Does EVERY LIFE really count?? - page 2

How do you deal with situations where you know the Docs are not giving aggressive care to a patient? You know those patients who "fall through the cracks" or for whom someone decides that they... Read More

  1. by   deeDawntee
    Quote from Balder
    I'm not trying to be inflammatory or anything here, and you have far more experience than me, but what about advocating for your patient?

    Isnt that the next most important thing to actually providing care?
    Yes you are absolutely right, but it is just not that black and white. For me, as a relatively new ICU nurse, now understanding more and more what should and could be done, I can see looking back where some treatments were not done. Unfortunately, if you confront a Doctor about his care, he will probably write you up and generally make your life miserable.

    In the case about the intubation, I will not know what happened until I go back to work and even then, won't really know because I wasn't there. It is illegal for me to look back at the medical record, so my hands are really tied in what I can do. I will have to count on other nurses letting me know, if they even remember the situation and then it is only hearsay.

    Unless I directly see neglect on "my watch" or have access to the chart because the patient is currently mine, I have little recourse.

    I will check out the whistle blowers protection and also look into the anonymity of the ethics committee at my hospital.

    It is all very complicated and legally intertwined with HIPPA laws etc.
  2. by   banditrn
    Maybe it's a regional thing, because I never observed docs at our hospital treating those without insurance or anyone that was 'disabled' in a lessor way.

    I do know that several of them treated patients who couldn't afford it for free. I remember one of my favorite surgeons talking to a patient one time - and he asked her if paying his bill was going to be a hardship for her - she told him yes, so he said not to worry about it then, that he just wouldn't bill her.

    I almost cried, and when I told him that I thought he was a darn good man for doing that, he just poo-pooed me and told me that he'd just write it off.

    I do have to say that, as a nurse, the patients who tried to mistreat me were, for the most part, the non-paying patients or those on medicaid. I seldom had that same behavior from those with insurance.
  3. by   walk6miles
    In most facilities I have worked in, the fault was not under treating (DNR doesn't mean do not treat) but rather, over treating. I found this to be the case especially with no family or care-taker. A terminally ill patient (mets CA) is pegged, trach'd, sometimes even Swanned, arterial line, etc. because no one wants to say, enough!! Hospice!

    I think we have all seen enough to know that if you want your wishes carried out, you had better hire the meanest, stubbornest, most straight forward personal representative your money can buy.

    I have a daughter in ICU who countermands EVERY wish her mother states to the physcians... she grabs them by the arm and leads them out of the room where she tells them "I am in charge (she doesn't have POA) and you'll do what I say or I will sue". Quite awful and unethical and illegal!
  4. by   Jo Dirt
    I've learned life is cheap when you're poor. Wherelse would great lengths and efforts go to keep an 80 yr. old tube fed vegetable alive while the young uninsured mother is left to die from something that could have been treated?
  5. by   deeDawntee
    Quote from walk6miles
    In most facilities I have worked in, the fault was not under treating (DNR doesn't mean do not treat) but rather, over treating. I found this to be the case especially with no family or care-taker. A terminally ill patient (mets CA) is pegged, trach'd, sometimes even Swanned, arterial line, etc. because no one wants to say, enough!! Hospice!

    I think we have all seen enough to know that if you want your wishes carried out, you had better hire the meanest, stubbornest, most straight forward personal representative your money can buy.

    I have a daughter in ICU who countermands EVERY wish her mother states to the physcians... she grabs them by the arm and leads them out of the room where she tells them "I am in charge (she doesn't have POA) and you'll do what I say or I will sue". Quite awful and unethical and illegal!
    That is a VERY good point Walk, that happens as well...it is sooo frustrating. What about equity, what about seeing things fairly?
    I need help getting over this because it is definitely affecting my sense of making a difference and my joy in my career.
  6. by   Alpha13
    I think this is an area where the idealism of nursing theory seperates from real world practice. Healthcare is a business just like any other and has limited resources. In the real world sometimes you just have to "let the bad apples rot" to protect the good ones.
  7. by   TheCommuter
    Quote from Alpha13
    In the real world sometimes you just have to "let the bad apples rot" to protect the good ones.
    People are not automatically "bad apples" because they're either poor, mentally ill, uninsured, underinsured, or noncompliant. Regardless of one's circumstance in life, past history, or ability to pay, the poor man's life is worth just as much as the rich man. The poor man should not be labeled a "bad apple" because he possesses less money and resources than the rest of us.
  8. by   SuesquatchRN
    Quote from TheCommuter
    People are not automatically "bad apples" because they're either poor, mentally ill, uninsured, underinsured, or noncompliant. Regardless of one's circumstance in life, past history, or ability to pay, the poor man's life is worth just as much as the rich man. The poor man should not be labeled a "bad apple" because he possesses less money and resources than the rest of us.
    I'm choosing not to read what she said as you interpreted it. I hope I'm right.

