Ignorant Stupid Patients

Nurses Relations

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:angryfireWhy do the patients that do not pay for any healthcare complain and gripe the most? It irritates me when a patient is on Medicaid and expect to be treated like they are at the Ritz Hotel. "GRRRR"!!!! It seems like a vast majority do not want to accept responsibility for their own actions. Perhaps if they paid for some of their healthcare, they would be more willing to be compliant with their treatment plan.

I had a pt. today post op with a BKA. She already had a previous BKA a year ago. I walk into the pt's room and the family has brought in 6 Snickers bars. Ok, your BS is 600, you just came from surgery 2 days ago, you have no legs, you weigh 600 lbs. and you are in the process of eating 6 Snicker bars at once!!! I have tried to educate the pt. and the family and I feel like I am banging my head against the wall.

She told me, "Honey, it's ok for me to have Snickers. I know how to control my blood sugar." UMMM, NO YOU DON'T!!!! You would not be in this situation. If she was responsible for a portion of her medical bill, then I think she would be more compliant. Since there is no incentive to change, these populations continue making poor choices. It is SO frustrating!

Specializes in School Nursing.
the anger you feel inside is largely based on your experience with your own mother's noncompliance and you are angry. that anger IS going to affect your nursing when you graduate. my advice would be to get a therapist and work thru that anger you feel towards your mother. if you dont, it WILL manifest itself in other ways in your life and your career.

This is an excellent point and a great post, southernbeegirl. Thank you so much for sharing your story. This is a lesson we should all take to heart. When a patient evokes such strong emotion in you, it is wise to look INWARD to see what is behind that emotion rather than projecting that negativity onto your patient.

OT, but this post gave me a light bulb moment about negative feelings I have for a 18 year old kid I know with a new baby at home. She constantly complains about having to grow up so fast and what this baby is costing her socially. I have been married 10 years and unable to become pregnant, yet we are emotionally & financially ready and want it badly. It does not take a rocket scientist to see where my anger comes from, but I did not realize it until this moment. Sorry for the OT but I had to get it off my chest.

Specializes in Cardiac Telemetry, ED.

I recently cared for a young person in with fulminant liver failure due to ETOH abuse. The person had been housebound for two months prior to admission.....now who was bringing them the liquor if they couldn't leave the house? Why, the fiance of course.

None of these people live in a bubble. They are part of a system, and when looking at them, you cannot look at them as an isolated thing. You have to look at the whole system to which they belong.

from the bottom of my heart, i truly believe that these "ignorant stupid patients" live in a black hole, where hopelessness and acceptance of their perceived destiny, is etched in their souls.

that no matter how much we educate, their depression is such that they are going to 'enjoy' their vices, even if it costs them their lives....

which sadly, many of these folks find acceptable.

of course it's frustrating and at times, you want to shake some sense into them.

but once we accept where they are at, it really does make caring for them, much more doable.

are these folks ignorant?

yes, as we all are in some form or another.

no, i will not bring them a donut or a smoke, nor will i jump to get them their meds early.

but just acknowledging the waste of life they feel doomed to, makes my job a lot easier.

when they're not receptive to my information, i won't push it.

but i do encourage them to do something about their depression...

whether they admit it or not.

i give them referrals to reputable therapists, and can hope they make that call.

it's not our job to save a life.

rather, we provide them w/all necessary information in hopes of them making the best choices.

we should not be taking this so personally that it elicits emotional outrage.

acceptance and a smile, will bring you far...

and will ultimately benefit your pts much more than feeling pressured to make life changes they are not ready to make.

i need to eat my chobani yogurt w/sliced banana.

enjoy your day!

leslie

Specializes in Cardiac Telemetry, ED.
....because most of the patients are medicaid/medicare and require alot of discharge planning and teaching starting even upon admission...

Yep, I was taught that DC planning begins at admission. In order to do that, we need to understand what kind of situation they're coming from and what resources they have or lack access to.

Specializes in Cardiac Telemetry, ED.

Agree, Leslie. I also think that many of the morbidly obese feel a tremendous amount of shame about their bodies.

