Emergency Care and Treatment Form Template

Edit: This story about Aetna being successfully sued for 25M USD only happens in America and is, in my view the main argument why being scared of “single payer systems” is ill advised.Lets start by making sure we have the same understanding of things:Single payer = where one entity (usually a government entity) uses a pool of funds paid into by the whole community/country to pay the health care providers (doctors/nurses/pharma) for the services they provide to the community.Socialism = a political and economic theory of social organization which advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole.Socialist country = as defined above would be countries like Mainland China, the former soviet union, cuba, vietnam, depending on how you look at it North Korea…Socialism (bis): Often used by political parties who propose a society where the richer pay a larger tax in order to support infrastructure and policies that also support the lower income portion of the population.Although to a lesser extent than most advanced nations, the US is a Socialist(bis) nation. Less so than most countries in Europe, but you do have medicaid and host of services offered by the government.My first question to you is which of the two definitions are you using?For the sake of the argument I am going to assume you are using definition (bis) which includes countries like Denmark, Finland, Australia, Japan, France, Italy, Germany, Netherlands, Belgium, Greece, Canada.Within Single Payer there are many ways to do it and two levels:Reference: List of countries with universal health care - WikipediaFree Health care: Free health care refers to a publicly funded health care that provides primary services free of charge or a nominal fee to all its citizens, with no exclusions based on income or wealth.[3]Universal Health Care: Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, usually refers to a health care system that provides healthcare and financial protection to more than 90% of the citizens of a particular country.[4]There are 118 countries who provide both Free and universal health care.These include: All of the countries I listed above as examples of “socialist (Bis)” countries, as well as other countries such as Vanuatu, Palau, Uruguay, Chile etc etc.There are 43 countries that provide neither of these. ie if you are sick you are on your own or at the mercy of the free market.These include Iran, Iraq, China (a socialist country in the real sense of the word), Turkmenistan etc … with two exceptions, all poor countries who are behind in their development. Exception 1 is China…(although one can debate as to exactly how advanced it is). Exception 2 is the United States of America.So only 25% of countries provide neither universal nor free healthcare… And with the exception of the US, they are all poor countries (if one thinks a majority of Chinese people are still in poverty)Over 50% of countries provide both. Do you see mass demonstrations in the news about health care being bad in 50% of the world?The fact that 50% of the world (including a large number of democracies) are voting for policies and to keep single payer systems alone is an indication. Now please go on the net, and do some research, and tell me what percentage of the world outside of the US is looking at the US health care system and saying “maybe we should do like them”… (ie the perception the US system is better than the one they have now). While you will for sure find many many pages about how they wish their system to be improved, I challenge you to find information on a country in which people are voting for law makers who propose to change to the “multi payer “ system the US has… In fact I challenge you to find a law maker outside of the US who is even suggesting (never mind pushing for policy) their country should move from single payer to multi payer. Does that tell you anything? Do you think their might be a reason for that?Now lets look at the results. The point of the health care system is to keep you alive and healthy so lets look at track records:I don’t know about you but I think children are important. So what is better to help children: Single payer or not? According to your logic (ie single payer is bad), countries with single payer should have a higher mortality rate and those without should have a lower mortality rate for children. Here is how the CDC (US organisation) ranks infant mortality rates in the world: US… 27!!!!! BEHIND Poland Hungary and Slovakia, all of which are signNowly less wealthy countries than the US. Please also note that EVERY SINGLE country ranked above the US on that list has both free and universal health care / single payer. (https://www.cdc.gov/nchs/data/nv...)But maybe infants/children are not important to you. Lets look at life expectancy:The US is 31 !!… behind countries like Slovenia, Chile and Costa Rica… not exactly known for being paradise of wealth and health on earth (with all due respect to these countries which I happen to like)List of countries by life expectancy - WikipediaMaybe you say, I’m not interested in living long. OK lets go to how does the World Health Organisation rank national health care systems ? Keep in mind the WHO (as it is known) incurs strong influence from he US.US Ranking : 37… BEHIND Morocco (Single Payer, Universal) and Colombia (Single Payer, Universal and Free)!!!World Health Organization's Ranking of the World's Health SystemsI challenge you to find one … 1… one ranking where the US health care system (or lack therein of) comes in the top 10 for positive outcomes for the population at large.So, I’m sorry but what is scaring you exactly?Please tell us so we can look at it.Thank youEdit: Let me add the economic side to it.“The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person”Health Costs: How the U.S. Compares With Other CountriesSo look at this way: not only is multi payer system inferior to single payer at keeping you alive longer and keeping children healthy and alive longer, it also costs about TWO TIMES MORE per person than Switzerland (ranked 20) , Netherlands (ranked 17) and Norway (ranked 11). Which implies the top ten countries pay less than half what the US pays per person to be in top 10 except the US is 37 out of 200 countries…So lets put it this way: Your multi payer health care system actually performs in such a way you spend twice as much as #11,17,and 20, and nearly 3 times over the global average to make it to #37 BEHIND THIRD WORLD COUNTRIES, as shown by the infant mortality rate and life expectancy rate. Think about it this way: if you spent the same as the rest of the world, you would be #80 something…with every one of these countries having single payer…. And by the way, in the case of Single payer, when we say “costing them”, the government pays, so people are not going bankrupt because of health issues. In your case, it is YOU… paying and when you have cancer, diabetes, or some form of heart disease, it is you who will be paying much MORE than 8,000 dollars, where a single payer patient would be paying probably around $500 if you average out across the different systems (ie, the govt pays most of the bill and the individual is left with 10~30% depending on which country it is, a bit like a deductible if you like)…. So not only do you not seem to like to live long, and not seem to think it is important to give your kids the medical care they need to prevent them from dying at a higher rate, you also seem to like paying 12 times (when comparing what is paid by the patient) more for the privilege of not getting what people in other countries do get. So you are terrified of what?EDIT: This is one of many perfect examples of why single payer works much better:Girl has words for Aetna after brain surgery deniedThis ONLY happens in the US on a very very REGULAR basis. I might add when I was living in the US, my insurance denied a trip to the hospital for my then wife who was complaining about acute stomach pain. “wait till tomorrow” they said We went anyway. She was operated on immediately. She had peritonitis. She ran the risk of dying because I had to choose between paying thousands of dollars (I was billed 6,000 for the ambulance) or wait till the next day. A company who has a financial interest in making sure you don’t get treatment should not be allowed to make decisions on whether you need it or not.EDIT 2: Here is a graphic that says something: Notice less advanced and far less rich countries than the US have it too, and notice non of them are “Socialist” as defined in the dictionary and executed in the USSR or China.

