Socialized Medicine/Nursing - page 4

Hi everyone. I am especially interested in how nurses are treated in the UK and Canada. I feel the US is moving more and more toward socialism, more taxes, more regulations, more government... Read More

  1. by   LRM
    Got to agree with you Lee about the military system, yes it is a socialist system but you are right that the pt has little control & there is a reduction in accountability (worked as civilian in army hospital & it was like being a fly on the wall, very interesting!)

    Also, why are we stereotyping the rich & poor, do ALL rich people let their loved ones die & ALL poor people try every avenue to prolong life? Come on guys, we can do better than that, judgemental & stereotypical statements are unethical practices.
  2. by   snickers
    hey Bunky....
    I now work in a critical care area, however I've spent the last hundred years working on the floor. i talked to nurses who work on the floor, just to make sure that I had the patient numbers right. On the general medical floor on a night shift there is one rn with licensed practical nurses for 13 patients.On the internal medicine unit, there are 3rns and i lpn. The patients on this unit are renal, with ongoing hemo and peritoneal dialysis. It also includes cardiac patients, chemo telemetry(10),There is a charge nurse on both these units from 7-3, each of whom have no patient load. They deal with all the docs concerns, get all outdated meds re ordered and generally keep the docs up to snuff. On a daily basis there are Quinton catheter, tenckoff insertions, renal biopsies occurring on the floor with the floor nurses assisting. The internal medicine unit is 26 beds.The nurses are responsible for the telemetry,although they are out on the floor, not at the station monitoring.On the night shift there is an rn who is in charge
    and also has an 8 patient load.(We get 1:25/hour for i.c.)!!!

    In terms of charting,there are flow sheets with various system assessment. A head to toe assessment is done on all patients on admission, each 12 hour shift and prn.The cardiac patients require daily and prn vitals that are done by the rn and then charted by the lpns.
    The renal patients are mostly bid lying and standing b/p.s...or lying sitting.They are also all daily weights...many bed scale.

    In terms of the lab work. Nurses don't do any lab draws on the floors here.It is all done by lab techs. They are phoned for stats, or computerized req's for ongoing. There are also unit clerks on the units from 07-2100, who do all the lab reqs, booking of tests etc, which they transribe onto the kardex.
    CBGM"s are done by the lpns and transribed onto the diabetis record by them. Anyone on tpn is qid cbgm(glucometer)
    In terms of transribing new orders...the unit clerks do all of that, on the hours they work, after they are gone...then its up to the nurses. The sicker a pt, is on a night shift, the more orders are gotten and then transcribed and then co-signed by another rn.
    All the patients have a primary care doc (gp) on the internal medicine unit all patients are referred to an internist, depending on what their speciality is .gps don't generally write orders , just comment in the progress notes. There can sometimes be 4-5 docs involved in the same patient.
    Mars....pharmacy generated computerized mars that are sent up on Thursday night (around 2230), Nurese on night shifts check and cosign all the mars. If anything is amiss it is the nurses job to fax memos to pharmacy with the correct info.
    meal breaks....Most of us work 12 hour shifts. We are entitled to2 half hour meals breaks and 3- 15 minutes coffeebreaks in that time. One of our coffee breaks is supposed to come after our supper break it's too late by then, so we take a1/2 hour coffee break instead, if we miss a meal break, then we put in for over time(double time) we can't claim for missed cooffee breaks, so if we miss a coffee, we add the 15 minutes to our next break.All breaks are supposed to be taken away from the floor, if one has to stay because of inadequate staffing, then it is not considered a break.
    Benefits...We have medical benefits...going to a doc, or any of my family going, does not cost me any money(the employer pays that, we also have extended benefits that cover a large majorityof what isn't covered by medical....physio, medications, anything above and beyond we are covered80% for extended benefits, we have dental coveragefor the family, it covers 100% of basic plan(cleaning hygienistsetc., 60% forcrowns and bridges,dentures and 50% for ortodontia up to a maximum of 1850$, there is no limit on the preceding three.
    Inderal costs 14.95, for 100 pills,,,that is claimed back at 80 percent.
    Eyeglasses arecovered under the extended benefit package. Children under the age of 16 can see an optometrist q12 monthly,(its covered under medical and q24 months for adults). These benefits are all paid by the employer to any FT employee after 3 months.I think that casuals , once they work 700 hours, and if they have had to pay out any money for these services, then they are reinbursed. Don't forget that when I refer to the employer I mean the government(Provincial), I believe each employees full benefit package is worth about 400 dollars/per employee/ per month.We also have 2 pension plans that we pay into as well, When we retire. the hospital matches the money we have contributed.
    Anyway, I think I've answered about half the questions you asked ...I will finish with the next post.