Specializes in Rehab, Infection, LTC.
This is an excellent point and a great post, southernbeegirl. Thank you so much for sharing your story. This is a lesson we should all take to heart. When a patient evokes such strong emotion in you, it is wise to look INWARD to see what is behind that emotion rather than projecting that negativity onto your patient.

OT, but this post gave me a light bulb moment about negative feelings I have for a 18 year old kid I know with a new baby at home. She constantly complains about having to grow up so fast and what this baby is costing her socially. I have been married 10 years and unable to become pregnant, yet we are emotionally & financially ready and want it badly. It does not take a rocket scientist to see where my anger comes from, but I did not realize it until this moment. Sorry for the OT but I had to get it off my chest.

i'm happy for you and your lightbulb moment! it's very eye opening to realize where emotions come from.

my husband is a drug/alcohol counselor and he's very good at it. but he turns it around and uses my own words to help me learn lessons like this. and i could whop him on the head for it, lol.

he always asks me "what is really making you so mad about this patient?" type stuff. but it really helps ME give them better care to at least know where my anger comes from.

for instance...i am a very prejudiced woman against other morbidly obese women. or i used to be anyways. it took him a very long time to help me understand that what i hated in them were the very things i hate in myself. that was my lightbulb moment because that was exactly how i felt if i were to really admit it to someone besides God. it completely changed my own nursing with morbidly obese women. now i know how to put them at ease when i need to do procedures and the like. believe me, i would much rather have a fat woman putting a cath in me than some skinny little thing. and it wont be because i think the skinny little thing would think i'm disgusting (well that would be part of it) but the main part is the shame i feel.

i havent had a pap smear in 5 years. i have PCOS so i have periods all the time. and when i lose even 5 lbs i immediately start bleeding. i'm an RN and I know i need to have one because my bleeding is abnormal and i have had a history of abnormal cells and had laser tx to remove HPV cells on my cervix when i was younger. i know all this but i cant go thru with the exam. the last one i had i cried all the way thru and was so ashamed i didnt leave my house for days.

so if I feel that way and i'm actually working on my core issues and emotions...can you imagine how some others feel that have no idea why they eat like they do?

thats what i try to keep in my mind.

BUT! im not perfect either and i get frustrated at patients too. please dont think i dont cuz i do. sometimes i get on my own nerves when i read my posts because i think i sound sanctimonious or something when im just as bad as everyone else, lol. we gotta vent, right?

Specializes in Cardiac Telemetry, ED.

southernbeegirl,

I don't think that as nurses we should have no biases, but I do think we should be able to identify our biases and question them. All human beings have biases, and nurses are human beings. It's when we are blind to them, or lack insight, so to speak, that these biases can affect us in the way we treat other people. Good for you for being able to identify and examine a bias of your own! I think it makes you a better person.

Specializes in Hem/Onc.
It's true that I don't know the experiences behind this woman and what led her to be 600 lbs. However, I feel so frustrated when you teach, teach,teach, and teach some more and they do not respect their health or their bodies. I just feel like it is a waste of taxpayer money that could be better spent elsewhere.

I do agree with the frustration of attempting to teach a brick wall. However, where I work I haven't seen a real difference based on the payment source. Stupid is stupid no matter how poor, how wealthy or how covered.

I wonder though. Is there a link between education level, teach-ability and the ability to get and keep a job with good health insurance??

Specializes in Cardiac Telemetry, ED.

One of my biases that I'll admit to is that I have a hard time with anxious middle aged to older women. I have this knee jerk, reflexive disdain for them. The reason is that my mother has struggled with depression and social anxiety her entire life, and it made my upbringing difficult in many ways. One way was that I was the caregiver, or the mother, in the emotional relationship with my mom. I have never wanted to be anything like her, and have cultivated a strong, independent, and self sufficient personality for myself as a result. Older women who are emotionally needy irritate me because of that baggage that I carry. When I identify this happening inside myself, I am able to step back and take my own baggage out of the picture and provide good care to this patient population. I literally visualize in my mind's eye picking up a couple of suitcases and depositing them outside the door to the patient's room; I am leaving my baggage at the door.