Here's the answer as it pertains to my specialty, orthopedic surgery, and the hospitals where I work.When a patient comes into the hospital and there is a limb threatening emergency, there is no consideration to the patients financial status to provide emergency surgical management, PERIOD.Interestingly, I will take the scenario a bit further. We have patients who come in to the emergency room all the time with non-emergent orthopedic problems that to require surgery. These problems if left untreated would create signNow disabilities to the patient. However, they do not represent emergency situations.For example, a patient who has a displaced ankle fracture needs to have plate fixation in order to stabilize it. The patient who has a hip fracture, knee fracture, elbow fracture, wrist fracture, etc., may require surgery in order to restore appropriate function for the long term.Whenever a patient presents to the emergency room with this situation, the ER physician will give me a call. At no time do I make any request to determine what the patients financial status, including insurance status is. We review the x-rays, medical history, and appropriate social history. If based on these factors the patient needs to be admitted to have the problem corrected, then it is done. We will then manage the patient surgically to correct the underlying problem during that hospitalization.After that, it will be up to the hospital to decide how they want to manage the finances with the patient. However, the important point here is that the decision to admit and move forward with surgery is my own. It is not directed by hospital administration.This is the way that we manage it at two different hospital systems. One of them is a large community based system that has many hospitals throughout the state. The other hospital system is a level II trauma center.My experience may be different then the way that other hospital systems manage it with their orthopedic surgeons.Dr. Brian HattenMy Knee Guide

Not at the diagnosis itself but getting here has been kind of amusing.A few years back, a doctor looking at a chest x-ray noticed that I had a healed crushed vertebra. I knew that I had hurt my back a year earlier but didn’t realize it was a crushed vertebra. When I told her that I got it lifting a shop-vac into my pickup truck, she was suspicious. As a (then) early 50’s male, I shouldn’t have bones getting crushed for something that innocuous. She ran some tests that showed that I had abnormally low bone density but everything else was fine. She suggested that I see a specialist.After a (long story) while I get to see an hematologist/oncologist. They start doing some measurements of protein in my blood. The value keeps rising. Bone marrow and biopsy tests from my hip shows unusual cells. The doctor says I have Waldenstrom’s macroglobulinemia. But … they keep testing and the protein value roughly stabilizes. It’s too high but not high enough for a definitive Waldenstrom’s diagnosis. I have Monoclonal Globulinemia of Unspecified Significance, MGUS. Treatment is to watch and wait to see if it develops into something more serious.This summer, I crush another vertebra lifting up a computer. MRI scan shows a tumor in the crushed vertebra and the vertebra next to it as well as some other damage. Diagnosis? Multiple myeloma.I get signed up for a clinical study for multiple myeloma. Doctors need to get another bone marrow and biopsy from my hip to baseline my condition before starting treatment. Diagnosis? Not multiple myeloma. It’s Waldenstrom’s.The hematologist wants to have a back specialist take a look. When I see the very experienced back specialist he says that he’s never seen Waldenstrom’s lead to crushed vertebra. Diagnosis? It’s probably multiple myeloma.But, importantly, he says we can’t keep guessing. We need to get a bone marrow and biopsy test from the vertebra to be certain. Result? It’s Waldenstrom’s. Everybody is now in agreement.I know way more about my immune system than I ever expected to know.