    sj.
  3. by   bunky
    OK LRM, you are right. We are making what sound like stereotypical statements but I want to clarify that no where did I say "stupid"! There is a HUGE difference between being stupid and having a lack of knowledge! My point in talking about it was that KNOWLEDGE IS POWER! In terms of knowledge, the layperson person gains knowledge concerning their health through their physician! If a person can't afford to go to the doctor then they lack that knowledge until they have to get a crash course in it! If someone is well aware of their disease condition in the beginning, the treatments and prognosis, they are in a better position to make informed choices in their care and have realistic expectations of their care! Generally speaking, people who can not afford health insurance do NOT seek care until their symptoms are severe because of the cost! This is not their fault, nor is it fair. Study after study on the effects of poverty and health says I am right on this, so I DO stand behind my statement on it. Many times it is a choice between going and having something checked out, or buying groceries. In a socialized medical system this decision between buying food and paying rent over seeing a doctor isn't an issue! Sometimes when it comes to end stage illnesses, it may even be lack of the knowledge that they CAN say NO! As a nurse I am not allowed to stand behind a doctor who is suggesting surgery and shake my head emphatically and make throat slitting motions behind his back! And my idea about G-tube insertion is this: In an end stage illness patient who is unresponsive, thus no longer able to eat, I feel that had loved ones been informed and prepared for this eventuality all along (as is what occurs with ROUTINE CARE BY A PHYSICIAN,) the decisions made would be paliative ones. I am not talking about temporary peg tube placement in a person who is expected to gain back a reasonable quality of life through rehab! I am talking about people who are actively dying! I don't feel that the decision to "lean more toward life" as it was so romantically, and dramatically, put is an INFORMED decision in these circumstances! And I see this a lot!

    As for the military system in this country. I have a little bit of knowledge from experience with it, (American loved one misdiagnosed and treated for a serious,non- existant illness until second opinion obtained)and realize that there ARE definate problems, but I also live in a military town with 5 military bases. Two of the military hospitals here have outstanding records and are used by civilians. One is a world renowned burn center, and one is a first class trauma unit, so there are some positive sides to this! I merely pointed out the military idea as an example of socialized medicine existing here. I am well aware of the unaccountability of certain physicians in this system, but what can you expect from a military that once paid $600 a piece for toilet seats! LOL

    Now, Ms. Snickers, thank you for all the answers thus far. Do you consider your benefits to be good by comparison to others in your community? From the sounds of it your staffing is about the same as here, and I am going to wait until you are done before I give you a comparison on protocols here and charting etc. I think you are going to be quite surprised.

    [This message has been edited by bunky (edited June 27, 2000).]
  4. by   snickers
    and now the rest of the story......
    g-tube feeders....not too many generally, maybe one or two a month. Quite a few keofeed tubes though, ,checking residuals q4-6h and charting of same.
    corpses....nurses spend a lot of time getting "no code orders " on elderly non functioning patients..
    The majority of family members treat nurses well, the ones who are unreasonable and complain a lot...I refer them to administration, to vent their concerns. The emerg nurses put up with a lot of s--t and abuse,with the frequent flyers,.The patients generally treat the nurses well...I sometimes have to remind people that the hospital is not a hotel....
    The paperwork required with an admission is a three page (doublesided) admission database.It involves a head to toe assessment,weight, height, vitals. The 2nd page is a "have you ever had" list of diseases, previous surgeries(relevant to this admission).
    The 3rd sheet is mainly a social questionaire..(previous capabilities before admission, in an attempt to address the elderly situation...whether or not they use any community resources or hospital resources., basically so when they are discharged they are plugged in to the system and hopefully their admissions are not so frequent.The whole thing from start to finish generally takes,20-30 minutes,
    No, the place where I work doesn't try to simulate icu units on a 1st aid budget.
    It is a social system, whatever surgeries that need to be done,are done,Whatever care needs to be done is done.We have no idea as to the cost of procedures,because it is all covered under medicare.Some procedures are beginning not to be covered and people are beginning to have to pay out of pocket ie: plastic surgery that is wanted,not medically required.We receive monthly lists of what supplies costs, just a fyi thing, but the patients are not billed individually for all those things, Hence it seems that nurses place little monetary value on the supplies we use...we use what needs to be used.
    When we have pts. that are from outside of Canada, and they want a breakdown of their medical costs(for their insurance companies,) it never ceases to amaze me as to how much things really do cost.
    I've never worked outside of Canada, so I have no basis for comparison to the American system.I do know that if people don't have medical coverage(most do), then the application is somehow back dated, so that the admission and treatment is covered under medicare,the social workers handle that. We are starting to see more
    docs balk at providing care, if the person doesn't have medical coverage, however, no-.one can legally be refused here, because it is a "universal system".
    What we are experiencing is, huge waiting lists for all types of surgeries, and that is Canada wide. Many of the acute care beds in B.C. are being taken up by elderly patients awaiting placement in long term care places. But there are no long term beds, or extended care beds being built, hence the acute care system is bogged down with"alternate level care patients".The patient population in many extended care and long term care places is changing.It used to be mainly the elderly, now, many beds are being taken up by young head injured people,(blown out their brains on drugs, or mva's,,,with that, an increase in aggressive and violent behaviour that nurses must contend with. Emergency department hallways are lined up with people on stretchers awaiting care, there just aren't enough beds(because of the elderly taking up the acute care beds.!
    So anywayPPL and Bunky, hope Ive answered your questions....
    Good luck to ya all.

