NEWS BLOG
Medical Administration Careers: Medical Scribes Can Learn About Sepsis and SIRS by Watching Videos and Discussing Scenarios
Medical Scribes can learn medical terminology and familiarize themselves with medical procedures by watching videos and discussing scenarios like the one below.
By Walter Rodriguez, PhD and Valerie Weiss, MD
“Sepsis and SIRS are severe conditions that require interventions to counteract. If not treated properly, then multiple organ dysfunction syndrome (MODS) and death may occur.””
Lesson: What is Sepsis? Sepsis is the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound (Ref. https://vimeo.com/129916157). Check also: SIRS
Scenario
Pedro Ramirez is a 67-year old retired veteran who had a routine prostate biopsy in an outpatient hospital facility on Thursday. He was released in the late afternoon and went home with his wife, Gladys. Pedro had a heavy dinner and watched TV with Gladys in their family room. Pedro complained of feeling “crummy” but nothing that a little rest couldn’t fix. Gladys went to bed at 9:30 p.m. leaving him alone. When she awoke at 6:00 a.m. on Friday, and he wasn’t in bed beside her, she went downstairs and found him lying on the family room floor. He was extremely drowsy, shivering, and had urinated on himself.
Gladys called 911. The local EMS arrived and asked his wife what happened. She told them about the prostate biopsy, and that he was fine before she went to bed. She reported that Pedro had taken pre-operative antibiotics, but she didn’t know the name of the antibiotic or dosage. She wasn’t sure which medications he took regularly, as there were many bottles on his dresser.
“Post-operative infection is a broad term which applies to several types of infections a patient can experience as a consequence of undergoing surgery.””
Symptoms of Sepsis
Pedro was drifting in and out of consciousness and was only able to answer the question pertaining to his name. He was taken by ambulance to the local hospital (different than the hospital affiliated with the outpatient facility). The EMS professionals told Gladys to get dressed and meet them at the hospital. Once in the ER, the attending nurse tried to get some pertinent information from Pedro. Unfortunately, all he recalled was his biopsy. Pedro’s vital signs showed:
Temperature of 102.5 degrees F
Blood pressure 88/68 mmHg
Pulse of 122 beats per minute
Respiration rate of 32 breaths per minute
His blood pressure was dropping--he was going into shock.
Coordination of care
Gladys arrived and was told that her husband would be fine; she did not need to worry. However, she was unable to provide any more insight or a list of his meds. She did not know his baseline vital signs. It was Pedro’s first ER experience in this hospital so he had no prior records on file. The ER doctors determined he was in septic shock and once stabilized would be moved to a critical care unit for recovery. Once stabilized, Pedro was able to provide a list of his meds to the nurses. The hospitalist came to see Pedro who said he would contact his primary care physician (PCP) to provide an update. During the next two days (the weekend), numerous tests were administered to Pedro to test for the function of his heart, kidney, liver, etc.
The hospital staff was unable to gain his medical records from the outpatient facility where the prostate biopsy was performed because it was done in another hospital system. On Monday, they were considering a pacemaker because his heart rate was so low. Frustrated by all of the uncertainty, his wife Gladys called the PCP and asked why she wasn’t involved. Dr. de' Medicis, the PCP, said the hospitalist never notified her that her patient of 15 years was in the hospital. She also told Gladys that Pedro had a very low resting heart rate when well and that his current heart rate was normal! At that moment, Dr. de' Medecis (PCP) stepped in and coordinated Pedro’s care with the hospital.
Discussion Questions:
1. How would Electronic Medical Records (EMR) and Electronic Health Records (EHR) help in the above scenario?
2. How would a Medical Scribe assist the Hospitalist and/or the PCP in this scenario?
Medical Administration Careers: 15 Reasons Why Medical Scribes are Valued and Appreciated by Doctors
By Walter Rodriguez, PhD and Valerie Weiss, MD
More and more often, medical scribes are being recognized by physicians in all healthcare settings. Physicians are becoming more aware of the Medical Scribes' qualifications and how they can assist them in their medical practice.
Medical scribes allow for a dynamic conduit between a tangible record and a patient encounter, including the care provided. The role of the medical scribe is more than relevant because physicians are traditionally trained for direct patient care rather than for clerical work.
