By F. Eusebio. School of the Art Institute of Chicago. 2018.

Much of the above information can be summarised in a discharge re­ port discount zetia 10 mg without prescription. Key documents to be kept on file: q results of assessments and investigations relating to the discharge decision q copies of referrals to other services q copy of discharge instruction sheets given to clients including directions about medication zetia 10 mg lowest price, self-administered health care or therapy regimes q discharge reports generic 10mg zetia with mastercard. Post-discharge The health records of clients who have been discharged must be retained for the recommended period of time zetia 10 mg low price. This will include carrying out ad­ ministrative procedures to record that the notes are in discharge cheap 10mg zetia otc, thereby ensuring easy access to them in the future. Work with a colleague and audit a sample of each other’s clinical notes. Are there any areas where you are consistent in not meeting the standards? Notes 1 Options that involve clients actively in record keeping are likely to increase their motivation and understanding of the care process. A c t i o n s R e c o r d K e e p o n f i l e R e f e r r a l / f i r s t * S e t u p p e r s o n a l h e a l t h * C l i e n t i d e n t i f i c a t i o n d e t a i l s * R e f e r r a l f o r m o r l e t t e r / a d m i s s i o n s l i p c o n t a c t r e c o r d * R e a s o n f o r a n d d a t e o f r e f e r r a l o r a t t e n d a n c e * A c c o m p a n y i n g r e p o r t s * N a m e a n d p o s i t i o n o f t h e r e f e r r e r I n i t i a l * E v a l u a t e c l i n i c a l n e e d * A c a s e h i s t o r y * C a s e h i s t o r y f o r m o r a d m i s s i o n s h e e t a s s e s s m e n t * C l i e n t ’ s v i e w s a b o u t t h e p r o b l e m * C l i n i c a l o b s e r v a t i o n s * T e s t s , i n v e s t i g a t i o n s a n d p r o c e d u r e s * C o n s e n t f o r m s f o r s p e c i f i c * I n t e r p r e t a t i o n i n v e s t i g a t i o n s * D i a g n o s i s / p r o g n o s i s * F o r m s o r c h a r t s u s e d i n t e s t s , i n v e s t i g a t i o n s o r p r o c e d u r e s * A c t i o n s / r e c o m m e n d a t i o n s * C o m m u n i c a t i o n a b o u t * C l i e n t ’ s c o n c e r n s a n d v i e w s o n t h e a s s e s s m e n t * A c o p y o f r e p o r t s o r l e t t e r s c i r c u l a t e d a s s e s s m e n t a n d o u t c o m e a b o u t t h e a s s e s s m e n t * R e f e r o n a s a p p r o p r i a t e * C o p i e s o f r e f e r r a l l e t t e r s t o o t h e r p r o f e s s i o n a l s I n t e r v e n t i o n * S e t c a r e p l a n * R e c o r d o b j e c t i v e s * C o n s e n t f o r m s f o r t r e a t m e n t , t h e r a p y * R e c o r d c l i e n t ’ s v i e w s a b o u t c a r e p l a n o r s u r g e r y * C a r e p l a n F i g u r e 4. This chapter reviews how to plan, structure and present such correspondence. The two are distin­ guished from each other by different styles, presentation and tone. Formal letters refer to correspondence that has an official or business function. They are printed or typed on headed paper using a conventional style of composition. The manner of address is formal rather than personal, so the preferred title and last name of the recipient is used to start the letter. They are signed off with the name, position, title and qualifications of the letter writer. Informal letters are written using a more conversational tone and are sent between two people who know each other. Letters are only one of the means of communication available to the health professional; however, they have certain advantages over other methods. Choose a letter if you want to: ° present complex information and elaborate on ideas ° have time to organise your thoughts and review your intended message ° have a confidential means to convey information 71 72 WRITING SKILLS IN PRACTICE ° indicate to the recipient the seriousness of the matter under discussion. Sometimes a letter is not always the most appropriate or most sensitive choice of communication. If your message: Consider using: is urgent e-mail, fax, telephone is an apology telephone, face-to-face contact requires explanation face-to-face contact, telephone is informal, brief or a reminder e-mail, memo requires discussion or exchange meeting, of ideas or involves decision making video or telephone conferencing. Structure of letters Letters consist of: ° a greeting ° an introduction ° the main body ° the conclusion ° a closing sentence ° a signature. Greetings The way in which you address the recipient will depend on whether you are writing a formal or informal letter. In certain circumstances a more gen­ eral term like ‘client’ or ‘parent’ may be permissible in letters sent en masse or if you are unable to verify the recipient’s name. Introduction The first paragraph will state clearly the reason or purpose for writing. LETTERS AND REPORTS 73 The following examples show how the use of some pertinent details (including the date) helps the writer indicate the topic or subject of the message to the reader. In response to a letter or other type of contact – ‘Thank you for your letter dated … regarding …’ or ‘Thank you for your phone call on the … I am sorry I was not available to speak to you personally’; ‘I am writing to you regarding your enquiry on the … about the waiting list for day sur­ gery. I would like to find out whether it would be possible to install a barrier that will restrict access to staff mem­ bers. For example, referral let­ ters usually start with a sentence like: ‘Thank you for seeing this elderly gen­ tleman who has been complaining of chest pains for the last three days. Conclusion The content of the conclusion will vary according to the purpose of the letter. It may include a summary, recommendations, request for action or a statement of what is expected from the recipient.