Doctor’s smile.When I had the doctor visit, the experience was great because nurses and doctors seemed so amiable. However, other things are not so good.I’m an international student. I asked for an annual examination in Student health center. The examination went very quickly. During the visit, my doctor said nothing about cost. Since it’s a student-health-center-recommended health examination and I paid school’s wellness fee and school-approved health insurance, I thought it would be fully covered or at least 80% covered. A month later, I suddenly got a $300 bill. Now I need to contact insurancer, test provider, and the doctor to find out what is this $300 for and whether I can get some coverage. Though it’s not a big money. But I get a glance of this system. Patients here are supposed to be super knowledgeable in healthcare and insurance issues. Or they can be easily trapped in healthcare bill bankrupt. No professionals told you in advance what are include in the service package and how much they actually cost you.What if I asked my doctor to assess the cost in advance? Amiable as she is, she will probably show me the total cost without any insurance coverage. In my last dental visit in America, the doctor kindly showed me a $1,800 estimation after school’s dental insurance and suggested me to communicate with insurancer first. Both insurancer and the doctor warned me with“maybe more” and comforted me with “maybe less”. For the fear of cost uncertainty and the impatience in schedule waiting. I had that dental surgery in China with social security insurance full coverage on the 3rd day back in Shenzhen. Well, my Chinese doctor didn’t smile at all.I must admit I was too simple-minded on this issue at first place and the expensiveness of American healthcare is beyond my imagination. I expected too much for my meager wellness fee and health insurance… Because in China, even $7/semester school’s wellness fee will cover most services in school’s health center(90% cost of visit, equipment, test, medicine…everything included). In America, I paid $130 per semester for visit copay waiver and some discount??? In China, I paid $100/month for social security insurance (healthcare, retirement, birth, work accident, unemployment combined). Basic public health and medicine services are fully covered(100%). In America, I could sense that doctors thought the $100/month insurance I bought was too-cheap-to-have-any-use. Maybe that’s how capital flows in America. Chinese people spend life-time saving on house and education. American people spend life-time saving on healthcare and education.Some people mention that if you get a real good job, employers will pay for that, so it can be great. It’s not great at all. This will add to companies’ operation cost and undermine companies’ competitiveness in the global market. For Year 2015 data, average employer sponsored health insurance in family unit is $12,591. Average American household income is about $59,000. Companies need to pay nearly 20% extra money to hire one.What Percent of Health Insurance is Paid by Employers?Household income in the United States - Wikipedia11.20 updatesI phoned insurancer about the $300 bill I received. The agent said it’s because my doctor didn’t state my bill as “preventive care”… Annual examination won’t be taken as preventive care? I feel this problem is like a ball kicked between insurancer, test provider, and doctor. Wish myself can find some warm in the school tomorrow.

A True MonsterWorking street crimes, the prosecutor’s Office called our office and asked for a favor. They had received an anonymous tip identifying a possible case of child sexual abuse. The suspect was identified by the address where he was staying and was described as a middle-aged man living with a single mother and her two-year-old daughter. They asked us to check it out.My partner and I dropped by the apartment early that evening for a welfare check. When we arrived, we were greeted by a man who was in his forties, was short and heavy set, and wore wire-rimmed glasses. He kind of reminded me of the George Costanza character on the TV show Seinfeld. He had that innocent round face and acted kind of socially awkward. It’s not possible that this little man could be a child molester?The woman he was living with was at work, and the man was watching her two-year-old little daughter. We asked the man if the child was there with him, and he pointed over to a playpen. Now, without going into much detail, I can say the child was not clothed and what we saw alarmed us to the point of believing that the child may have been abused.Our observations were sufficient to take the man into custody and call the child's mother. She was distraught and seemed to have no clue what may be going on with her new live-in boyfriend.She met us at the house and transported her child to the emergency room for a thorough examination. I transported our suspect to a separate part of the hospital, and we were directed to an isolation room, which was completely separate from the rest of the emergency room. It was a small room with no windows and one steel door which I kept closed. This was the room where I would spend an eventful five hours alone with this man.I had two daughters at home, who at that time were ages two and five, so this whole situation was hitting really close to home for me. I was not sure how I would react if the tests on the child came back positive. I had a feeling that it could be a long night. My partner had already left taking comp-time to go to a hockey game, leaving me alone for the duration.My understanding was that the initial visual examination of the child was not entirely conclusive, but there were indicators such as redness, which could easily be mistaken or explained as diaper rash. Additional tests would give a more accurate account of what happened. I was hoping for a plausible explanation which didn’t confirm my darkest suspicions.We were waiting for a doctor or more likely a nurse to come into the room and complete a rape kit on the man. This might identify any possible physical trace evidence of a crime. Shortly after we arrived in the room, a nurse popped her head in and said they had incoming patients from a car crash which took priority, so we should expect to be there awhile.I thought, great, just what I wanted to be doing on a Friday night, babysitting a potential pervert. All kinds of things go through your mind when you're sitting alone in a room with a person who may have sexually abused a toddler. I thought about different things that could happen to this person, like if they tried to escape and I shot him? I also had pictures running through my mind of what this person might have done to this innocent young child, who was very much like my own children.I completed a Miranda form advising this man of his rights almost as soon as we entered the room. I didn’t expect to be questioning him, but I thought, I should do this in case he decided just to start talking. It was a smart move; it turned out that my instincts were right.We sat in that room together in silence for probably a half hour. Silence can be a powerful weapon in an interview. But I have to admit I wasn’t that sharp or calculated. I just didn’t want to talk to this guy before the physical examination results were completed.He was seated on a hospital examination table with one hand handcuffed to a railing. Given some time, I started to see that he was beginning to show signs of becoming upset as he stared at the floor without blinking. It looked like he was searching his mind for something, or perhaps concocting some acceptable excuse for what we might find.I wondered what this guy was thinking about. I had attended the Reid Polygraph School in Chicago many years ago, specifically to learn interview techniques and indicators of guilt. Sex offenders are a different breed, especially those who harm children. They know they are universally despised by everyone. Even in prison, they have to be segregated from other prisoners to remain alive. How could I use what