Below are fifteen (15) reasons why Medical Scribes are valued and appreciated by primary-care clinics, hospitals, healthcare administrators, physicians and specialists.
1. Medical scribes are able to navigate electronic medical records (EMR) with ease, while shadowing a physician. In this way, the physician can focus on the patient, rather than on a computer screen.
The scribe is able to record the physician’s interaction with the patient, including all of the following: physical exam findings, medical decision-making, laboratory results, radiological reports, clinical re-evaluations, consultations, and dispositions. Medical scribes are given unique logins and passwords.
2. Scribes are intimately familiar with HIPAA regulations. In this way, they can maintain the patient's privacy and the institution's security. The federal Health Insurance Portability and Accountability Act was passed in 1996 with a primary goal is "to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs."
3. Scribes understand the flow of information and the function of the various medical departments in a variety of healthcare settings. i.e., hospitals -- including ED (emergency department) or ER (emergency room).
Scribes are being employed in many arenas of the healthcare field including primary care clinics, hospitals -- including the ED (emergency department) or ER (emergency room), and urgent care centers.
4. Medical scribes understand basic medical terminology and can converse with other members of the medical staff--including hospital administrators, physicians, pharmacists, nurses, medical coders, and so on. If they work with a specialist, they quickly learn highly specialized terms.
5. Scribes become versed in general anatomy and physiology. In their formal certification training, medical scribes are introduced to all of the major organ systems of the body. They understand the "roadmap to the body" and how the organs function. This knowledge provides them with an appreciation of the human body and its complexity.
Many scribes use this knowledge and invaluable experience as a stepping-stone to further education and training in any health-related field.
For example, some medical scribes go on to study nursing or medicine. And some leverage their medical scribe's experience (shadowing the physician) in their application to medical school.
6. Medical Scribes fully understand the methodology of writing of the HPI (History of Present Illness). For instance, scribes are able to record a chronological description of the development of the patient's illness from the first sign and/or symptom or from the previous encounter to the present--including the following elements: location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms.
7. Scribes are aware of billing codes and principles as they pertain to the medical chart.
A well-written medical record will result in smoother claims processing and provides a medico-legal resource as to the care provided.
8. Medical Scribes are familiar with common medications and will become familiar with specialist's medications, as they go on rounds with physicians.
9. Scribes understand information systems technology, including flow and control of information as well as the technological platforms available.
“they allow for physician to leverage time and see more patients or spend more time with individual patient as less time is spent doing clerical work ... the record may actually be more complete with scribe completing and adding more text or completing ‘meaningful use’ boxes required by third part payers and therefore coding may be more consistent with submitted bill therefore shorter time for reimbursement by the insurance company because chart meets criteria for submitted bill ... lastly, data is better able to be mined and queries submitted which allows for greater chance of meeting quality metrics”
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10. Medical scribes communicate effectively and are able to use correct medical terminologies. They efficiently take medical notes and accurately record doctor’s patient interaction using electronic tools available.
11. Medical Scribes know the medical scribe tools and information systems available for improving efficiency and effectiveness and healthcare decision-making. They are able to recognize characteristics of various medical scribe systems. In addition, scribes can recognize benefits from various medical scribe systems and understand the cost and issues of various medical scribe systems.
12. Medical Scribes recognize the sources of system threats and ethical implications associated with patient information security and privacy issues, and explain how organizations can address these issues.
13. Scribes recognize network and mobile technologies used in medical practice as well as the issues associated with network and mobile technologies.
14. Medical Scribes can also describe the sources of information security and protection in medical information systems.
Medical scribes recognize the importance of an electronic health record that is connected to the Internet. Thus, they understand the vulnerability of the patient’s chart and the importance of preventing a breach in security.
15. Finally, scribes recognize or describe approaches and technologies that could be used by hospitals to meet the information privacy regulations and standards (technologies and employee training, etc.). They recognize information privacy regulations and standards with which health care facilities must comply. And, more importantly, they recognize the ethical implications of medical scribe information systems.
