AMA? Bad Idea, Sherlock!

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An online resource called Acronym Finder lists 123 meanings for AMA, and makes note that there are another 250 definitions in their Acronym Attic. Perhaps the most recognizable definitions are the American Music Awards, the Automobile Manufacturers Association, and the American Medical Association. Lesser known are the Academy of Magical Arts (sorry, Harry Potter), and the American Mule Association (nice site, lots of great mule photos).

Another lesser known definition of the acronym AMA is the term, Against Medical Advice. This definition applies specifically to the situation that arises when a patient decides to leave the hospital against the treating physician’s advice.

If the patient wants to go home, what’s the problem? It’s not a prison, after all. We see it on TV often enough. Last year, BBC’s Sherlock Holmes took off from his hospital room after being admitted with a gunshot wound to his chest. No one mentioned that he should have signed an AMA form before leaving. But maybe it’s different in London. We’re here in America. Besides, it was Benedict Cumberbatch, and he’s so loveable, we’d forgive him anything.

It turns out there are a number of potential problems related to patients who sign out AMA. Problems for the patient, the treating physician, and the hospital. For the patient who bolts before allowing a full evaluation of his or her care, the consequences can be dire. That nagging pain between the shoulder blades could develop several hours later into a full-blown and fatal heart attack. For the physician who signs out an angry and hostile patient without fully explaining the dangers in leaving without treatment, there may be a medical liability lawsuit on the horizon.

Doctors are cautioned to try every avenue to avoid the AMA discharge situation. If all else fails, the patient must be asked to sign the AMA form. Even then, there have been many cases where plaintiffs successfully sued hospitals and doctors following AMA discharges.

If you are the patient, it would be wise to consider your treating physician’s advice, even if you’re either angry enough or fearful enough to want to escape from your hospital room to the imagined safety of home and hearth. Patients who leave AMA have a four times higher rate of readmission within thirty days than other patients. Often they are in far worse shape than they were on that initial admission. So remember that exitichecked_out_300 (1)ng your hospital AMA could be the worst decision you ever make—in spite of what you’ve seen the hero do on your favorite TV show. (We know it wasn’t your idea, Sherlock. The writers made you do it.)

In CHECKED OUT, rodeo cowboy Cody O’Brien suffers the fatal consequences of leaving Timbergate Medical Center against medical advice. Published by Camel Press, this second book in the Aimee Machado Mystery Series was released October 1, 2015. It can be purchased online in paperback and as an eBook through Amazon.com via this link:  http://tinyurl.com/oglp496  Checked Out is also available online from Barnes and Noble, or by order at your local bookstore.

 

 

What is a Medical Staff?

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119543789489042057caduceus_ryland_sanders_01.svg.thumbNot a question that comes up often in conversation, but when it does, many people will envision the caduceus, a staff associated with the messenger god, Hermes, in Greek mythology. With two wings at the top and entwined with two snakes, it is often mistakenly assumed to be a symbol of healing. In fact, Hermes, known as the  god of commerce, moved between the world of man and the world of gods, acting as a messenger and the link between mortals and the Olympians.

Sodownloadme may be familiar with the more correct, but lesser-known symbol, the Rod of Asclepius, which is entwined with a single serpent and wielded by the Greek god, Asclepius, a deity associated with healing and medicine. In spite of the symbols carried by these gods, there is a more down-to-earth meaning to the term medical staff.

When a health crisis occurs, most patients put their lives in the hands of the doctors in the nearest hospital. They do so in good faith, without knowing what goes on behind the scenes in order to protect them from unqualified medical practitioners.

If you’ve ever been a patient in a hospital, you were probably admitted by your primary care physician. And that’s where the hospital’s medical staff comes in.

Hospital-based television shows are unlikely to demonstrate the rigorous process your doctor went through to earn the privilege of admitting you to a specific hospital. It would not pass as entertainment.