I knew to learn his version of the truth?I recalled from this training that perhaps he hated himself and the things he had been doing, as much as society would hate him. There is a technique I learned, where to get a person to admit to their horrible behavior, you had to give them an excuse and basically convince them that it wasn’t their fault. Could I convince him that I thought he was blameless for his actions?I decided, based on the non-verbal indicators I was seeing, I would give it my best shot. I would have to convince him that I was that one person who he had been waiting a long time to confide in. I thought for a long time on how to break the silence. I would either make a connection or get shut out.I finally broke the silence with a single statement. I pulled the folding chair I was sitting on close to where the man was seated. I was now close enough to signNow out and touch him. I signNowed out and touched his arm at the elbow, just to get his attention and make some eye contact.I then said: “Not everyone who comes to a hospital has broken bones or visible wounds. Some people are broken on the inside. “This 40-year-old little man immediately began to cry. That was the precisely the sign I was hoping to see. For the next several hours he talked to me, and I listened. I only interrupted to keep the conversation moving forward. It was probably the first honest conversation he had in his entire adult life. I’m sure he wasn’t being completely honest, but what he said made my skin crawl, so close enough! He told me, in detail, about 25 years of being sick and the depth of his sexual perversion.First, he targeted several small children in his neighborhood as a teenager. He would volunteer to babysit them in the summertime, while the children’s single parent was at work. Then as a young adult, he abused several persons he helped care for who were severely mentally disabled. I could feel my face flush with anger, so I diverted my mind away from the pictures in my head and thanked him for his honesty.Still later in life, he would target young children, through relationships he would establish with single mothers. He would actually choose the single mothers at playgrounds or in the park, based on the mother's young children.What he said totally disgusted me on the inside yet on the outside I remained calm and supportive of his ability, to be honest. I told him the non-judgmental things he wanted to hear which would keep him talking. I said that it was a treatable illness and his behavior was not his fault. I told him I thought deep-down he was a good person with a horrible disease. I said, “Today was going to be the first day of the rest of his life, the day to come out of the shadows and let the healing process begin.”Yes, as lies go, these were whoppers, which I didn’t believe for one minute, and some may condemn me for, saying police should never lie during interviews. But it worked, and no slick lawyer could get this man’s words suppressed.I transported him back to the police station and had him give me a voluntary tape-recorded statement which filled several cassette tapes. It covered his behavior from the time he was a teenager all the way up to admitting what he did with the child that very night. I recall thinking that anyone that ever heard that tape would make sure he could never do this to another child.It was about 5 AM by the time I finished his tape-recorded statement at the station and placed him in jail. I felt several different emotions, as I left the station that night. I felt a sense of accomplishment in hopefully stopping this sick individual. But I also experienced a deep feeling of disgust that people like this actually walk among us. He looked so innocent and child-like, but the reality was, HE WAS A MONSTER! I was angry with myself at some level that I hadn’t smashed his face in. It would have been so instantly gratifying, but also stupid.For a long time after that night, I looked at everyone I met a little differently. I was suspicious of everyone who had contact with my kids from a babysitter to a tee-ball coach.This monster pled guilty to his crimes and was sent to a special prison for sex offenders. The term of confinement was long enough I was convinced he would never see another day of freedom in his life.This ended his twenty-five-year string of sexual abuse and assaults on both helpless adults and small children. I never got an accurate count of his victims, but it was a substantial number.I was disgusted by all I heard that night, and couldn’t wait to get home and take a hot shower as if I could wash away these disturbing images from my mind. I told myself to remember the countless victims who will never meet this little baby-faced monster, and how the world was just a little bit safer for everyone's kids.As I gave my two little girls a strong hug that next day, they would never know what I was going through, but I was coming to grips with the world we lived in. I would be their protector against all harm, especially the monsters, who were real and walked among us wearing disguises.

As many of you know, I was homeless when I was younger. Life on the streets is hard, harder than you can possibly imagine.The first night was terrifying. I knew I was going to die. I knew I was going to get stabbed by other homeless people for my boots and sleeping bag, and God forbid they discover I had £38 in cash, they would probably slit my throat for that. I was going to get AIDS and I was going to die. It was a certainty.The first time I came across a group of homeless people that night was when I tried to find a place to sleep in an abandoned building. One happened to see me trying to climb through a broken window and told me it was a bad idea. That's where the prostitutes took their punters, and where the local heroin dealers plied their trade. I had no idea about any of this stuff, so I was glad of the advice.The person who told me to stay away from that building told me he and a few other homeless guys had a place in the park nearby and I could come along if I wanted. I knew the park and knew it was open on all sides, so I could get away if anything went sideways, so figured I had nothing to lose.Those guys asked me what happened to make me homeless. I told them exactly what my landlord did. I think they took pity on me as they could see I was scared, and let me know what to expect. I discovered how to apply for council housing, where the nearest soup van was and how often it turned up. They told me where I could find food and some of the things they found useful to survive. They were really nice people, and that surprised me. I didn't feel threatened in their presence, but wasn't ready to stay with them.Let me tell you, that first night was petrifying. Every noise was a threat. Every shadow a murderer. It was the start of the coldest winter on UK record at that time and believe me, I felt every bit of it. I was alone in the world. I was cold and I was scared. I'm not ashamed to admit I cried my eyes out that night and didn't sleep a single second. It was the longest night of my life.Early the next morning I got out of my sleeping bag and packed it away. I had a steely determination to sort everything out. I had been told what to do, I was intelligent and I could figure this out. I wasn't going to to spend another night on the riverbank.Number one on my list was to get a council flat. All I had to do was visit the housing office, declare myself homeless and sign some forms. Surely they could understand that I was young, naïve and desperately vulnerable. It should be enough to get me to the top of the list, or at least into emergency accommodation. Well first I had to find the housing office. I never needed to go there before so I had no idea where it was. Luckily there is a council advice centre in the local shopping centre. I went there, made a quick enquiry and walked to the next town to start the process of getting myself somewhere else to live.I decided on my way there I was going to speak to the police after I had finished at the housing