    That said, I think we go to far. We keep infants alive with anomalies that are incompatible with life and a good life because - why? We can? As to the old ones that are kept going and going and going....
  9. by   piperknitsRN
    If there is an ethics committee at your facility, you may wish to contact them with your concerns. I worked at a facility where this option was possible, and the ethics committee dealt specifically with these concerns; I believe there was some degree of confidentiality involved to protect the identity of the provider who alerted the committee to the circumstances, as well.
  10. by   jbp0529
    Quote from deeDawntee
    How do you deal with situations where you know the Docs are not giving aggressive care to a patient?

    You know those patients who "fall through the cracks" or for whom someone decides that they will not do all that is possible? I am not talking about the end stage diseased patients for whom nothing we do will save them, I am concerned with patients with mental illness or disabilities or patients from poverty for whom it is obvious that only so much treatment will be done for them. I believe I have seen several of these cases and it is really disturbing me. I don't feel that I can give details, because the patient's identity may be discerned, but I hope that some of you can share if you see this and how you deal with it.
    When there is an issue, we as nurses at my facility can contact the ethics committee to come and eval the situation. Has helped more than several times.
  11. by   Ruby Vee
    Quote from deedawntee
    how do you deal with situations where you know the docs are not giving aggressive care to a patient?

    you know those patients who "fall through the cracks" or for whom someone decides that they will not do all that is possible? i am not talking about the end stage diseased patients for whom nothing we do will save them, i am concerned with patients with mental illness or disabilities or patients from poverty for whom it is obvious that only so much treatment will be done for them. i believe i have seen several of these cases and it is really disturbing me. i don't feel that i can give details, because the patient's identity may be discerned, but i hope that some of you can share if you see this and how you deal with it.
    granted, i've always worked in tertiary teaching hospitals, but i haven't seen that many patients "fall through the cracks." mental illness, poverty, poly substance abuse, total lack of compliance -- no problem! we'll just stick this biventricular assist device in you (so you can't leave the hospital anyway and compliance won't be an issue) and you can spend the rest of your miserable life in our icu being tortured with procedures and dialysis and multiple harsh drugs for multi-drug resistant bugs at the taxpayer's expense!

    healthcare costs are spirally out of control, and the money that we're using to keep some few patients alive with vads, balloon pumps, multiple surgeries, etc. could have purchased basic healthcare for half of the town! and maybe we should be choosing to spend our health care dollars that way. in fact, maybe we should be choosing how to spend our health care dollars rather than just throwing money at some poor indigent in the last days of his life.
  12. by   ASSEDO
    Interesting topics. I see over-utilization more than under-utilization. Sometimes a decision needs to be made to pull the vent, instead of letting a patient rot on the vent. The outcome would be the same, only quicker.

    As far as low income, I see families in all walks of life making weird decisions. Today an elder lady was dumped at our ER as the family wanted her to go to a nursing home. The hospital could not admit her, because she did not meet medical necessity to be inpatient. Family didn't want her because of dementia. Family refused to pay for a sitter.
  13. by   talaxandra
    We don't have quite the same divide between non-insured and insired in Australia - or at least, not yet. But I do see a difference between the way patients with and without family/advocates are sometimes treated.
    What I'm more aware of at the moment, because I've got a patient in the situation presently, is the difference the assertiveness and English skills of the family make to how paternalistic the medical treatment is.

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