That goal does not necessarily include providing you with compar- isons or a full study of the drugs discount 10mg zetia with visa. One group from the University of Iowa College of Medicine confirmed this by reviewing the material found on the websites of nine pharmaceutical companies that manufacture medication to treat depression order 10 mg zetia otc. Most of the material on the websites consisted of advertis- Medical Detective Work on the Internet 85 ing buy generic zetia 10mg on-line. None mentioned drug costs 10mg zetia amex, and only one listed the percentage of adverse effects discount 10 mg zetia with mastercard. The group from the University of Iowa concluded that the information pharmaceutical websites provided regarding the treatment of depression is limited and makes it difficult for consumers to compare drugs. Commercial Versus Noncommercial Sites Although you need to be aware of whether a site is a commercial one and whether the studies mentioned on that site are medically valid, the fact that a site is commercial does not mean it is not a good source of information. As we mentioned before, clinics, hospitals, and pharmaceutical companies often have websites that offer useful data. However, if you are looking for the most objective information or need to make comparisons, these sites are not necessarily the best. And obviously any site where the main objective is to sell you something should not be your first choice. Two researchers studied all the information available on the Internet for an herbal remedy called Opuntia. The authors concluded that “the only way to assure high content quality was for the website to provide references to scientific publications. There is no doubt that 86 Becoming Your Own Medical Detective chat rooms can be a great place to commiserate with fellow sufferers, gain support, and exchange ideas that can sometimes be valuable when dealing with a mystery malady. They are a great place to ask questions and hear what others have to say. After all, as we have said many times, answers may come from any source and you must keep an open mind. Nevertheless, it is imperative to check out the information you find there with a trusted physician. Equally important is the warning that some- one else’s advice or experience may send you off in a direction that is not the most fruitful use of your time or may create a false expectation—be it positive or negative. Just use your discretion and don’t take anyone else’s advice without consulting your physician. Conclusion As you begin to explore the Internet on health topics, you will be amazed at how much information is available. You will be able to gain access to research studies and clinical trials. If you check the “About Us” sections, nar- row your searches, ask yourself the nine questions we’ve outlined, avoid the possible pitfalls we warned about, use your common sense, and always con- sult with your physician, you are sure to find surfing the Web an invaluable part of your medical detective work. With the tools you’ve learned in this chapter in combination with the Eight Steps to Self-Diagnosis, you’ll be well on your way to a correct diagnosis. In the next section, we’ll discuss different categories of symptoms and conditions and illustrate them with numerous case studies. We’ll show you how our revolutionary model of medical detective work turned these diag- nostic nightmares into treatment successes. Part 2 DIAGNOSING YOUR MYSTERY MALADY Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum. Many mystery maladies are characterized by vague symptoms that could be associated with many different conditions. They are diagnosed by the absence of evidence of any other disease that could account for those symp- toms. Some mystery maladies have not even been recognized until recently, and many more are yet to be named. For example, as we mentioned in Chapter 1, multiple sclerosis, once known as “faker’s disease,” was finally recognized because advances in medical technology (magnetic resonance imaging [MRI] of the brain and spine) finally allowed objective verification. The disorder described in the following case study was still relatively unknown at the time it occurred. Although recognized today as a legitimate ailment, it is still not always easily identifiable by most physicians, and there remains disagreement among board-certified rheumatologists about its cause. Yet if left untreated, this condition can become chronic and debili- tating.

