Monthly Archives: May 2017

What Sets Correctional Medicine Apart

Correctional medicine staff provide medically necessary care to some of America’s nearly 2 million incarcerated people. This non-traditional health care environment has unique challenges that teach important lessons

The Patients Don’t Leave, So You Improve Communication Skills  
In traditional health care environments, patients and providers fire each other. Firings can happen for a number of reasons.  Maybe the patient disagrees with the provider’s recommendations.  Or perhaps the patient violated a care plan, and the provider announces that the patient needs to seek care elsewhere.  Regardless of the reason, patients in the outside world can often find new providers. In correctional medicine, patients are not free to seek care elsewhere.
Patients and providers will continue to disagree.  In correctional medicine settings, both parties need to find a way to move past it.  Providers will need to maintain boundaries while providing medically necessary care.  These are difficult conversations with a variety of factors to consider.  Yet these discussions will teach (and solidify) valuable de-escalation skills.

All the Patients Know Each Other, So You Practice Fairness  
In traditional health care environments, patients do not know each other.  There is no opportunity for patients to discuss their clinical experiences.  In correctional medicine, all patients share the same providers.  Given that, there is a much greater opportunity for patients to discuss their clinical experiences with each other.  Any provider that is perceived as doing a favor for one patient will be asked to do the same for others.  Correctional medicine providers need to ensure that they are treating all of their patients similarly.
Providers in correctional medicine have the chance to provide medical care to their patients without considering the person’s financial status (or their ability to pay.)  The opportunity to provide fair care is unique to correctional medicine because providers in traditional health care environments consider the impact and the importance of insurance payments dramatically.

Your Patients Are Always Around, So You Can Witness Daily Life and Disease Progression
A fascinating part of medicine is watching a patient’s daily life, and how their disease progresses. Often, health care providers in traditional settings only get to see snapshots of the patient’s progression.  So they mark the changes between today and the patient’s last appointment.  Although providers can surmise about what the patient experienced between appointments—they don’t know for sure.
Correctional medicine providers do not have to surmise.  Instead they get to witness aspects of their patients in daily life.  A few providers note that the correctional medicine environment gives them much more exposure to witness disease progression than they did in traditional settings.

 
Working in correctional medicine has a unique set of challenges and learning opportunities.  Correctional medicine may not be the right fit for everybody.


Correctional Facility Nursing. Minority Nurse, 7 February 2016, http://minoritynurse.com/correctional-facility-nursing. Accessed February 9, 2017.
Correctional medicine. Wikipedia, 2 June 2016, https://en.wikipedia.org/wiki/Correctional_medicine. Accessed February 7, 2017.
Giang, Vivian. Jailhouse Doctor Shares What It’s Like To Care For The Most Dangerous People In the World. Business Insider, 20 March 2013, http://www.businessinsider.com/what-its-like-to-be-a-doctor-in-prison-2013-3. Accessed January 31, 2017.
Keller, Jeffrey. Correctional Medicine is Different: Our Patients Don’t Go Home! JailMedicine.com, http://www.jailmedicine.com/correctional-medicine-is-different-our-patients-dont-go-home/#more-2985. Accessed February 7, 2017.
Keller, Jeffrey.  Correctional Medicine: The Principles of Fairness.  JailMedicine.com, http://www.jailmedicine.com/correctional-medicine-the-principle-of-fairness/.  Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: All Clinical Encounters are Discussed in the Dorm. JailMedicine.com, http://www.jailmedicine.com/correctional-medicine-is-different-all-clinical-encounters-are-discussed-in-the-dorm/. Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: We Can’t Fire Our Patients-and They Can’t Fire Us! JailMedicine.com, http://www.jailmedicine.com/correctional-medicine-is-different-we-cant-fire-our-patients-and-they-cant-fire-us/. Accessed February 7, 2017.

Introduction to the Everett Clinic

Everett Clinic was founded when four local physicians partnered together following World War I.  Atthe time, the city of Everett was thriving.  Lumber was a huge industry and many migrated to the city looking for jobs in the mills.  When the Great Depression hit a few years later, the clinic survived because they provided medical care to mill employees.  The four founders, Drs. Samuel Caldbick, Harry Secoy, Arthur Gunderson, and Leo Trask, created a healthcare organization that continues to serve patients in the Everett and larger Snohomish County communities.

