Patients who "cheat" and drive home - page 5

by Lilme04

14,287 Views | 62 Comments

I work at an endoscopy center (and a freestanding surgery center). A few times, we've had patients lie to us about how they are getting home, and they've ended up returning to their cars, and driving home. Of course we find this... Read More


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    Here's what happened to me. I was sedated to have three impacted wisdom teeth extracted. My friend was to drive me home a 3:00pm. She had to be at work by 4:00pm. So she dropped me off at noon. The prcedure was to be started at 12:30. It wasn't started until 2:00pm. There in lies the problem. I had no way to get home except for hoofing it. So I didn't "cheat" I was cheated in this situation.

    To answer the orginal question. Our patients spend the night for no charge if their ride doesn't show up. After all we just cannot let the cats, birds, ferrets, snakes, rats, and dogs loose. That would be illegal in this area. Not to mention unethical. The second and subsequent nights are charged to the client.

    Fuzzy
    maelstrom143 and morte like this.
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    Quote from RNsRWe
    By the way, when YOU eventually HAVE a license to lose, as I see you are still a student, perhaps you will view things differently. I hope, at least, you'd be far less judgmental of those who DO this job.
    You don't have a clue who I am, or what my experience is, beyond the fact I'm a student nurse. You don't know what I've done in my many years in the corporate world, what positions I have or have not worked in in healthcare, what volunteer work I do in my community. I don't have to be a licensed nurse to have experienced the problem being discussed and formed an opinion about how we should be delivering health care in this country.

    I understand that the nurses have no option but to follow the procedures outlined by their facility and the orders given by the docs. I believe we should, however, try to identify barriers to health care delivery and try to come up with solutions. I think several really good ideas have been floated in this thread, and I hope that conversation here eventually makes its way to the people who make the decisions, because we're talking about a real issue and floating some do-able solutions.

    You said, "it's a non-issue, really" because your center simply doesn't do the procedure if they don't do what they were told, and well they had plenty of notice. There is a large patient population for whom no amount of notice is enough because they simply have no access to the transportation and aftercare that's been specified. You have no clue how many people simply don't have care that they need, because they don't have access. Just because a procedure is "elective" doesn't mean it's not critical to their health care. The fact that your elite facility just doesn't have to deal with that patient population doesn't mean that it's not a problem, or that your facility's response is good for health care as a whole. Hence my observation that ** your statement ** was short-sighted and privileged. I criticized your RESPONSE, not you as a person.
    llg likes this.
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    I don't need "a clue" as to who you are, what you have done outside of being a student. As you don't really need to know my CV either. It's irrelevant to the situation at hand, in which you criticized how I responded to something when it was NOT what I was actually discussing. You criticized my response to a problem YOU perceived as being THE problem. But the OP didn't ask about that at all. I responded to HER question about what to do with some patients in a specific setting--one we seem to share-- not YOUR pondering of how to fix the national crises in healthcare.

    I wasn't responding to the problem of "what is wrong with healthcare in this country that patients have trouble getting procedures they want because of the liability issue". I responded to "what do you do if you have patients that 'cheat'" with what WE DO.

    You turned it into my apathy for patients on a national basis, who don't have access to healthcare for a multitude of reasons. NOT the OP's problem at all. NOT MY basis of response.

    Seems like you needed to debate this perhaps in a different thread? Or, if not, don't attack my position as "short sighted and privileged". It just doesn't relate to what YOU wanted to discuss.

    I'm not criticizing you as a person either. By noting that you are a nursing student instead of a practicing nurse, I'm simply pointing out that experience AS a working nurse (regardless of one's previous life experiences) will either give you greater insight OR, at the very least, give greater weight to your position when debating with nurses.

    Funny thing is, I don't disagree in the least with what you are saying. I only take issue that you have taken my response out of the context in which it was given, and turned it into something that looks disagreeable. In fact, we DO agree on the national/patient care needs level. However, the OP wanted to know how others would handle this problem---and I told her. Period.
    Altra likes this.
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    Quote from Fuzzy
    Here's what happened to me. I was sedated to have three impacted wisdom teeth extracted. My friend was to drive me home a 3:00pm. She had to be at work by 4:00pm. So she dropped me off at noon. The prcedure was to be started at 12:30. It wasn't started until 2:00pm. There in lies the problem. I had no way to get home except for hoofing it. So I didn't "cheat" I was cheated in this situation.