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However buy 10mg zetia otc, a negative response is not necessarily a sign that your proposal is at fault discount zetia 10 mg amex. I feel this practical article will fit with your magazine’s modern approach to childbirth discount 10 mg zetia visa. It provides advice on planning a home de­ livery and includes two case studies cheap zetia 10 mg online. I have previously had articles published in the Midwifes Associ­ ation Newsletter and Parentcraft Journal generic 10mg zetia free shipping. Yours sincerely, Signature Name (title/qualifications) Position Figure 22. Is the idea basically sound but is it not what the editor is looking for at the present time? Has the topic already been covered, or is it not one the editor feels will interest his or her readership? Answers to these questions will help you decide whether you need to modify your style, ap­ proach or content. If you still think your idea is good, then move quickly on to another publication and start the process all over again. Whatever happens, remem- ber–arejection at this stage, before you have written an entire article, will save you time and effort. Writing your article It is worth spending time studying how media articles are written and con­ structed. You will find that like any other piece of writing, each one will have a typical three-part structure. The introduction Introductions tend to be brief with the topic and the author’s perspective on it quickly conveyed to the reader. Read the introduction to different ar­ ticles that deal with similar subject matter: how did you know what the content would be? Check that your introduction clearly indicates your topic and signals the perspective you will be taking. The main body The main body of the article will contain the bulk of the information. Content Compare the content of different articles on the same topic: ° List the key messages. ARTICLES FOR THE MEDIA 311 help direct the reader’s attention to key information. When giving advice try: ° Top Tips ° Helpful Hints ° Five Ways to Help ° Three Golden Rules ° Dos and Don’ts ° If you… When giving information try: ° It’s a Fact ° Did you know…? When providing guidelines on seeking professional help: ° Five Reasons to Call a Doctor ° Warning Signs ° If you are worried… ° You need help if… ° Seek help when… Be careful not to overuse boxes. Articles must be fitted around the important income-generating advertisements. Part of your planning will involve working out how many words you want to allocate to each section of your work. As you start to write you may 312 WRITING SKILLS IN PRACTICE find that you have to adapt your plan so that some sections are longer and others shorter. If you find that you have strayed over the word length, try to edit your work so that it is more concise. For example, ‘your headings’ uses fewer words than ‘the headings you use in your manuscript’ but still retains the meaning. However, if this is not possible you will have to consider omit­ ting some of the content itself. Select minor details that do not affect the overall meaning of the piece. In general, headings help: ° to provide a framework ° to break the text into shorter and more manageable sections for the reader ° as signposts to help the reader find specific information ° to signal a change in topic ° to help the flow of the article. However, be aware that the editor may need to change your headings in order to fit your piece into the available space. This is often achieved by the use of short sentences written in the active rather than the passive voice. This will influence your choice of language and the way in which you express ideas. You will not be able to assume an underlying knowledge base in the same way that you can when writing for other professionals. For example, you may safely assume that many female readers will understand the term ‘oestrogen’, but they may need an explanation of ‘androgens’.

