air into and out of the lungs and the lungs where the exchange of oxygen (into the blood) and carbon dioxide (out of the blood) happens. The task of the respiratory system is to supply sufficient amounts of oxygen regardless of how much the body needs and to remove poisonous carbon dioxide from the blood.

Delirium: Also known as acute confusional state. A serious, but usually temporary and reversible, state of impaired brain function with confusion and sometimes hallucinations and hyperactivity. Can be seen I high fever, intoxication (chronic alcoholism often leads to delirium tremens), and other disorders.

Dementia: General term to describe a decline in mental abilities that is severe enough to effect daily life. Dementia is not a disease itself, but a symptom of other diseases and can also be considered part of a normal decline in higher age, which it is also often called senility. The most well known type of dementia is dementia caused by Alzheimer’s disease.

Heart bypass: Surgical procedure to bypass a blocked blood vessel (coronary artery) be connecting the area before the blockage and the area behind the blockage by inserting a healthy blood vessel (graft) from another area of the same patient. Originally the surgery required to stop the heart from beating during the procedure and surgeons had to use external pumps to keep blood flowing through the body. Nowadays the procedure is done on the beating heart.

Heart valve replacement: Heart valves regulate the flow of blood thought he heart, just like valves regulate the inflow and outflow of air and gasoline in car engines. Defective heart valve that either don’t open properly (stenosis) or fail to close completely (regurgitation) effect the flow of blood and put extra stress on the heart, which can lead to heart attacks and death in the long term. Heart valves can be replaced using mechanical valves, animal valves (pigs) or donated human valves.

Propofol: A short-acting anesthetic used to induce or maintain anesthesia. It became infamous when it was discovered that the late Michael Jackson had received propofol iv injections to combat his insomnia, which may have caused or contributed to his death.

 

Medical Administration Careers: Bacteria Are Your Best Friend. And a few definitions medical scribes and healthcare students should be aware of.

Peter Reuter, MD, PhD

It has been known for a long time that there are many bacteria that grow on the body membranes that cover our outer (skin) and inner body surfaces (mouth, gastrointestinal tract, vagina). Many of them will cause disease when they overgrow an area, while others will never harm us or can even help protect us from disease causing microbes (so-called pathogens). We knew that some pathogens could cause severe diseases when introduced into our gastrointestinal system, such as food poisoning. It has also been known for quite some time that some of these bacteria help us break down certain food we eat, which can be beneficial, but can also cause irritation and embarrassment (beans, beans the magic fruit…). However, there were also indications that at least some bacteria have an even greater and more beneficial influence on what is going on inside our body, such as strengthening our immune system.

Over the last 10 years or so our understanding of and appreciation for the bacterial garden, especially inside our mouth and the large intestine has grown tremendously. We now estimate that for each cell in our whole body we have 10 bacteria colonizing our large intestine. Researchers have found that there are many different bacteria that together form a so-called microbiome. Which bacteria are dominant in a person’s microbiome is of great importance for how their body processes food, how many calories we extract from the food we eat and how our body weight develops.

Over the last few decades almost all developed countries have experienced an ever-increasing weight problem. Although no one really knows what a “normal” weight is, long-term research has shown that overweight people are at a higher risk to develop certain diseases. The Body Mass Index (BMI) or Quetelet index is used to classify people based on body weight and height into normal body weight (BMI below 25), overweight (BMI between 25 and 30) and obese (BMI above 30). Even though those ranges aren’t a law of nature and may be changed depending on future research, we still know that the heavier people get the more likely they are to develop cardiovascular system diseases, diabetes mellitus type II, and osteoarthritis. Currently approximately 1/3 of Americans are of normal weight, 1/3 are overweight, and 1/3 are considered obese.

Because of the negative long-term effects for overweight and obese people themselves as well as the enormous financial burden treatment of their obesity-related diseases puts on society as a whole, there have been many attempts at educating people about the dangers of obesity and the benefits of weight loss. Still, the percentage of overweight and obese adult and children keeps rising steadily. Researchers looking into these issues kept coming across people who seemed to do everything right, they ate healthy food in recommended amounts and exercised, but couldn’t lose weight or even gained some more, whereas others seemed to do everything wrong, from eating too much unhealthy food to not exercising at all, and yet didn’t gain any weight. We couldn’t find any reason for this difference when we measured how much energy they burnt at rest (basal metabolic rate, BMR) or when active (total metabolic rate, TMR), which indicated that there had to be something to how these different people digested food and absorbed nutrients.

The first hints about the importance of our gut bacteria for our body weight came from twin studies. They showed that “lean” twins and “obese” twins had different bacterial floras. When they ate the same kind and amount of food the lean twins would stay lean, while the obese twins gained more weight.  We also saw the importance of a healthy microbiome when we looked at the reasons for severe bacterial infections of the large intestine caused by antibiotics given for the treatment of bacterial infections. One of the most surprising findings, however, was the importance of natural birth and breastfeeding on the long-term body weight of babies and children. Babies born via C section and babies raised on formula instead of breast milk have a much higher chance of becoming overweight or obese. Looking into this topic, we realized that babies pick up a healthy bacterial flora on their way through the birth canal of the mother. These bacteria colonize the skin, the mouth and the large intestine of the newborn and establish a healthy environment. Breastfeeding encourages further growth of this healthy microbiome. Babies delivered via C-section don’t pick up bacteria on their way out of the womb and babies fed on formula grow bacteria that breast-fed babies start growing once they transition to solid food. As their immune system had time to develop first they are more likely to being able to resist and suppress unhealthy microbes.