The Everett ClinicToday’s Everett Clinic
As time went on, the organization gradually grew.  Each new location meant that more providers and medical specialties were added into the organization.   Today’s Everett Clinic has 28 locations serving Snohomish County communities.  There are primary care services offered for patients of all ages.  Specialty care services include physical therapy, pain care, surgery, obstetrics, and many more.
In 2016, the organization passed two milestones.  It opened its first clinic outside of Snohomish County—in Shoreline.  Second, the Everett Clinic merged with DaVita Healthcare Partners, a Fortune 500 company that shares similar core values.

Organizational Values
The Everett Clinic provides value to their patients by prioritizing service, quality, and cost. Simply, this means that the organization recognizes that patients need treatment plans that meet their personal goals.  Throughout the organization, Everett Clinic providers provide high-quality care while also working with patients to determine the best care plan for the individual.
The organizational values translate to how the organization cares for their employees.  The Everett Clinic provides medical, dental, and vision insurance to eligible employees.  There is also paid time off, disability insurance, life insurance, tuition reimbursement, 401(k) plans and more.  The organization shares similar goals with its new partner after their 2016 merger.  DaVita Healthcare Partners has the core values of service, integrity, team, continuous improvement, accountability, fulfillment and fun.  In 2011 the Everett Clinic was recognized nationally as one of the best places to work.  In 2013, it was named as the fifth largest private employer in Snohomish County.

The Everett Clinic has provided important medical care to Snohomish County residents since 1924. Although the scope of the organization’s offerings has expanded, it is still driven by the same values that its four founders held.  Provide high-quality care to patients that helps the patient reach their personal health goals.  With 28 clinic locations sprinkled throughout Snohomish County, the Everett Clinic is an important part of the healthcare landscape in western Washington.


About DaVita Inc. Davita: Bringing Quality to Life.  https://www.davita.com/about.  Accessed February 21, 2017.
Benefits: For the Whole You. The Everett Clinic, http://www.everettclinic.com/work-everett-clinic/benefits-whole-you. Accessed February 22, 2017.
Everett, Washington. Wikipedia, 20 February 2017, https://en.wikipedia.org/wiki/Everett,_Washington. Accessed February 21, 2017.
Maps and Directions. The Everett Clinic, http://www.everettclinic.com/find-us. Accessed February 21, 2017.
More than 90 Years of Excellence. The Everett Clinic, http://www.everettclinic.com/about-us/more-90-years-excellence. Accessed February 21, 2017.
Our Core Values. The Everett Clinic,  http://www.everettclinic.com/about-us/our-core-values. Accessed February 21, 2017.
Snohomish County. Wikipedia, 2 February 2017, https://en.wikipedia.org/wiki/Snohomish_County%2C_Washington. Accessed February 21, 2017.

What is a Medical Assistant?

Throughout the healthcare industry, staff and providers rely on medical assistants for their versatile knowledge and skills.  Found in both inpatient and outpatient settings, medical assistants support patient care clinically and administratively.

Medical AssistantWhat is the role of a Medical Assistant?
Medical assistants are an important part of the healthcare team.  They work closely with providers to complete assigned patient care tasks, and responsibilities vary depending on organizational needs.  In smaller healthcare offices, medical assistants schedule patient appointments, coordinate referrals, obtain insurance authorizations, room patients, request medical records, and assist in recording patient information into charts.  In larger organizations, medical assistants may have a more narrow scope of responsibilities.  Specialized clinics may require that a staff member focuses on a specific skill set.

Medical assistants work in a fluid environment, and staff must quickly adapt to changing needs. Even if there are multiple medical assistants, they may have separate responsibilities. Some staff may be expected to master a complex set of circumstances—like working on a procedure team.  Other staff may be responsible for making sure that patients are promptly roomed and paperwork is completed.  All medical assistants are available to assist patients by answering questions and solving problems.

Generally, medical assistants can room patients, take vital signs, record patient history, prepare samples for the lab, and record medical information into charts.  As appropriate, medical assistants also help physicians with appointments.  These staff members are also usually responsible for communicating updates after the patient has been roomed.