office. I knew they couldn't do anything about the illegal eviction as it was a civil matter, but they would be able to punish my landlord and his mate for threatening me with extreme violence if I didn't leave immediately.I got to the housing office around mid afternoon. It took me a while to find it as I hadn't really been to the next town over much before. Walking in, I took a ticket from the machine on the front desk and waited my turn. I was called up to a private booth within a few hours. I didn't mind the wait as I knew I would get some keys at the end of it.The housing officer asked me loads of questions and gave me stacks of forms to fill out. It took ages. Eventually I was called back to a booth where a different officer looked over everything. He asked me why I left my previous home. I gave him all the details. All he was interested in was that I had left voluntarily. If you make yourself intentionally homeless, regardless of the circumstance, you go straight to the bottom of the list. I tried to plead with him and told him exactly what my landlord said, and how he acted. This guy was huge. Six foot four of bad tempered agressive muscle. I was a 9.5 stone weakling. I am not exaggerating when I say that one punch from this man could easily have killed me. The housing officer didn't care about that. All he kept telling me was that what I was alleging to have happened was illegal and landlords can't evict people without notice, so obviously I had done something wrong to warrant it. I hadn't. I rarely ever spoke to my landlord, and had been paying my rent in full, on time every month. I had never been so much as a day late.I asked to speak to another housing officer as I knew I wasn't getting anywhere with this one. A woman came and sat in front of me and asked me all the same questions, but seemed more willing to listen to me. She said there were other criteria for immediate assistance I might meet so reeled off a few more questions. Was I a drug addict seeking rehab? No. Was I dependent on alcohol? No. Was I disabled or mentally ill? No. Was I an ex offender? No. I didn't fit any profile which mattered. The council had discharged their duty of care by adding me to the waiting list and there was nothing else I could do.Dejected, but more determined than ever to get revenge on my landlord for what he did, I went to the police station next. I told a constable what has transpired and that I wanted to press charges. He didn't care either. The threats, whilst illegal, came down to his word against mine. He was a successful landlord who had evicted me for some reason, I was a homeless guy with a grudge. It was obvious the police were not taking my side and I was wasting my time.I went back to the riverbank.The next morning I met up with the guys from the park. I told them what had happened and they said they weren't surprised. I asked for some more advice. I don't remember what they told me, but I do remember it didn't help.I picked up a free newspaper from one of the stands in the town on my way back from the park to the riverbank. It mentioned that the winter shelter was reopening soon and gave it's address. I was there the day it opened but was already too late, all the rooms were gone. I went there every day for 2 weeks trying to get a room, and eventually got lucky. They had a zero tolerance policy towards drugs and one of the residents had been caught with syringes. He was being kicked out as I arrived. I took his room and stayed there for a week before I was evicted for some made up reason I don't remember.I went back to my friends in the park, but none of them believed I had gotten a room there as they were so difficult to get.A few weeks later, one of the big hospitals in my town closed down for a complete refurbishment. I saw it as a way to move off of the riverbank to somewhere inside. I scoped out the hospital and decided against trying to to sleep inside the main building as I could be found by the workmen and thrown off site. I looked at the external lab buildings but they were either being demolished or had big alarm boxes on the outside. Eventually, at the very far end of the site, I saw what was to become my home for the next several months. It was an abandoned brick shed. It was full to the ceiling with empty cardboard boxes, but best of all, the door could be secured from the inside. I had a roof over my head, it was dry and it was lockable. I made a tunnel through the boxes to the wall furthest from the door and made a little den. There was just enough room for me to sit up in one direction, and lie flat in another. If I was quiet, no one would know I was there.I needed to make it comfortable. I used several thick cardboard boxes to insulate me from the bare concrete base, and took a load of hospital bedding out of a skip on site one evening when the workers had gone home. Piled on top of the cardboard, it was quite comfortable. I already had a sleeping bag, so I slept on top of the sheets in that.That shed probably saved my life.I mentioned the soup kitchen van which came once or twice a week. Well sometimes it didn't come at all. I was already eating out of bins, but I needed that soup as it was the only warm food I could get. Eventually it's funding must have dried up as it stopped coming to altogether. I had also been careless in allowing myself to be seen taking food out of a bin at the back of a bakery, and the bin was locked away. That was the end of the food. I didn't eat for nearly 2 weeks.Something people don't tell you about real hunger is the pain. Being hungry hurts. Being hungry can make you hallucinate. You can die of hunger with a full meal in front of you as you are too weak to eat it. I came very close to starving to death.Someone told me the salvation army give out food, all you have to do is ask. I made my way to the nearest Sally army church and waited until the service was over before asking to see the vicar. He took me to the kitchen and filled a carrier bag with food. I was too dilerious to notice he had given me a frozen loaf of bread and a load of tins I couldn't open as I didn't have a can opener. What it did have was some fruit, a few slices of ham and some biscuits. That carrier bag of food lasted 3 weeks.I was having a conversation with one of the other homeless guys I knew and he told me that the council didn't just offer their own properties, they offered a service to private landlords too. This was later confirmed in a story in one of the free local newspapers, which also mentioned that the council didn't take all the properties offered, despite having a deficit, as they didn't consider some of the accomodation to be suitable. I suddenly had a new mission.I started waking up early, so I could make my way to the housing office and be first in line every day. I stayed there all day,every day for several weeks until I had a lucky break. A middle aged lady came in and I heard her say to the person on the front desk she had some bedsits to offer. They ended up not being suitable, but while she was waiting I struck up a conversation with her. I told her why I was there and what happened to make me homeless. I persuaded her to give me a chance and we filled out the housing benefit forms there and then. She gave me a lift to her bedsits and showed me inside.As I now had an address, on the way to the bedsits we stopped at the benefits agency so I could register for income support. It would be a few days until I received my first payment.As I had not taken off my clothes in many months, I was desperate for a bath. I had to wait a few days as there was no way I was putting my dirty clothes on again. I slept on the floor as I didn't want to get the bed dirty.Once my first payment arrived, I went shopping. I bought fresh socks and pants, a new pair of jeans and a new t-shirt. I also bought the cheapest shampoo and toothpaste they had. I went home, sat in that bath for hours and fell asleep in a warm, comfortable bed for the first time in months. The next morning I put on my fresh clothes and haven't looked back since.