    sj.
  5. by   snickers
    Yup, I make good money and have a great benefit package......FOR A WOMAN!!!!!!!!!!!
    Plumbers make 35 dollars an hour, mllworkers at the pulpmills make 35.00 an hour. Electricians make about 45.00 dollars an hour.The other thing I just found out, is that long term care aides make 20 bucks/hr and lpn.s make21bucks an hour. I make26.50 and have all the responsibility.However, that is a union issue that will hopefully be addressed in our next contract.Don't forget Bunky...we have nursing unions in all the provinces in Canada.
    Look forward to hearing from you soon.

    sj.
  6. by   bunky
    Thank you snickers for your answers. Now I will do a partial comparison as I have to get to bed, and I am sure that PPL may have a thing or two to add to this. In CVICU where I worked last week, each patient was assessed and flow sheet filled out at 7,11,3 round the clock, full head to toe, and EKG's. Vitals are done continuosly and recorded q2 by protocol and PRN changes as well as a narrative entry in the nurses notes Q2 and PRN changes. Stat labs are drawn by the nurses, and there are a lot of them. On the surgical unit where I normally work, we do head to toe flow sheet assessments q8, are expected to chart a blurb with them on the narrative, as well as chart on them q2 and PRN changes. On our flow sheets we are expected to sign or initial things like that we turned them every two hours, did ROM with them q2, we checked there IV site every 4, IV tubing changed (protocol is q3d and they are to be labeled on the tubing so why we have to put it on the flow sheet is but another mystery to me) as well as all the rest like visitors present, spec sent to lab, use of infection control measures etc. We even have to check off q8 that plan of care was discussed with the patient and their reaction to it. Our vitals are done q4, and we draw all stat labs, as well as getting out our trusty glucometer and testing blood sugars, usually AC and HS, and give regular insulin by sliding scale if needed according to the sugar. If a diabetic is NPO we do it q6h, and I'd guestimate that 95% get this kind of glucose monitoring even if they are only on oral hypoglycemics. On any given day, we have at least 8-10 diabetics out of average 24 patients. We on nights, have computer printed MARS sent up by pharmacy EVERY SINGLE NIGHT, and every night we must go through them all and check them and put the old ones in the chart, and the new ones in the MAR book. With our new staffing grid, which we are not allowed to see, we were to be given 2 RN's and an nurses aide for 23 patients the other night but the supervisor felt bad and gave us three RN's with no nurses aide. Every night we are expected to evaluate the care plan and add to it. We do all of our own vitals on nights. We get maybe one DNR every few weeks, no matter what condition these patients are in. We have at least 2 G-tube feeders on the floor a shift, we have more nursing home residents and with medical problems than we do surgical patients. We are still expected to chart as though they are all acute surgical. On day shift in particular we almost NEVER take our breaks, receive no compensation for not taking them, because THEN you'd get in s--t for it although there is no offer that those giving you s--t will cover your patients for you. If you claimed it on your hours you'd be spoken to about poor time management skills. THEY know you aren't getting to take your breaks! So long as you don't complain about it, then everyone just accepts that it's too busy and no one bats an eyelash. The admit forms sound similar but in addition to yours, here they get us to screen for such things as sleep apnea, and TB! We must also complete a pt education record and keep up with it during their entire stay. Each patient has a new nurses note and flow sheet attached every day to be used for the one day only and filed in the chart. We are expected to do daily weights for pt's with g-tubes and for cardiac patients (although why a CHF who is not a DNR is on a surgical floor with no tele capacity is a mystery to me). We see a lot of TPN on the floor too. Oh and each nurse notes all the orders on each of their patients using a unit secretary, but when even a complicated surgical patient has 4 and 5 doctors consulting and writing orders it is hard to keep up. Oh on nights we go through every chart to look for anything not done. Which means going through the computer to check out lab slips if they didn't save them. I have come in on nights at 11 and found orders written for stat things at 6 PM not done! I find orders from day shift 7-3 written at like 8am not noted by the RN. It's not their fault! They are too busy and I am being sincere. This is but a partial list of what it is to work on the floor here. I am sure that PPL can add her own. Can you see the differences? Can you see why I think we have the right idea in Canada? So much of our charting is CYA work that takes us away from the patients.
