High-Value and Low-Value Patients

Some patient populations are highly prized in our society while others are very much devalued. This is because American society views some clusters of people as 'high value' and others as 'low value.' Do you believe that all people were created equally? Do you feel that all individuals are treated equally? Nurses Announcements Archive Article

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babyNP., APRN

1,922 Posts

Specializes in NICU.

TheGooch: chill. I'm glad Kooky was able to comprehend it and state it better than I could. At no point in time did I say that breast cancer is only ever caused by lifestyle factors. I have breast cancer in my family and yeah, of course it does have genetic and idiopathic components.

I was pointing out the fact that the overwhelmingly large perception is that breast cancer is something you get and it's never ever have anything to do with lifestyle choices and you should make them of the highest value patients ever because a woman losing her breasts is losing what makes her female (that was sarcasm in case you didn't catch it). There is also an overwhelmingly large perception that diabetes is something you do to yourself and woe is you because you did it and nothing else that you cannot help (like your ethnicity) had any factor in it whatsoever. Therefore, you deserve no concern. (that was also sarcasm).

C'mon guys, we are here to support each other and do the very best for our patients no matter what is going on. Give me the benefit of the doubt and re-read my posts or others if you are taking "offense" to them. I've made this very mistake on AN myself, so I know it's easy to do. I felt like a fool afterwards and make it a point to read "offensive" posts more carefully to make sure I'm not reading between the lines or too fast on my iphone ; )

hikernurse

1,302 Posts

Specializes in NICU.

Your post sure gave me pause to think. It is disappointing that there is a perception of hierarchy of patients and disease--although I do agree with you that this exists. I think your candor is a good way to open discussion and look for ways to improve the view that society (including nurses) has on this topic.

I work in a Newborn ICU and I do get a lot of comments about how rewarding my job must be. And it is. Sometimes. My mom, older and overweight, had both knees replaced a couple of years ago and I think her nurses worked a lot harder than I do in helping her get back on her feet. (Literally, lol.)

Thanks for writing this.

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

22 Articles; 9,987 Posts

Specializes in LTC, assisted living, med-surg, psych.

Getting into a peeing contest over whose disease/disorder is the worst is neither productive nor appropriate, IMHO. Regrettably, the OP is spot on about high-value and low-value patients, and some of this discussion illustrates her points all too clearly.

This comment brought to you by a patient who's about as "low value" as it gets (diabetic, HTN, obese, older, poor, and dual diagnosed).:no:

And oh, yes---I'm uninsured too. People are going to be falling all over each other trying to take care of me. NOT.

amoLucia

7,736 Posts

Specializes in retired LTC.

OMG!!! Never in all my years of nursing had I ever noted a correlation between LTC pts with its LTC nursing staff being on the low-value end. Never put the high-value and low-value into words before. Never saw it in print. Did feel it and see it but never saw it so clearly described before.

Makes perfect sense to me now. Low value pts don't need a lot of anything special. They only need the minimum to get by so the nurses who care for them need not be anything special either. (NOTE: am being sarcastic!!!)

Just playing with variables one can see how perceptions can change. A 19 y/o is pregnant. But she is a drug-addicted mother of 3, having dropped out of school and with no job, is now pregnant with #4. High-value or low-value?

Wonder if there's a previously identified name for this phenomena. Very interesting article.

Specializes in Geriatrics, Home Health.

As someone whose family has a lot of cancer, though not breast cancer, the cancer hierarchy amazes me. Ruby's description of the breast center where she received treatment was nothing like the facility where my mother's colon cancer was treated. There were no ribbons, and no one remarked about how brave anyone was. It almost seems that if you don't have childhood cancer or breast cancer, it doesn't matter as much. And God help you if you have lung cancer, even if you've never smoked.

NurseDirtyBird

425 Posts

I remember in nursing school, there were several classmates who said something along the lines of "Ew gross, I NEVER want to work geriatrics! Who wants to clean dentures and change adult diapers? I want to work L&D/ER/Peds/etc...!" Nobody wanted to work methadone clinics, free clinics, psych, LTC, or corrections. While I understand that people have their preferences, and wanting to specialize in a field they love would be more fulfilling, these people deserve compassionate care too! I personally had (very ignorant) family ask me, "Why would you want to watch people die?" when I told them I was interested in going into hospice work. However, they pretty much idolized my family member who was a cardiology nurse. "Saving lives" is perceived as more noble and more useful to society than providing care to "low value" patient populations. Even fellow nurses look down on those who choose to work with these populations. I know the perception of nurses who work in LTC (or what have you) must be bad nurses who can't get hospital jobs. It's a product of our youth and beauty worshiping, death denying society and prejudice against those who don't fit the young, thin, rich and pretty mold. It's a bunch of crap is what it is, and I'm glad you brought this up, Commuter.

ausrnurse

128 Posts

Specializes in ICU.