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He denounced politicians who indulged in the ‘facile rhetoric of healthism’ which ‘increased their popularity at no cost’ and ‘enhanced their power to control the population’ (Skrabanek 1994: 16) 10 mg zetia with visa. He reminded doctors that medicine was ‘not about conquering diseases and death cheap zetia 10 mg, but about the alleviation of suffering generic zetia 10mg, minimis-ing harm discount 10mg zetia overnight delivery, smoothing the painful journey of man to the grave’ (Skrabanek 1994:22) order 10 mg zetia. He also reminded them that they ‘had no mandate to be meddlesome in the lives of the well’. In his first book, written in collaboration with James McCormick and published 84 THE POLITICS OF HEALTH PROMOTION only five year earlier, Skrabanek had challenged the notion of ‘prevention as a crusade’, which reminded him of ‘the ideological simplicity of the quasi-religious crusades against the old enemies, sex, drugs, gluttony and sloth’ (Skrabanek, McCormick 1989:108). The authors condemned ‘the self-righteous intolerance of some wellness zealots’ with their policing of lifestyle, denial of pleasure and preaching of a modern form of asceticism. This vigorous defence of personal liberty against state coercion and professional puritanism stood in marked contrast to the left’s casual endorsement of authoritarian health promotion policies (indeed radicalism on the left was measured by the scale of demands that the state go even further). Skrabanek and his colleagues also advanced a devastating critique of the abuse of epidemiology and statistics by the advocates of the new public health. These publications clarified the confusions about association and causation, relative and absolute risk which, as we have seen, have played a major role in the rise of health promotion in relation to diet and CHD, passive smoking, and other controversies about risk factors and individual behaviour. They also exposed other examples of statistical scams and tendentious arguments used to justify interventions in lifestyle and screening programmes in relation to a wide range of diseases. The radical statisticians of the left identified so closely with the new public health movement that they were incapable of challenging the specious statistics on which much of the movement’s policies were based. Though the conservative critics of state health promotion provided a valuable service in challenging its authoritarian character and in exposing its cynical manipulation of epidemiology, their attempts to explain the origin of this policy were unsatisfactory and incoherent. Whereas Skrabanek denounced The Health of the Nation policy as ‘health fascism’, Bruce Charlton considered that it resembled ‘a Soviet-style command economy’. The term ‘health fascism’ became popular in tabloid attacks on health promotion, which often focused on Virginia Bottomley who became something of a hate-figure for the Tory right. But Bottomley and Major seemed unlikely Nazis and the rhetoric of ‘informed choice’, ‘non- judgemental’ counselling and ‘empowerment’ that permeated official health promotion appeared far removed from the language of fascism. More importantly, though considered objectively The Health of the Nation had an authoritarian character, it was not perceived as coercive by the vast majority of people. The instinctive 85 THE POLITICS OF HEALTH PROMOTION distaste for health promotion expressed by right-wing libertarians was understandable, but it also reflected their distance from the subjectivity of the British public. Charlton’s parallel between The Health of the Nation and Stalinist ‘command and control’ bureaucracy, with its plans and targets, had an immediate appeal (though Anderson’s epithet ‘food Leninism’ seemed rather forced) (Anderson 1994). While conservative ideologues have never had difficulty in equating fascism and communism, they had a bigger problem reconciling the notion that the government had adopted a state socialist strategy towards health promotion at the very moment that its wider reforms of the health service were proceeding under the influence of an extreme version of the ideology of the free market, as expounded in Working for Patients (DoH 1989). As Charlton recognised, these appeared to be ‘two distinct, and perhaps irreconcilable, philo-sophies of what the NHS is and what it should be’ (Charlton 1994: 51). Behind The Health of the Nation, he discerned a ‘peculiar alliance between the free marketeering right wing and the revolutionary left wing’ (Charlton 1994:55). Of course, no such alliance took place, not least because, by the early 1990s, both these familiar poles of twentieth-century politics had, for all practical purposes, ceased to exist. This made it quite possible for a pragmatic government to synthesise elements from different political traditions (an approach systematically pursued by New Labour under Tony Blair). Though in its twilight phase the Conservative government undoubtedly adopted some irrational measures (such as, for example, the Poll Tax), there was, as we have seen, a coherent thread running through its policies in the sphere of health. In practice, there was no contradiction between The Health of the Nation and Working for Patients. The common theme of both documents was the promotion of individualism, in personal behaviour and in the provision of healthcare. Ironically there was more scope for this under the state-led health promotion policy than there was under the ‘quasi-markets’ in which competition between ‘purchasers’ and ‘providers’ was supposed to flourish. In these documents, which were both given high-publicity launches, style and symbol were as important as substance. In the Health of the Nation, socialist rhetoric provided a popular packaging for an essentially individualistic policy; in Working for Patients, free market rhetoric gave the impression of a more radical restructuring of the NHS than actually took place. The paradox of the new world order of the early 1990s was that, when the state had been rolled back and socialism crushed, the result was not a society of robust and intrepid entrepreneurs, but one of weak and vulnerable individuals.