I don’t like to be that judgmental about it, although it’s true that we get a lot of patients coming in on Sunday nights and very early Monday mornings.Sometimes the patient is elderly, and explains, “I didn’t want to mess up my son’s weekend by calling him earlier, so I waited until Sunday evening to tell him I was having abdominal pain.”Sometimes the patient is a child, who ignored mild symptoms until bedtime.Sometimes the symptoms the patient is experiencing actually do get worse at night, when the person is lying down: toothaches, earaches, difficulty breathing.Some day care centers won’t allow children with certain symptoms, unless they’ve got documentation that they’ve been on antibiotics (or other appropriate treatment) for 24 hours. In these cases, parents who can’t afford to take any more time off work than absolutely necessary don’t wait until morning to take the kid to the doctor.Some people truly can’t afford to seek medical attention (especially in an ER, which is by far the most expensive form of treatment), and wait to see if they’ll get better over the weekend, so they won’t run up a big bill. When Sunday evening arrives and they still feel lousy, they come in for treatment. By that time, they usually have no other choice, since few urgent care clinics or doctors’ offices are open on Sunday evenings.And, finally, some schools and employers actually require a note from a doctor if the person calls in sick at work, or misses a day of school. So these patients come in as soon as they know they’re coming down with something.

My 8 year old son’s doctor kept stammering his words as he tried to explain to us why our son was so sick. He had called us into his office (which I had always heard was NOT a good sign) to tell us it looked like our son had cancer all in his abdomen.I already had an idea of what the doctor was about to say. I had opened the large packet of (supposedly confidential) newly developed X-rays and held them up to the light in the elevator when my son and I were going back up to the doctor's office, and I didn't care, I did it right in front of all those elevator strangers.They saw it too…a huge white glowing mass covering the left half of my son's abdomen. I muttered to my son without realizing it, “It looks like we've got trouble, little guy.” No one else in the elevator said a word.The nurse kept my son company while the doctor spoke with his dad and me in his office. I began to softly cry, more so at the moment from the sheer frustration of trying so long and hard to get a diagnosis. I had known something was wrong with my son's health for years, as he always complained of severe pain right under his left ribs, yet I couldn't get anyone to take us seriously. I had taken him to several doctors for help, and he had even been hospitalized trying to find this pain.This new doctor, originally from India and just out of a US medical school, found the problem in just under an hour.The rest of the day was filled with an extended array of tests, with my son being such a good boy, even though he felt awful. At one point he looked at me so sweetly and asked why “tears kept falling from my eyes”.“I've got a bad headache, honey. Mommy is okay,” I lied. I was worried to death.I can't even begin to tell you the amount of people that began to show up to observe my son's subsequent tests as word spread in the hospital there was a possible Wilms Tumor diagnosis. This is a cancer, diagnosed in young children, of the kidney(s). All sorts of technologists and doctors in various fields were packed into each observation room as my son went through Ultrasounds, CT-Scans and MRI’s. I never complained about all the observers because in the confusion, they let me stay in there with the medical staff. I don't think they realized I was the mother watching each test being administered. I even asked a plethora of questions during each test, and they'd answer and explain.After a long, arduous, draining day, it was 5 p.m. and it was pretty clear from test results my son's left kidney was filled with tumors. There were so many that his left kidney had stretched from under his lung to deep into his pelvis.Emergency surgery was needed. His blood had become septic because uric acid was leaking from the kidney where the tumors were. My son was becoming sicker by the hour and a strange rash started covering his body the night before. I could hear my son's doctor, being new to the hospital, making urgent phone calls to various connections within the hospital to find out the exact protocol to set up surgery to save my son's life.Just then, the head radiologist was hurrying down the hall with his briefcase trying to make it home for a prior engagement, and he was actually trying to avoid the crowd of medical staff that had gathered around my son's case.Someone from the MRI team said, “You've got to see this!” and took his arm to come see. He reluctantly came into the room where the technologists were recording images and stared intently at the screens. He asked them to show him the previous 10 images, and the next 10, then the previous 10 again, back and forth, back and forth.He took me into the room where my son was lying in the MRI machine and started drawing me pictures of what was really wrong with my son, and it wasn't cancer. It was a diagnosis, that if it had been caught early, would not have put his life in such danger. I'm telling you about this diagnosis in case you have, or know of, a child who keeps having severe pain on either side in the front of his abdomen under the ribs (small children's kidneys present themselves towards the front of their small body until they grow more) or pain in the back near their kidneys when older children, teens, or young adults.It turns out my son was born with a birth defect, one we had no way of knowing. His left ureter, the tube leading from his kidney to his bladder, was tied in a knot! This is called an UPJO or Ureterpelvic Junction Obstruction and occurs in 1 per 1,000–2,000 newborns. The ureter can be tied in a knot, or it can be so narrowed or crimped that urine can not drain from the kidneys. In my son's case, this knot kept his urine from draining, which caused his kidney to eventually become filled with uric acid crystals, which then formed hundred of various sized stones.Here is an image which shows a normal urinary system on the left, and a similar drawing of my son's condition on the right, except there's no knot in this drawing, but a crimp at the top of the ureter.images upj in children:“Defects in the urinary tract may block the flow of urine and create pools of urine. In stagnant urine, stone-forming substances tend to settle together into stones. Up to one-third of children who have stones have an anatomic abnormality in their urinary tract.”Kidney Stones in Children | NIDDKHere are some images that are very close resemblances of my son's condition. These