    To answer the orginal question. Our patients spend the night for no charge if their ride doesn't show up. After all we just cannot let the cats, birds, ferrets, snakes, rats, and dogs loose. That would be illegal in this area. Not to mention unethical. The second and subsequent nights are charged to the client.

    Fuzzy
    Your situation sucked, no doubt. The problem, of course, is that your procedure started 1.5 hours late, something that doesn't happen in my world. YES, I KNOW it happens (for those who will point that out) but I'm not sure what we'd do, because it DOESN'T happen that we have a 1.5 hour late start at our ASC. My best guess is since it wasn't that you would have driven yourself home (you didn't have a car there!), but that there was no one to TAKE you home, we might have made a bunch of calls on your behalf to see if there was anyone you knew we could get to come for you. Barring that, I'm a bit stumped. We've had people hang out in our waiting room for an hour or more, waiting for their rides to come for them.

    As for your own way of handling the "no shows", lol....yep, I think it'd be a tad bit of a problem if your "patients" made their own way home!
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    RNsRWe, you are spot on. There is a huge difference between the real problem--HEALTH CARE IN AMERICA--and our dilemma as we try to manage the daily fall out. In my setting, the procedure is not started unless the patient has an appropriate way to get home. End of story. I understand this may not work in all settings.

    In response to Fuzzy, medicine is a business in America. Not all facilities can afford to keep patients overnight for free. If they can that is great. If a patient at the time of checkout has no option but to "hoof" it home, a taxi would be a preferable alternative.

    Another thought. For those of us working in a public system, not all of our patients are the greatest at accepting personal responsibility. We see patients from every social strata. Sometimes they have resources they have not explored, and with our assistance can become more independent in advocating for themselves.
    maelstrom143 likes this.
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    Quote from trufflelilyRN
    RNsRWe, you are spot on. There is a huge difference between the real problem--HEALTH CARE IN AMERICA--and our dilemma as we try to manage the daily fall out. In my setting, the procedure is not started unless the patient has an appropriate way to get home. End of story. I understand this may not work in all settings.
    Exactly what I was trying to get across.

    In response to Fuzzy, medicine is a business in America. Not all facilities can afford to keep patients overnight for free. If they can that is great. If a patient at the time of checkout has no option but to "hoof" it home, a taxi would be a preferable alternative.
    well, I think the overnight thing isn't so much a problem in Fuzzy's facility, ans she must work in a veterinary office -- her patient list included four-legged clients, lol! Our ASC closes and locks the doors, lights out, there IS no overnight option, period. No humans can stay for any reason whatsoever--we all go home!

    Another thought. For those of us working in a public system, not all of our patients are the greatest at accepting personal responsibility. We see patients from every social strata. Sometimes they have resources they have not explored, and with our assistance can become more independent in advocating for themselves.
    Bingo again. We often do make calls on the patient's behalf to get them rides, if they look like they're going to be stuck and we won't start without knowing there's a safe way home. It's pretty darned rare, though, as it's known that we won't do the procedure UNLESS there's a plan.
    maelstrom143 likes this.
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    The oral surgeon's office closed at 5:00pm. There was a plan. that plan went bad when the procedure started late. I was new to the area so had no one else to call. I guess I could have called the police and asked for a ride home. Next time I will or I will leave if I have to wait more then 15 minutes. I have learned to do with regular doctor's appointments. I'm older now so I know what is best for me.

    Yes, I do work in a veterinary hospital. There are many days that I feel that I treat my patients better then I'm treated in the human medicine system.


    Fuzzy
    maelstrom143 and trufflelilyRN like this.
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    the bottom line, to me, is that if these patients require this much attention after the fact of the procedure, the procedure should not be done on an outpatient basis. Problem solved.
    Altra and llg like this.
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    Quote from morte
    the bottom line, to me, is that if these patients require this much attention after the fact of the procedure, the procedure should not be done on an outpatient basis. Problem solved.
    It's not that simple...it's not that they require actual nursing care, it's that the anesthesia meds make it so they cannot safely/legally drive themselves. Standard is no driving for 24 hours, although I'm sure you'd find variations in policy in different regions or States. Our anesthesia group has them sign the DC form for no driving for 24 hours. Do people ignore that and drive hours later? Of course. Some stupidly so (I read about one in the paper recently, actually). And some navigate quite well, despite the meds.

    They don't need inpatient care. They just need someone to take the wheel.
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    Quote from RNsRWe

    They don't need inpatient care. They just need someone to take the wheel.
    Then what's the problem with a taxi??
    redhead_NURSE98! and morte like this.


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