What are the Washington State Requirements?
Medical assistants in Washington must be licensed through the Washington State Department of Health. To be eligible for licensure, applicants need to complete a medical assistant training program.  Candidates should have completed a program that is offered or accredited by the Accrediting Bureau of Health Education Schools (ABHES) or the Commission on Accreditation of Allied Health Education Programs (CAAHEP.)  Programs with local or regional accreditations can be counted as long as the accrediting organization is recognized by the U.S. Department of Education.  Candidates can also be eligible if they have completed an apprenticeship program administered by the state.
Candidates who have completed an appropriate program are eligible to sit for one of four certifying exams.

  • Certified Medical Assistant Exam through the American Association of Medical Assistants
  • Registered Medical Assistant Exam through American Medical Technologists
  • Clinical Medical Assistant Exam through National Health Career Association
  • National Certified Medical Assistant Exam through the National Center for Competency Testing

Additionally, candidates must also have completed high school, have proficiency in English, and complete HIV/AIDS training. Candidates must submit all required materials for review by the Washington State Department of Health.  After review, the department will follow up with the candidate about the status of their application.


Resources
How to Become a Medical Assistant. United States Department of Labor: Bureau of Labor Statistics: Occupational Outlook Handbook, 17 December 2015, https://www.bls.gov/ooh/healthcare/medical-assistants.htm.  Accessed February 27, 2017.
Medical Assistants. United States Department of Labor: Bureau of Labor Statistics: Occupational Outlook Handbook, 17 December 2015, https://www.bls.gov/ooh/healthcare/medical-assistants.htm.  Accessed February 27, 2017.
Medical Assistant—Certified or Interim Certification Requirements. Washington State Department of Health, http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/MedicalAssistant/LicenseRequirements/CertifiedorInterim. Accessed February 27, 2017.

A Brief History of the Opioid Epidemic

America’s relationship with opioid medications has grown and changed over the past 100 years. Today, the medications are connected to a national public health epidemic.  The statistics are alarming, and getting worse.  Since the situation is complicated, everyone—from providers to patients to politicians—needs to be part of the solution.

Definition
Opioids include opium derived drugs (i.e. morphine and heroin) and synthetic drugs (i.e. hydrocodone, oxycodone, and fentanyl.)

A Brief History
Use of opioid medications began before the Civil War.  In 1898, Bayer Pharmaceuticals introduced heroin into the commercial marketplace. Opioid medications (including heroin) were widely available to treat a variety of conditions for the next twenty years.  During the 1920s, doctors recognized the addictive nature of these medications.  Heroin was outlawed in 1924.
For the next 50 years, doctors avoided prescribing opioid medications to minimize the risks of addiction. Popular belief began to change in the 1970s.  A few studies came out that questioned the widespread beliefs about the true addictive risks of opioid medications.  Over the next 30 years, three new opioid medications came out.
Percocet, Vicodin, and OxyContin brought the debate around opioid medications back into the forefront.  During the 1990s, doctors wrote millions of additional prescriptions for opioid medications annually.  Year over year, the total numbers increased throughout the decade.  Although as availability increased, more people became addicted or accidentally overdosed.  Once again, people began to question the safety of these medications.
Today, steps are being taken at local, state, and federal levels to combat the overuse of opioid medications and heroin.  Although illegal, heroin plays a role in the epidemic. Due to increasing restrictions on prescriptions, some patients find it easier to use heroin instead.  The opioid epidemic is a complex problem that needs a comprehensive approach to begin to reverse it.

Current Statistics

  • According to the American Public Health Association, prescription drug abuse has been the top public health concern since 1999.  Since that point, the rate has doubled in 29 states, tripled in 10 states, and quadrupled in 4 states.
  • Someone dies every 19 minutes from an unintentional overdose.
  • Drug overdoses are part of the reason that American life expectancy has declined.
  • In 2015, more than 52,000 people died from drug overdoses.  Two thirds were linked to opioids.
  • Deaths from drug overdoses are still on the rise.

According to the Department of Health and Human Services, 20 billion dollars is spent on emergency department and inpatient care for opioid poisonings.  Health and social costs related to prescription opioid abuse are closer to 55 billion dollars.