Based on these findings some researchers in Europe are experimenting with transferring healthy gut bacteria from lean patients to overweight patients to help them lose weight. Most doctors, however, want to wait and find out first which bacteria really are the good guys. In this way, we can isolate them and then introduce them into the body of overweight people. But, there are situations where a transfer of gut flora is a potentially life-saving procedure. Some patients on antibiotics or after gastroenteritis develop a Clostridium difficile infection in their bowels, which can cause vomiting, diarrhea and abdominal pain, and even be fatal in severe cases. One way to treat this disorder is to perform a fecal microbiota transplant – sometimes jokingly referred to as transpoosion. In this procedure a fecal sample of a healthy donor is introduced into the rectum of the patient. In a recently reported case from the United Kingdom a mother suffering from this condition was given a fecal transplant from her overweight daughter. The transplant did its job, the bowel infection healed, but the mother gained 36 lbs of weight over the next sixteen months going from a BMI of 26 (just above normal weight) to a BMI of 34.5, which is classified as obese, under the same diet as before.

There is still a lot to be learned about how bacteria influence our body as a whole and how we can use them to treat and prevent acute and chronic disorders. But, we can already say that bacteria, not dogs, should be considered men’s best friend.

© Peter Reuter 2015

Videos:

Bacteria: https://www.youtube.com/watch?v=qCn92mbWxd4

Body Mass Index: https://www.youtube.com/watch?v=1PyrXtYON1k

Definitions

Microbe: Microorganism that can cause disease or fermentation on carbohydrates

Pathogen: Also known as infectious agent. General term for anything that can cause disease in a human, animal or plant. Most often used for microorganisms, such as bacteria, viruses, fungi, and parasites.

Gastrointestinal system: Also known as digestive system. Organ system consisting of the gastrointestinal tract (mouth, gullet, stomach, small and large intestine) and accessory structures, such as teeth, tongue, salivary glands, liver, gallbladder and pancreas. It has to break down (digest) foodstuff and drinks to prepare nutrients, such as glucose, to be taken into our body.

Large intestine: Also known as large bowel and (mistakenly) colon. The last part of the digestive tract starts with the cecum, a blind-ending sack with a worm-like appendage called appendix vermiformis, and end with the anal canal. The longest part, the colon, starts at the right lower abdomen. It has four parts, ascending, transvers, descending, and sigmoid colon. The rectum, so called because it is straight, connects colon and anal canal. The colon isn’t important for nutrient uptake, apart from water and salt, which is why it is not essential to life and can be removed completely if needed.

Basal metabolic rate: The amount of energy expended by the body while at rest in a neutrally temperate environment. It is higher during childhood and teenage years and keeps declining throughout adulthood. Women have a fairly constant BMR between approx. 25 and 45, which makes it easier for them to keep their weight constant compared to men, who have a higher BMR during teenage years and early adulthood.

Total metabolic rate: The total amount of energy used by our body when we’re active. It depends on our basal metabolic rate (higher for men than women) and the level of physical activity, the more active we are the more energy we use and the more energy (calories) we can consume without gaining weight.

Bacterial flora: All the bacteria living in our digestive system form one big ecosystem. Depending on where we life, what we eat and drink and so on the composition of this flora changes. While most of the bacteria are harmless or beneficial for us, some of them can cause serious illness when they overgrow the others. Intestinal bacteria that find their way into the bladder or other parts of the urinary tract are by far (up to 90%) the most common cause of urinary tract infections (UTI).

Antibiotics: Substances that can fight and sometimes kill microorganisms, especially bacteria, that can cause diseases in human, animal, or plants.

C section: Also known as Caesarean section. A surgical intervention to deliver the baby through the wall of the abdomen and the womb (uterus). The surgeon has to cut through the abdominal wall and the wall of the womb to get access to the unborn baby. The surgeon has to work fast, because of the danger to mother and child, but also be careful not to cause harm to the baby when cutting through the womb.

Gastroenteritis: Originally to describe any inflammation (-it is) of the stomach (gaster) and guts (enteron) the term is now mostly used for any illness of the digestive tract that leads to diarrhea, nausea, vomiting, and/or crampy abdominal pain. Most cases are caused by viruses, such as an outbreak of Norwalk virus on cruise ships, or bacteria (classic food poisoning).

Clostridium difficile: Bacterium that lives in our intestines without causing any issue until it overgrows other bacteria, which is often caused by antibiotics therapy. Infection can cause severe gastroenteritis and death in rare cases. It is related to Clostridium botulinum, which produces a variety of toxins among them botox, which has found a lot of uses in medicine.

 

 

 

Medical Administration Careers: Why Should You Get Certified in a Medical Scribe Career? - Click here to add a Comment

You may have seen a person scribbling on an electronic notepad, while the doctor examines you (or your child) in an emergency room. Well … that was probably a medical scribe specialist, if you visited a doctor or medical facility with a busy practice.

Medical Scribe Specialists can be traced back to 1999 when they first started to work in emergency rooms. The scribe charter was recommended as a “highly effective practice for reducing emergency department … and improving patient satisfaction.” Essentially, the doctor can focus more on the patient and less time on administrative tasks–thanks to a well prepared medical scribe. And here is what the Advisory Board report says:  “Liberating physician time: The biggest opportunity to free physician time is through charting and documentation. A few hospitals are deploying specific ED personnel (`scribes’) to assume the majority of physician charting duties, freeing physicians of indirect patient care tasks.”

Medical Scribes usually become the right-hand of the M.D. or caregiver. What a great position to be in: helping caregivers be more effective and efficient as well as helping reduce the cost of healthcare.

Please tell us about your experiences in the health field.