Medical Administration Careers: Herbal Remedies Making a Comeback and 12 Related Definitions for Medical Scribes
"In the case of malaria, reverse pharmacology pointed to the benefits of Mexican prickly poppy (Argemone Mexicana) for the treatment of milder cases of malaria"
By Peter Reuter, MD, PHD
For most of human history herbal medicines were the number one remedy used by people worldwide. All that gradually changed with the advent of chemistry and pharmacology. Instead of using herbal teas or pastes people started to use standardized drugs produced by pharmaceutical companies, prescribed by medical professionals, and dispensed by pharmacies. Many of these drugs were naturally occurring substances or derivates that had been used as part of herbal medicines for a long time. Aspirin or acetylsalicylic acid (ASA), for example, is a derivative of salicylate, which can be found in such plants as willow tree and myrtle. It was first mentioned as a remedy for pain, fever, and inflammation in an Egyptian papyrus more than 3500 years ago.
Scientists, especially ethnobotanists, went all over the planet in search of other substances from plants, fungi, and lichen that could be tested for their medicinal properties. Over time, however, chemists took over, and more and more pharmaceuticals were created in the lab. That made the process more controlled and made it easier for companies to claim patents on newly synthesized drugs. Yet, approximately 95% of tested components fail in clinical trials and for those few that pass the whole process from start to finish takes about 12 years and costs up to $800 million or more.
That kind of investment is significant for developed countries, but almost too much money for most developing countries, which explains why there are no new drugs coming out of developing countries. It also explains why there are only few and often no recently introduced drugs for rare disorders or disorders that mainly occur in poorer countries. Malaria is a typical example for that. Although there are an estimated 200 million cases of malaria every year and about half a million deaths related to malaria, there hasn’t been a new drug to treat malaria since artemisinin-based combination therapy (ACT) was introduced in the 1990s. One of the reasons for companies not investing into the development of new antimalarial drugs is that about 85% of all cases occur in Africa, where people can only afford to get the drug if governments or international non-governmental organizations (NGOs) subsidize the costs of treatment.
Starting in the mid 1990s, a new approach developed that looked into traditional herbal medicines and their efficacy in treating certain diseases. For example, researchers in India conducted a nationwide survey of Ayurvedic physicians to take inventory of herbs used to treat conditions such as arthritis, diabetes, and hepatitis. After they had identified certain herbs for treatment of arthritis they started observational studies in a clinical setting as well as animal studies. Because this approach reverses the order in which traditional pharmacology works, it is usually called reverse pharmacology.
In the case of malaria, reverse pharmacology pointed to the benefits of Mexican prickly poppy (Argemone Mexicana) for the treatment of milder cases of malaria. Although the poppy was native to Mexico, it somehow made its way to Africa sometime in the 1800s and soon became a part of herbal remedies. When researchers talked to traditional healers in Mali in West Africa they learned about the beneficial effect of Argemone tea on patients with mild malaria. That led to a first prospective study that compared using Argemone tea for half of the patients and a standard artemisinin-based combination therapy (ACT) for the other half. Surprisingly Argemone tea did almost as well as ACT therapy in patients with non-life threatening malaria, although it hadn’t been refined and patients just drank as much tea as they liked.
But, there are still a lot of scientists, especially in pharmacology, that are skeptical or outright opposed to this approach. They prefer to use well-defined compounds and point to the fact that herbal remedies often contain a mix of many active substances that may cancel each other out or cause uncontrollable side effects. Teas and infusions are almost impossible to standardize, which makes it difficult to give exact doses of active ingredients to the patients. They also point to unknown toxicities of plants or parts of plants. When we look at Mexican poppy, for example, then we find that the poppy seeds contain the poison sanguinarine, which was implicated in a mass poisoning of 3000 people in India in 1998 that lead to the death of 65 people. The leaves, however, are nonpoisonous and its tea is safe to consume.
Another success story for reverse pharmacology and herbal remedies is happening in the western Pacific. Palau is an island nation of more than 500 islands that is a paradise for scuba diving and snorkeling. However, Palau also has the seventh highest obesity rate on the planet and many inhabitants suffer from high blood pressure (hypertension) and diabetes. Instead of relying on the tried-and-true methods that failed to stop the obesity epidemic in western developed countries, doctors tried to find herbal remedies to help treat hypertension and diabetes. After analyzing traditional herbal medicines, they were able to draw up a list of herbs that showed potential. In the end two plants, Morinda citrifolica (a tree from the coffee family), and Phaleria nisidai, were associated with weight loss (M. citrifolica) and lowering of high blood pressure (P. nisidai).