  7. by   PPL
    Well, with everything I am reading, I've decided that MAYBE it would be OK to be a nurse in Canada, but I don't know if I'd want to be a patient! Based on everything Snickers has told us, it sounds like they have less bull---t paperwork for sure, but it doesn't sound like needs are getting met, unless it's an emergency; what with huge waiting lists, people lined up in the halls, etc. She certainly is making more money then I am, and the benefits sound good, but how much of that $26.50/hr is she taking home? Are the patients on waiting lists for surgery/procedures because there are fewer docs(docs fleeing the situation), or because the money is just not available to treat anything but "life and limb" as she so aptly put it earlier? Leem and LRM make mention of lack of patient control/rights, but here in the states, it seems like patients have all the rights, and don't mind telling us so! I, like every other nurse, have been taught to be patient advocates, but at what point do we advocate for ourselves? I have never been in a union, like Snickers is, but I believe that whenever you have heavy government involvement, you'll have unions. I feel helpless to change the nurse's situation here in the states, because I feel that any time you have some fat bureaucrat(read management)sitting on the throne, insulated from having to do the job in the trench, and in fact, receiving a fat paycheck for decreasing the numbers in the trench; the situation will continue, and may in fact, get worse! I see our situation here as being VERY MUCH bureaucratic, even without a "universal" system, so I am hard pressed to believe that the government could and/or would enhance the system, by taking it over. And so, like LRM has said, we just have to do what we can to make our little patch livable, by sticking to our ethics and values, but the problem being of course, that in the present climate, it's becoming nearly impossible to do it! Hey, maybe we should start Vol II of this subject, this topic has become so long, but I am getting an education, which I thank you all for that!
  8. by   LRM
    What a lot of info to absorb. I agree with bunky that socioeconomic status & health are directly related (the poorer one is the worse their health) with education & knowledge identified as the main variables. And in a system where accesibility to health care is available for everyone (rich or poor) health prevention measures are instigated & knowledge is disseminated more readily. Now bunky I never said poor people were 'stupid'.

    PPL, I did say in the military that the members often don't have much control over their health care but this is different in the oz public health, socialised system (totally different culture). We have a full pt rights bill that allows pts to seek second opinions & refuse Tx. There is no option for selecting dr (this is where private has advantage)but many of the drs are first class in the public system, yes the hospitals are all teaching hospitals but pts are allowed to question Tx & dr's. opinions.

    As far as pt advocating, yes it is a priority here too. One can advocate in both the public & private system. In terms of advocating for ourselves, do you mean wages or staff nos?. Aren't both also advocating for the pt, adequate staff nos are needed for safety & reasonable wages are needed to encourage nurses to enter work force & encourage them to further their education & enhance their knowledge base thus knowing they will be sufficiently renumerated.

    Unions here in oz are looking at striking soon as we have been waiting for >6 mths for the government to meet & discuss pay increases (Queensland hospitals). No nurses like taking this action but staff satisfaction also needs to be a priority. Nursing is no longer solely a 'vocation' where a person enters this profession because "they wanted to care for people". Caring alone does not pay the bills & we all have a life outside our jobs & if not then we MUST make one.