The process began when your physician was required to provide proof of medical education and training as well as letters of reference from any former hospital where he or she possessed privileges. A credentialing committee then scrutinized the request for membership and privileges and verified the physician’s credentials. Once privileges were granted, the physician spent a period of time being monitored by a senior member of the medical staff. And that’s just the beginning.

To remain on the medical staff, your doctor must regularly fulfill continuing education requirements by attending pertinent educational programs. To retain treatment privileges, he or she must serve on medical staff committees and must attend mandatory medical staff department meetings. On top of that, all physicians who are granted medical staff membership must abide by the medical staff bylaws and are subject to having the quality of their patient care scrutinized by their peers.

The next time you’re in a hospital, either as a patient or a visitor, rest assured that hospital’s medical staff organization is working in the background. Let the television version of hospital life entertain you, but be grateful for real life, where the less entertaining work of upholding the quality of the medical staff goes on, ensuring that you and your loved ones are in good hands.

checked_out_300 (1)CHECKED OUT, book two of the Aimee Machado Mystery series, will be released October 1, 2015. Available for pre-order now, it introduces Aimee’s colleague Cleo Cominoli, Director of Medical Staff Services at Timbergate Medical Center. When Cleo becomes suspicious of a controversial and potentially dangerous woman surgeon on the medical staff, she enlists Aimee’s help and the excitement begins.

Discovering the Azores

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When I bring up the subject of the Azores Islands in conversations about vacation destinations, most people I know respond with a blank look. They may have heard of the archipelago, but in most cases, have no idea where the islands are located.

Manadas shoreline

That response changes when conversing with someone of Portuguese descent. Portuguese Americans whose great- or great-great-grandparents emigrated from the Azores know exactly where the islands are. They’re situated in the Atlantic Ocean, approximately 900 miles off the coast of Portugal, somewhere in the vicinity of the fabled lost city of Atlantis. More than one theorist has explored the possibility that the Azores Islands are the remnants of Atlantis. But that’s another story.

In contrast to today’s typical island tourist traps, the Azores are relatively untouched by commercialism and have retained their charm. Tourists are welcome and find it very easy to enjoy the many lovely features of these islands. A four hour flight from Boston brings visitors to a refreshing world of islands with diverse vacation pastimes. Hiking, swimming, sailing, whale watching, or simply lying on a pristine beach under a Mediterranean sky.

Hydrangea Hedges

The visual feast alone is worth the trip. Green hills bordered by giant hydrangea hedges, rocky slopes dropping to a shoreline dotted by rustic villages untouched by time. Harbors filled with yachts making this ideal pit stop on their way to or from faraway destinations.Horta Marina

The gustatory feast is one to be savored and remembered long after the experience. The subtle green wine and the cheeses made from the truly happiest cows on earth would be enough to sustain most travelers. But that’s just the beginning. There is nothing as delightful as Portuguese cuisine. Fresh-baked breads, chicken prepared in succulent recipes, myriad seafood dishes, of course, and roast beef flavored with secrets handed down for who knows how many generations? Perhaps from the inhabitants of Atlantis.Atlantis

For folks who dream of finding that mythical location, the Azores Islands might be the next best thing.

The Aimee Machado Mysteries feature a protagonist whose parents have retired and moved to the island if Faial in the Azores. They are very happy with their new life. So far, they are unaware of Aimee’s tendency to get caught up in solving murders that involve her job as a hospital librarian in northern California.

Many websites feature visits to the Azores. One good example is www.visitazores.com.

A Vacation Getaway

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Have you ever longed for a few days without computers, television, do-everything phones and devices? It seems ironic that most luxury getaways offer to keep us plugged in and turned on, even when we’re paying a bundle to get away from life’s constant demands on our time and attention.

What could be a greater luxury than to disconnect from the cyber world and reconnect with the natural world we’ve nearly forgotten? Thanks to our country’s protected mountain wilderness areas, it’s still possible to get back to basics—and to remember that we were once, not so long ago, creatures of the earth who used more parts of our bodies than just our thumbs.