imaging views are views from the top. Notice the differences between kidney size. The healthy kidney is on the left.images upj in children:In the following image, it shows the various infiltrations in the kidney cavities with stones and concentrated uric acid crystals. You can see three stone filled dark cavernous regions in the kidney on the right as compared to the healthy kidney on the left.images upj in children:In this image, you can see presented a photo of a kidney damaged from the failing ureter:My sweet little boy had been suffering, since age 3, from kidney stone pains, pains which most adults can't bear to tolerate even a tiny speck of a stone, and I had been trying to get his doctor to take us seriously for years. When I finally changed doctors, after over many many visits to other doctors within my insurance’s “approved” doctors, the problem was found, but now he was going to lose his kidney. It was so damaged from scar tissue and infection, taking out the diseased kidney was the only way to save his life.I'm writing this to hopefully save someone from going to the horrible experience we did. My son almost died that day. The doctor who refused to believe his pain moved to a new practice in another city. I found him, though it wasn't easy, and told him what his continued doubt had done. I even reminded him how he accused my son and me of needing psychological help.He apologized over and over and said he had never heard of that diagnosis, though it's not that uncommon. Many times it's seen in ultrasounds of the baby in the expectant mother. It was the way he spoke to me that solidified my decision to not file for malpractice, though I had two doctors who said I had a solid case.However, I think I made a wrong decision not doing so. Having only one kidney affects life in more ways than you'd think. It's a pre-existing condition, which sometimes affects insurance (depending on who's in political office) and though one can survive with just one kidney, many medical considerations need to be adhered to.Here are some other symptoms, besides the pain, which children with this presentation exhibit. Many times there are no symptoms. It took a while for my son to show his symptoms and it wasn't until it had progressed quite a bit.Extreme pain on either side under the ribs in small children, or the back where kidneys are located in older children.Vomiting, a lot. This could be from the pain or the enlarged kidney pressing against the stomach.Low weight gain, also called “failure to thrive”. My son had just looked “sick” as a one and two year old, and my dad kept telling me he didn't look well. I took him to the doctor many many times but nothing was found.Urinary tract infection. A doctor did do that, but since just one kidney was working, the urine from that kidney looked fine. The urine from the diseased kidney wasn't being released.Finally the symptom that made me call work and say I wouldn't be back until I found out what was wrong with my son, and also what made me tell the new doctor at his primary care clinic that I wasn't leaving until they found out what was wrong with him, was a protruding side where his kidney was. Then he developed a rash all over his body.UPJ Obstruction - Symptoms, Diagnosis, Treatment of UPJ Obstruction - NY Times Health InformationI can't tell you how guilty I feel even all these years later that he suffered so much, but I took him to three different emergency rooms and a total of 35–40 doctor visits. He just got married last weekend to a beautiful woman, but when I think how close it came to never happening, my heart breaks for him all over again.I wrote this hopefully to help another parent or guardian in case their child is experiencing these same symptoms.Thank you for reading.

Just a little over four years ago, Snapchat was supposedly just an idea that founder Evan Spiegel and friends had while in a class at Stanford.Now, over 100 million active users and 7 billion daily video views later,the White House has joined, presidential candidate Bernie Sanders is running a campaign on it and senior ad buyers are starting to take notice and planning to advertise on the platform over other social media sites.How did Snapchat, an app that first made headlines as the“sexting app”, get here?THE HISTORY OF SNAPCHAT: HOW DISAPPEARING PHOTOS CHANGED THE GAMEI was surprised early on that people didn’t realize that the way Snapchat works is much closer to how we communicate face to face than any other social network. What I mean by this is that: when we talk to each other, passing in the halls or just living out our lives, those moments disappear. Snapchat emulates that behavior and psychology.Snapchat was started at a time when everybody and their mom thought they were an entrepreneur who could launch a successful social app. Facebook was where you went for updates on family and friends, Instagram was beautiful photo content, and Twitter was the conversation at a cocktail party. These three social giants dominated most of the conversation, but they all played off of each other in terms of functionality, and, most importantly, audience. However, Snapchat was able to counterbalance the strengths of all three players and create a new social pipeline.The norm of the internet age is to create platforms in which everything is saved—everything is stored and documented digitally. Snapchat went the opposite direction and is predicated on our reality: moments are temporary and that’s exactly the feeling and behavior that Snapchat mapped to. Snaps could even be compared to television the first fifty years it was introduced: the broadcast aired, and that was it. Snapchat managed to tap into a lot of historical truths, instead of creating something entirely new.FACEBOOK OFFERS TO BUY SNAPCHATAll these things quickly led Snapchat to come to the attention of Facebook’s CEO Mark Zuckerberg. Just one year after launch, Zuckerberg reportedly tried to buy the app for $3 billion.Let me just say this: Zuckerberg is the greatest trader in consumer attention of all time.He understands the value of attention. He recognized that Snapchat was well on its way to winning the attention of a generation, much like he did with Instagram (which Facebook bought in 2012 for $1 billion). He saw it as a vulnerability and saw that a Snapchat generation could emerge, much like there was a Facebook generation before it. Facebook acquired a monopoly on 18 to 24 year olds with Instagram, they had a monopoly on an older demo with Facebook; they just needed Snapchat to fill the gaps.But Spiegel turned the offer down. He saw what Zuckerberg saw: the potential to fill-in the social pipelines that other platforms had ignored. He knew he had one of the hottest apps of the time; now it was just up to him and the team to blow out their user base and execute against their core function.THE MATURATION OF SNAPCHAT’S ATTENTIONBut, let’s