    By the way, I have never been a big union supporter but since doing my degree my eyes have been open to many sociological issues that I didn't really have an opinion on before. I still think unions should not have control & manipulate the system for their own benefits (then the fat cats in the unions sit back & dictate, no different to capitalism) however, they do have strengths & when used for the right purposes (pt safety or in eduaction, student benefits by increasing teacher nos & decreasing class sizes)they facilitate a more equitable distribution of resources & allow a voice for the people.
  9. by   snickers
    PPL:
    You've mentioned a couple of times in your posts about we in Canada being heavily taxed, hence I thought you'd be interested in seeing a breakdown of a typical paycheque I receive and the subsequent breakdown of deductions...... for 7 shifts
    gross pay was 2376.57 net pay....1282.21 total deductions 1094.26.

    Income tax...........672.01
    Canada Pension...90.55
    Unemployment Insurance....57.04
    Superannuation....128.28
    Canada Savings Bonds84.82
    Union dues.....41.74
    R.N.A.B.C......14.92

    year to date, gross earnings have been 27,667.31 & takehome....15,175.27 total deductions 12492.04. So,,what do you think? Any basis for comparison?
    oh yeah,we also accumulate sick time (maximum 1100 hours at the rate of 7.5 hours a month, aswell as holiday time.(230 hours this year.)


  10. by   PPL
    Snickers, thanks for posting. I'm only working prn right now, but I'm going to hunt a pay stub from when I was going full time. Bunky, if you're out there, look at yours and compare it to Snicker's. It looks to me like they're stealing the shirt off her back!
  11. by   PPL
    Oops! I forgot something. LRM, you are exactly correct, advocating for ourselves can only help make the nurse's and patient's experience better. Leem seems to think that we're allowing the powers that be to dictate everything, and it's not that we're not speaking out, many are, but maybe it's to the wrong people. He's right, I don't just want to ***** , but like everybody else, the fight to just do your job can sap your energy, there doesn't seem to be any fight left in me at the end of the day. Would you mind telling us a little about your pay/deductions, etc., like Snickers did? It interests me a great deal to get an idea what others are experiencing. Thank You.
  12. by   bunky
    LRM it wasn't you that said "stupidity", it was Leem, but I was more responding to the idea you pointed out that we were sinking to an unethical level, when my point about education was being distorted to look like an elitist viewpoint.

    PPL, I haven't got a pay stub handy at this time to make a comparison, however I most certainly will do so with Friday's pay. What you may not understand about Snickers deductions though is this: The deductions for Canada Savings Bonds is voluntary. It is the same as you buying a savings bond from your bank, only in Canada, many employers allow their employees to purchase them on a pay roll deduction plan. Canada Pension Deduction is the government retirement plan, she collects it when she turns 65 just like here. And seniors in Canada get their prescriptions for $2 each, and continue to receive healthcare. On a typical pay, her Income Tax deduction is indeed higher than mine, but if I were to add in my income tax deduction with what I pay for my health insurance, it's not all that much higher, and in terms of taxes, having paid them in both countries, you DO get what you pay for in Canada as opposed to here. Don't forget that she is getting healthcare benefits out of that money. She also likely has been the recipient at one time of the Child Tax Credit, formerly known as Baby Bonus where by parents are given a monthly sum for each child they have until that child is 18. Unemployment Insurance deduction is also a safety net which I sure don't have here! If Snickers found herself out of work tomorrow, she'd still be entitiled to 66% (Is that correct percentage Snicker?) of her wages for a period of 17 weeks (Again, is that still the time alloted Snickers?) unitl she gets herself a new job. If Snickers were to become pregnant she could take up to a year off because of that! If Snickers got hurt at work, Workmens Compensation would go so far as to pay her tuition and pay her to go back to school to retrain, and it pays her as she is seeking medical treatment for her injury, sending her to PT as well. And as you see she has UNION DUES! I'd gladly pay for that one, but here it is a four letter word and grounds for immediate dismissal. I promise to submit my pay stub for inspection and comparison purposes and we'll outline what my deductions entitled ME to compared to Snickers deductions. Snickers, I am not sure what Superannuition is though. I can in the meantime say that last year I paid over $7000 in income tax, with a gross pay of $40,500. If I were to lose my job tomorrow, I'd get nothing! I am not sure how they do your holiday pay there PPL, but mine is called PTO short for paid time off. I also have what they call EIB, or earned illness bank. I earn 7.1hrs? roughly each pay period of PTO, and 2.1hrs of EIB each pay period. Unless I am sick for 3 days, I can't touch my EIB hours! No siree, it's got to come out of my PTO, and if I don't have any then too bad. If I work a holiday, I don't get time and half! I get extra PTO hours. I'd be willing to bet that Snickers gets time and a half or better when she works a holiday, and she gets something for it even if she doesn't work it! And there are 12 times a year for holiday pay there as opposed to varies between 5 and 6 here! And are you following that Snickers gets one sick day a month that doesn't come off of her vacation pay! You heard about her other benefits too such as dental, and vision and drug benefits. And hers weren't even as generous as I've seen before either. My sister who works for a municipal government has a far better drug plan.