Health Crisis. Wikipedia, 17 April 2017, https://en.wikipedia.org/wiki/Health_crisis. Accessed April 25, 2017.
Lopez, German and Sarah Frostman. How The Opioid Epidemic Became America’s Worst Drug Crisis Ever, in 15 Maps And Charts. Vox. 29 March 2017. http://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts. Accessed April 25, 2017.
Meldrum, Marcia. The Ongoing Opioid Prescription Epidemic: Historical Context. American Journal of Public Health, 2016 August, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940677/. Accessed April 25, 2017.
Moghe, Sonia. Opioid History: From ‘Wonder Drug’ To Abuse Epidemic. CNN, 14 October 2016, http://www.cnn.com/2016/05/12/health/opioid-addiction-history/. Accessed April 25, 2017
Opioid. Wikipedia, 2 April 2017, https://en.wikipedia.org/wiki/Opioid. Accessed April 25, 2017.
Opioids: The Prescription Drug & Heroin Overdose Epidemic.  United States Department of Health and Human Services, 24 March 2016, https://www.hhs.gov/opioids/. Accessed April 25, 2017
Opioid Overdose. United States Centers for Disease Control and Prevention, 16 December 2016.  https://www.cdc.gov/drugoverdose/data/overdose.html. Accessed April 25, 2017.
The Opioid Epidemic By the Numbers.  United States Department of Health and Human Services, June 2016, https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf  Accessed April 25, 2017
Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medication.  American Public Health Association, 3 November 2015, https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/12/08/15/11/prevention-and-intervention-strategies-to-decrease-misuse-of-prescription-pain-medication. Accessed April 25, 2016.
Understanding the Epidemic. United States Center for Disease Control, 16 December 2016, https://www.cdc.gov/drugoverdose/epidemic/index.html.  Accessed April 25, 2017
Inside a Killer Drug Epidemic: A Look at America’s Opioid Crisis. New York Times, 6 January 2017, https://www.nytimes.com/2017/01/06/us/opioid-crisis-epidemic.html?_r=0. Accessed April 16, 2017.
Opioid Epidemic. Wikipedia, 13 April 2017, https://en.wikipedia.org/wiki/Opioid_epidemic. Accessed April 16, 2017.

http://adai.uw.edu/pubs/pdf/2015drugusetrends.pdf

How To Respond To 2 Common Patient Fears

While it may not be visible, nervous patients walk into healthcare organizations every day.  Although each patient is unique, most share two common fears. First, they fear that they won’t be listened to.  Second, they fear that their care will be too expensive.  Here are some ideas about how to respond to these two widespread patient fears.   Community Health Doctor
No one will listen to me
There are two popular views of doctors.  Some patients consider doctors as trusted partners in their medical care.  Others feel like the doctors will judge them.  Regardless of a person’s specific beliefs, patients and providers can work collaboratively to ensure that the appointment goes smoothly.
Steps For Patients: Prior to the appointment, write down your concerns.  Practice explaining these concerns in the simplest way possible. When patients complete these steps, they often feel more confident—and prepared—during the appointment.
Steps For Providers: During the appointment, remember that everyone communicates differently. Ask questions and listen to answers. Summarize what the patient said, and repeat it back to them.  When possible, allow the patient to finish answering before asking another question.
I won’t be able to afford it
High medical bills are a barrier to care for many people.  Finances impact each patient differently, and clinics should have a variety of resources to help.
Steps For Patients:  If possible, enroll in health insurance.  Once enrolled, read plan documents carefully.  Learn what your insurance policy includes and excludes.  Note any additional requirements (like prior authorization) to ensure coverage. Often, patients with active health insurance have an easier time establishing care with providers.
If unable to enroll in health insurance, you should begin researching.  Ask your providers if they offer financial assistance programs or discounts for cash payments.  If the clinic does not offer it, consider calling other local healthcare organizations to ask the same question.  Healthcare social workers also may be able to connect you with community resources to further assist you.
Steps For Providers:  Clinics should always be transparent about their financial policies and resources.  Offer copies of these policies to patients.  Train staff to explain the organizational billing system in an understandable manner. Implement tools that estimate the costs of office visits or medical procedures.  When possible, offer alternatives to the recommended treatment plan—particularly when there are concerns about if the patient’s insurance will cover it.