be honest: what really makes a new social network become popular fast?Teenagers.There are two things that are very true when it comes to teens. One, it’s not cool to hang out at the same club as your mom. And two, you want to lock your room.Snapchat solved both those things. Parents were starting to join Facebook in droves, so teens were looking to leave and looking for somewhere to go. And, the disappearing photos function was essentially the same thing as a “do not disturb” sign on your door, except much more effective. Both these things led to Snapchat’s extreme and sudden user growth. Just a year after launching, Snapchat hit 10 million active users.In October 2013, Snapchat made a signNow update to the platform:Stories. Users could now also add Snaps to a feature called their “Story”, which acted like a longer narrative of snaps strung together. The stories last twenty-four hours after being posted and are public to all their followers.I’m going to be very clear here: I went on the record saying I thought the update was a bad idea. I thought it was absurd to imagine that users would actually go out of their way to watch something on a platform where things were historically delivered to them (Stories live on their own page and you have to click into a Story to watch it).But boy was I wrong. This update marked Snapchat’s first big move into becoming a major platform by creating it’s own social language and context. It already had functionality very different from any other social network at the time; you could draw on top of photos, content disappeared, and the gestures of swiping up, down and to the side were relatively new. But after Stories the platform began to take off and mature as a content destination. By August 2014, 40% of 18 year olds in the US were using Snapchat on a daily basis.The biggest update in recent Snapchat history, and the one that really changed the game for me to push it towards the mainstream, has to be Discover.SNAPCHAT BECOMES A MEDIA DESTINATIONIn early 2015, Snapchat launched Discover. It’s a feature that allows users to receive content provided by top media companies. Launch participants included National Geographic, Vice, ESPN, and more. Eleven participants in all started it off. It was, and still is, a serious play to be part of Snapchat Discover because it puts a company in a very aggressive place within the overall user interface of the app and delivers an unmatched form of attention from their youthful user base. It also completely changed the swipe navigation and how the app is used.It was very exciting step forward for Snapchat. It was obvious they were paying attention to current trends and were ready to act: the explosion of content and companies becoming media companies, putting out their own content, the importance of mobile being first.Using Discover as their platform, Snapchat went out and made deals that allowed them to curate some of the top content providers in the world in this one spot. This gives them more power in the micromanagement of what shows up on the Discover page.The brands that launched as partners, and the 18 brands now currently in the space, have an enormous relationship with Snapchat, and they are getting great equity for it. Why? 45% of Snapchat’s users are under 25.There are over 100 million users, nearing 200 million. Snapchat is basically handing these brands the 25-and-under demo. So it’s no surprise that these media companies have hired entire teams around the initiative. Their only job is to make content for Snapchat.Now, Snapchat is partnering with the NFL, the White House has recently joined, and it’s safe to assume they’ll continue to broker relationships with more content creators as they’re proving that they are a real media property to be reckoned with.THE BASICS OF SNAPCHATSo now that you know everything there is to know about the history of the platform, let’s get down to the most important part: how the fuck do you use this thing? On every article I have written about Snapchat in the past, most of the comments come back to me saying something like “Yeah, but how the hell do I use this this?” or “It’s so confusing!”No problem. Below are some handy guides I have put together to teach you guys the basic functionalities of Snapchat, as well as some cool hacks.THE DIFFERENCE BETWEEN SNAP, STORY, AND CHATSo…how exactly do you define a Snap?Great question. A Snap is the main functionality of the app and is what the disappearing photos and videos are called. You send these directly to friends in the app. They last anywhere from one second up to ten seconds after being opened, then the “snap” disappears.And the difference between that and a Story is…?A Story is a collection of Snaps put together to create a, well, Story. Unlike direct Snaps, these can be viewed by anyone who follows you. When you send a Snap to your Story, it becomes public to your followers. Stories last up to 24 hours before disappearing, but still can only be up to 10 seconds long.There’s also chat right?Yep. When you swipe right on a person’s name in your direct Snap inbox, the chat function will appear. You know you’ve received a chat when a blue speech bubble appears next to someone’s name. Chats also disappear after being opened.QUICK GIF GUIDES TO USING SNAPCHATSNAPCHATTING A VIDEO V/S PHOTOHOW TO ADD FILTERS AND DOUBLE FILTERS ON SNAPCHATHOW TO USE SNAPCHAT VIDEO FILTERSHOW TO SAVE A PHOTO OR VIDEOSNAPCHAT ACCOUNTS TO FOLLOWThis is just a short list of people who are killing it on the platform. There aren’t that many yet because people still aren’t taking it seriously. So get on it now.DJ Khaled: @djkhaled305Shonduras: @shondurasCasey Neistat: @caseyneistatLACMA: @lacmaDiplo: @diploOh by the way, I’m on there too: @GaryVee.THE HISTORY OF SNAPCHAT IN ONE TIMELINE

An emergency physician is a physician who works at an emergency department to care for ill patients. ... If the patient is admitted to the hospital, another physician such as a cardiologist or neurologist takes over from the emergency physician.

There is never a charge from a doctor for providing a fit note if you're off sick from work for more than seven days. For sickness of seven days or less, your GP practice may charge you to provide a private medical certificate.

A fit note must be signed by a doctor, but you don't always need to see your GP in person to get one. It depends on: why you're off work sick. Whether your GP needs to assess you face-to-face.

Exceptions. This means that although a backdated medical certificate bsignNowes the AMA's guidelines, there are circumstances where a medical practitioner can issue a medical certificate based on the employee's condition prior to the date of examination.

A fit note must be signed by a doctor, but you don't always need to see your GP in person to get one. It depends on: why you're off work sick. Whether your GP needs to assess you face-to-face.