RubyVee's comment on support with breast cancer vs TKR is spot on. When I worked in dialysis, we had no social worker, no support for the patients - it was get them in, get them out. CKD is not sexy. The oncology clinics have social workers, dieticians, OT's, physios, pharmacists, accommodation support, family support etc, etc.

Working in ICU, I much prefer to look after the medical/palliative patients than the brain surgeries/heart surgeries/traumas that everybody finds so exciting.

jadelpn, LPN, EMT-B

9 Articles; 4,800 Posts

There are some nurses, myself included, who prefer to care for those "low value" patients. Every day I learn something new. To me, high-value equals patients who also know they are "high value" and private duty under the guise of a unit nurse is not my gig.

Interesingly,in my experience, state funded insurances (Medicaid) pays for a great deal more than a number of other "private" insurances. Medicare is not ideal, however, it still pays a great deal more than a number of "PPO/HMO" plans. So all of the patients who are considered "low value" have more dollar value.

And Viva is correct--getting mixed up in "who is the worst diagnosed" gets us no-where. There are many facilites that it doesn't matter if you have sterling insurance or no insurance--it is all in the surveys--and if the "low value" patients feel slighted, a bad result means the same thing as if a "high value" patient feels slighted and gives a poor rating. And if the questioning remains on "how were your visitors treated" and "was the unit quiet" all of the magazines and internet access. coffee or tea in the world will not make that any better.

RNperdiem, RN

4,592 Posts

This topic reminds me about what I have read about the history of battlefield medicine before triage by injuries was started.

It used to be that injured soldiers were treated by rank rather than the extent of their injuries. An officer with a minor injury was treated before a more seriously injured man of lesser rank.

SoldierNurse22, BSN, RN

4 Articles; 2,058 Posts

Does a colored ribbon exist for all the people who died secondary to complications from diabetes? If so, please tell me about it. However, breast cancer has captured the minds of the American public after a young woman from a prominent family lost her battle against the horrible disease many moons ago. Now we live in a sea of pink ribbons.

I cannot like this enough!!!

When I worked oncology, I noticed immediately the hierarchy amongst cancer sufferers. Breast cancer survivors were brave and strong. Lung cancer survivors were often assumed to have "had it coming". And other cancers were stuck in the middle of the spectrum, with no hoopla, little support and absolutely no fanfare for the same rigorous treatment that they endured.

One of my former patients probably said it best. She was admitted to my hospital two years ago right around this time of year with a hemoglobin of 4. She was ashen gray, clinging to life and afraid to die. We gave her blood products to delay her death a few days so that she had a few more precious hours to say goodbye to her husband and two children.

As I gave her a final unit of blood the following morning, she and I talked quietly amongst the beeping equipment and machines. She had smiled ironically, her eyes focused on the hospital blankets that piled over her tiny form. "It's funny, you know."

"What's funny, Clara?" I had asked.

Her forehead kneaded in frustration. "My sister in law had breast cancer and got a mastectomy. She wears pink and runs races and got a tattoo where her breast used to be." She gazed out the window. "I have lymphoma. I'm going to orphan my children and make my husband a widower at 45, and no one will wear a ribbon or run a cool race for me."

Specializes in Pediatrics, Emergency, Trauma.

Great post and points. :yes:

I am more shocked about the hierarchy in oncology that was posted. :blink:

I have worked with the "not so sexy" occupations, and currently work in LTC/Sub Acute Rehab; we get the "mix" and yet, we give care regardless; I think in LTC we feel the ignorance and it gives nurses who love LTC all the more emphasis in giving good care. :yes:

I will say that when I worked with kids with special needs, people always gushed about "what an angel" I was :cheeky: yet I always believe nursing is nursing is nursing; If I ruled the world most people including lay people, would feel the same way I do.... :whistling:

I think that the endurance of illness, even chronic illness to major illness can be a very enduring ride and VERY scary; I think placing it "of value" is robbing the individual; something that healthcare places emphasis ON.

Guttercat, ASN, RN

1,353 Posts

The insights in this thread as to the value placed on varying forms of cancer...made my heart sink. I never thought about that.