This page intentionally left blank Introduction Alternative and complementary therapies are a popular form of health care in the Western world (Eisenberg et al purchase 10mg zetia visa. There are numerous therapies available and a variety of commercial outlets stock a plethora of vitamins cheap zetia 10 mg amex, herbal remedies purchase zetia 10mg line, and other types of alternative health care products purchase zetia 10 mg amex. A range of venues pro- vides information on healing groups and zetia 10 mg mastercard, in some cases, holistic health associations have centralized access to alternative therapies. Popular media, including television, radio, magazines, and newspapers increasingly feature these approaches to health and healing (Anyinam 1990). For example, in a search of selected popular print media in Canada I found almost four hundred entries for alternative health care between January 1995 and 1997 alone. In addition, there are hundreds of web sites devoted to discussion of alternative and complementary health care on the Internet (Achilles et al. This book concerns the experiences of Canadians who use alternative therapies. The first large-scale survey of the use of alternative approaches among Canadians was carried out by the Canada Health Monitor (1993), who found that 20 percent of Canadians reported participation in alternative forms of healing. Subsequently, in their survey of fifteen thousand Canadians for the Fraser Institute, Ramsay et al. Further, it is likely that the use of alternative health care in Canada is under-reported simply because a significant number of people remain reluctant to disclose their use of these therapies to others, especially their doctors (Eisenberg et al. For example, a 1997 Angus Reid poll showed that Canadians invested almost $1. Additional evidence for the popularity of alternative health care in Canada includes the number of courses in alternative therapies available. For instance, in September of 1998 one Canadian community college held weekend workshops and courses on a variety of therapies, including ear candling, mystical healing gems, herbalism, homeopathy, Chinese medicine, and shiatsu massage (Mohawk College 1998:156–59). By 2003, the same college not only offered several workshops or courses in complementary therapies, but also provided a certificate programme in aromatherapy, and was in the process of developing a diploma programme in herbal medicine (Mohawk College 2003a, 2003b). There is also evidence that participation in alternative therapies in Canada is on the rise (Achilles et al. For example, Northcott and Bachynsky (1993:432) found that “annual usage of alternative health care therapies (other than chiropractic)... Likewise, the number of alternative and complementary therapists in Canada has increased, and it is estimated that there are approximately twelve thousand licensed alternative practitioners in Canada (Achilles et al. The number of actual alternative and complementary practitioners in Canada is impossible to determine, as many practitioners—such as aromatherapists or reiki practitioners— remain unregulated and undocumented. Clearly, alternative therapies are an important part of Canadians’ health care regimes and their use of these approaches to health care is deserving of deeper analysis. Introduction | 3 Despite the number of people participating in alternative approaches to health and health care, very few sociologists have examined individuals’ experiences in using these therapies. Rather than focussing on alternative practitioners or the therapies themselves, this book provides the reader with a detailed understanding of the subjective experiences of the Canadian user of alternative approaches to health and healing. I explore how and why the people who took part in this research come to use alternative therapies, the ideology that informs the alternative models of health and healing they espouse, and the impact on them of the ideology underpinning these models. The people who spoke with me sought out alternative health care in order to solve problems for which they found little or no redress in other quarters. They began using alternative therapies through a variety of different points of entrée, including encounters with friends, family members, and the media, among others. Once involved in using these therapies, they developed ever-expanding networks of alternative health care composed of alternative practitioners and lay users of alternative therapies. In participating in alternative health care, and in interaction with others who use it, these people began to take on alternative ideologies of health and healing. For some, these ideologies became a mechanism through which they transformed their subjective perceptions of health status for the better. Quite simply, despite experiencing what is serious physical disability or disease, these people are able to see themselves as healthy because they are engaged in the process of healing. Others became so enamoured of alternative ideology that they sought training to become alternative practitioners themselves.

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