Finding scientific proof that traditional herbal remedies are almost as good for the treatment of a variety of diseases as modern drugs while often having far fewer side effects is a boost to many who look for a more holistic approach to medicine. Many people in developed and developing countries are trying to live a more healthy life by eating local and often organic produce, by cutting down on animal protein, and by using traditional remedies when possible and available. The more their number grows, the more companies will try to cater to their needs and demands, and the more herbal remedies will be used to treat physical and mental health disorders.
© Peter Reuter 2015
Malaria video: https://www.youtube.com/watch?v=jayoAFAtGQY
Ayurvedic medicine video: https://www.youtube.com/watch?v=sDtIs8p0Uuc
Herbal Remedies Making a Comeback - Definitions
Pharmacology: The study of chemical and biological substances, their effects on living systems and their use to influence biological systems.
Derivative: In chemistry a substance that is based on or derived from another substance.
Aspirin: Also known as acetylsalicylic acid. A pain killer (analgesic) based on salicylic acid, which is found in the bark of willow trees. The bark has been used for at least 2500 years to treat pain, fever, and inflammation. The chemical compound was first created by German chemists in the mid-1800s and sold under the name aspirin by the pharmaceutical company Bayer starting in 1897. It is nowadays used to treat pain, fever, inflammatory diseases (e.g., rheumatic arthritis), and to prevent heart attacks and some forms of cancer.
Willow tree: Name for a subfamily of deciduous trees and shrub found in cold and temperate regions on the northern hemisphere. The bark of willow trees has been used for at least 2500 years to treat pain, fever, and inflammation
Artemisinin: A drug against malaria isolated from sweet wormwood (Artemisia annua). Artemisinin and its related substances are the most commonly used drug against uncomplicated cases of malaria caused by Plasmodium falciparum.
Arthritis: Inflammation of one or more joints leading to pain, swelling and stiffness. Acute forms of arthritis are usually caused by bacteria. Common chronic forms are osteoarthritis (wear-and-tear arthritis often caused by overloading the joint and overweight) and rheumatoid arthritis (an autoimmune disease in which the body attacks its own joints). The treatment depends on the underlying cause of the inflammation.
Diabetes: Also known as diabetes mellitus. Generic term for a group of diseases with abnormally high levels of glucose in the blood. In type 1 diabetes (10% of cases) the body doesn’t produce any insulin (the hormone that helps glucose enter the cells where it will be burnt to release its energy), whereas in type 2 (90% of cases) the cells don’t respond to insulin properly. High blood sugar levels cause a variety of complications such as glaucoma, cataract, skin ulcers, heart disease, high blood pressure, stroke and kidney failure to name just a few.
Hepatitis: Inflammation of the liver caused by a variety in causes, most commonly viruses (hepatitis A, B, C), chronic excessive alcohol intake, and prescription and recreational drugs. Acute hepatitis can be fatal, heal on its own or take a chronic turn. Chronic hepatitis is often subclinical in presentation with few or no symptoms at all, but more often than not leads to scar formation (fibrosis) or chronic liver failure (cirrhosis) that cannot be cured unless the patients receive a liver transplant. Chronic hepatitis also increases the risk for developing liver cancer.
Obesity: The Body Mass Index (BMI) is used to classify people based on body weight and height into underweight, (BMI below 20) normal body weight (BMI between 20 and 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 diseases of the cardiovascular system, diabetes mellitus type II, and osteoarthritis. Currently approximately 1/3 of Americans are of normal weight, 1/3 is overweight, and 1/3 is considered obese.
Hypertension: Also known as high blood pressure. A blood pressure of 140/90 or above at rest is considered as hypertension. There are some known risk factors that increase people’s chances of getting high blood pressure, such as obesity, too much salt in the body, smoking, and lack of exercise. However, 85% of all people with high blood pressure have no known risk factor or underlying cause and the disease cannot be cured only modified. High blood pressure doesn’t cause symptoms for most patients for many years, which explains why it goes often undiagnosed for a long time. Untreated high blood pressure can lead to heart attack, stroke, blindness, and kidney failure
Holistic medicine: A system of alternative healthcare that considers the whole person, body, mind, and spirit, instead of focusing on physical symptoms only. There is, however, no consensus what holistic medicine actually is and does. For some practitioners it is the combination of mainstream medicine with traditional medicine and herbal remedies, for others the focus is more on working with the mind, spirit and emotions of the patients.