    Snickers you don't even WANT to know about nursing homes here either! The conditions are SO bad! They are grossly understaffed, the health care aids or CNA's as they are known here usually make minimum wage, and are expected to perform backflips for it. Two of them for 30 residents on a medicare wing, many of these residents are total care, and bed bound. Decubitus City, stage fours, happen all too frequently here. It is impossible to do the work properly with that kind of staffing, and it shows. They have NO incentive to do a good job, and on those wages they can't even afford company health insurance. They suddenly don't show up for work one day, and that's the last you hear from them. Who can blame them? Having done that job in Canada for 5 years, I can say that I wouldn't have lasted more than a week here without pulling a no show. I left my job as a CNA there making $10.04 almost 11 years ago! I worked hard for that money, but nothing like what is demanded of them here, and I got benefits for it that they can't even imagine. Sure there are more nursing home beds available here but I wouldn't send my cat to one.

    And PPL I talk to my family about you too! I told my sister about this debate we've been having and asked her opinion of her healthcare in Ontario, and she said that she is extremely happy with it! That is from a patients point of view too.
  13. by   bunky
    I found a pay stub! Here it goes:
    total earnings for two weeks work
    Earnings $1611.27
    Deductions $541.04
    What I took home was $1070 for 80 hours
    Break down of what those deductions were for:
    -HMO Employee and child $137.54 (that's my health insurance where I still pay a co-pay, and still pay some costs 20% for things)
    -Dental employee and child $17.85 (Doesn't cover 1/4 of what yours does Snickers!)
    -Longterm Disability $3.36
    -Life Ins. 1xannual $1.65
    -FICA-SS $89.96 (Like Canada Pension)
    -FICA-MED $21.04 (for medicare when I am 65)
    -FIT $249.74 (Income Tax)
    -ADL FED TAX $20.00 (I have them take off an extra $20 of tax)

    So, my year to date earnings on this cheque as of April were $12123.79 and my year to date net was $8035.29, with taxes being $2966.40 and other deductions being $1122.10.

    Unlike Snickers, I wasn't paying into a Savings Bond. I don't have vision benefits, and I don't have REAL dental benefits like Snickers, and my drug plan has a $100 per person deductable on it per year! If me or my kids get sick, I still pay out of my pocket for some of it, and with the cost of health care here, it can be an insurmountable amount. The long term disability is a joke compared to Workman's Comp there. If I were to go out on maternity leave, (God help me then ha! ha!)I'd only be entitled to as many PTO hours as I have banked. Imagine a two week maternity leave! Although I pay American taxes, I am not entitled to receive the same benefits, like Welfare etc.

    The worst thing that I see here is when I have patients and even lesser paid co workers who have things like bronchitis, and in who are in need of root canals and they suffer with it because they can't afford to go to a doctor or a dentist! One of my patients who couldn't afford to go to a dentist for a root canal wound up with pericarditis and now has a mechanical mitral valve and a hosptial bill that he'll NEVER be able to repay. Imagine Snickers not being able to go to a doctor when you need an antibiotic because you can't afford to go! Imagine what it'd be like to have a chronic condition such as one of my patients who was a frequent flyer with A-fib and an ejection fraction of 27%, who we'd treat and send out again with full knowledge that he'd be back because he wasn't able to afford ANY of the prescriptions he'd been given on discharge. I used to see this man riding around town on a bike, picking out of garbage dumpsters around apartment buildings. The poverty here is heart breaking. The difference between the have's and have not's is incredible. In Canada the welfare system may be generous to a fault, but being here, and having lived in a small very poor community, has opened my eyes to what poverty REALLY is! Welfare recipients in Canada are enviable by comparison. One of the questions I have to ask on an admit form her is whether or not they have electricity, water, or a phone! I can't even imagine what it'd be like to be poor and uninsured here Snickers. On top of being poor, having to worry about being sick would be enough to make you sick! I can't imagine what it'd be like to have a child born with a disability here either, because on top of all the rest of the sacrifces and heart aches, it's like you are penalized monetarily for it too. Going into debt up to your ears because you have a child who needs treatment. Be glad for the benefits you enjoy their Snickers!

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