Travel Arrangements:

My favorite luxury getaway is one where the only sound of civilization is the distant murmur of a commercial jetliner passing overhead. And speaking of travel, the mode of transportation in the wilderness is as basic as it gets. It’s called walking, and requires nothing more than a well-fitting pair of boots and proper socks designed for hiking. The movie Wild, starring Reese Witherspoon, does a great job of demonstrating the problems encountered with incorrect footwear.

Hiking accessories can be minimal, with everything necessary fitting in a backpack. Smoke packingAgain, Witherspoon’s character went far overboard with her pack. With the load she carried, she should have taken along a llama or two.

A few words about llamas: they are great pack animals, but only if the hikers are proficient llama packers. I have it on good authority that hikers with no llama handling experience should not try to rent these extraordinary animals for packing. According to my source, who has seen it happen, it can turn into a “horror show.”

Accommodations:

TentBe cautioned that there will be no maid service. Wilderness hiking requires that visitors leave their accommodations as pristine as if they were never there. Nothing is more disheartening than arriving at a campsite and seeing empty beer cans and cigarette packs scattered on the ground. Fire rings should be dismantled, and broken fishing line, particularly dangerous to wildlife, should be packed out along with all other trash.

Pets:

Dogs may be allowed on your trip, but check ahead to be sure. Outdoor outfitters sell doggy backpacks, so Rover can carry his own food, water, and bedroll. If your dog does come along, check leash requirements. Owners who do not respect these rules may be subjecting their animals to a heap of trouble. Dogs who spook passing llamas or horses on the trail could end up the victim of a vicious kick severe enough to spoil the outing.

Entertainment:

All in all, the preparation involved in wilderness hiking is well worthLake it when the destination is reached. There’s a special joy in sitting on a fallen log after a dinner of fresh trout, sipping hot cocoa while watching moonlight rippling on a clear mountain lake. No TV, no Internet, just human to human communication around a glowing campfire. Ahh . . . time to book a trip.

For information on wilderness hiking throughout the U.S. contact: http ://www.fs.fed .us /organization/506

Checked Out, the second book in the Aimee Machado Mystery series, finds Aimee and Nick llama packing in the northern California wilderness to track down a witness to murder. Due for release in October, 2015.

That Very Scary First Haircut

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We’ve all heard stories about the little boy who cries all the way through his first haircut. Our three-year-old was no exception . . . except he’s a llama.

Before we bought Quartz, he had never been introduced to electric shears. Now he was confronted with a big, strong stranger with a mysterious tool that made a very scary noise. The poor llama obviously believed he was about to be killed.

Shearing is important where we live. Our summer heat is not something you want to endure while wearing a thick wool coat. The heat came early this year, and the man who shears our animals had a long list of customers ahead of us. When he called to say he was available, we said, “Come on over.” The job needed to be done, in spite of our doubts about how our new boy would handle his first haircut.

DSC_1058

So what did our three-year-old do? He cried. He spit. He cried some more. Our shearer finally decided to put a blindfold over the llama’s eyes, hoping that would calm him. It did help, and when the job was done, Quartz was much cooler and far more comfortable. Except for the aftertaste of spit that kept him drooling for half an hour.

DSC_1062Smoke, our older, more experienced llama,had been standing by watching the drama of the first haircut unfold. Hard to know what he was thinking. Some people don’t believe animals think, but I disagree. In any case, when Smoke’s turn came, he knew the ropes, both literally and figuratively, and maintained his dignity throughout his own wool removal.

People always ask if we use the wool, or if we sell it. We don’t. Our llamas are used as pack animals. It is the smaller alpaca that is often raised for wool. A good explanation of the differences between llamas and alpacas can be found at http://www.mountairyalpacas.com/llama.html