As far as the MO, it took them their entire lifetime to become 600lb. I am not going to change a lifetime of experience in one eight hour shift. However, by being kind, accepting, and nonjudgmental in my interactions with them, maybe I can make a little bit of a difference.

but then i read this post and i am going to give you something that you obviously wouldnt give me...some understanding and tolerance. unlike you, after reading this post, i understand why you are so angry and obese, noncompliant people, esp. women.

you can't change your mom's behavior any more than you can change a patient's. and that pees you off. what you see is your mom killing herself and yes, she probably is, and there's nothing you can do about it until SHE wants to do something about it.

I would give you understanding and tolerance as I have seen it with my own mother. I am not obese, my mother is and is dying from it.

She WANTS help but the help available to her is not going to help her.

I feel the assumption is being made first that I treat these patients, and residents different than any other patient/resident.

I must make it very clear, I do not. I am able to maintain a professional manner with these people. I still care for them, physically and emotionally.

As my mother, she wants help...She just doesn't have the personality or will power to make those changes by herself. She would tell you she would not object to temporarily giving up her rights and being forced to make these changes. Yet this is not available to her because of patient rights.

Once she starts to see the results she could be more independent in making choices to insure she could do this in the real world.

Its that hopelessness that makes it hard for her...It the difficulty in making the right decisions when giving the patient rights.

This is because she still has that out...

She would fight initially. Heck, just last week she was hospitalized for a week for blood pressure, and out of control blood sugars. She became emotional and cried and said I just want to go home and be left alone. Yet in actuality that is not what she wanted it was just an extreme response to the fear felt being in a hospital.

She also was in intial shock over the extreme diet changes she was put on.

LOW SODIUM

LOW CHOLESTEROL

No CONCENTRATED SWEETS

If you ask her today she will tell you she wishes she had stayed. Do you not thinking that taking her rights from her and forcing her to change would not help her??? Even if she admits to it and signed a waiver?? So for example she gets through the first month and then she is given her rights back...she would stay from there until she is better on her own will.

So many people though assume her initial acting out is non-compliance. They also assume the treatment is not what she wants.

My suggestions, although radical and extreme in some peoples opinions, will never happen.

I gave two situations that could help my mother.

Taking away her rights for a month and forcing her to accept the treatment (with her consent).

Or taking away her insurance private or medicaid. Some would only need the fear to start making the changes. This fear would provide the motivation.

Others may still refuse, until they get so sick and desperate they too are willing to comply.

Some, even many people, need this motivation. Someone mention cocaine addicts, don't you think most of them would prefer this kind of treatment?? Including follow-up care to insure they don't end up in this same boat??

I am saying the system we have now is ineffective for some. Survey these people I would be willing to bet a majority would be for these consequences because that is what they need.

For those who feel it is too radical.....What if these patients consent to these consequences for a set amount of time???? Do you still think it is that bad??

Coming from a family member of someone dying from this....I am all for it!! I am not mad at my mother I don't hold resentment torwards her.

I feel resentment to the laws that are preventing her from getting the treatment she needs. Some family members are this supportive, some are afraid to give tough love to their family members. These too would more than likely be thankful to have their loved on back and healthy!!

My proof of this is the show "INTERVENTION" of those of you have seen it don't most times these people take the help. Some continue with the improvements and some revert back...I propose though aren't the ones who maintain these changes make this worth while for everyone??

Even those who revert back are still thankful for the changes and when they are ready have the knowledge to know what to do!!

Specializes in Rehab, Infection, LTC.
southernbeegirl,

I don't think that as nurses we should have no biases, but I do think we should be able to identify our biases and question them. All human beings have biases, and nurses are human beings. It's when we are blind to them, or lack insight, so to speak, that these biases can affect us in the way we treat other people. Good for you for being able to identify and examine a bias of your own! I think it makes you a better person.

aww thanks so much! since getting sober, it's been one never ending journey of learning about myself and how i affect others around me. my husband and i like to say that we (us addicts) are the lucky ones because we get to go to rehab and learn to work on our core issues and work the 12 steps. "normal" people never get to work on themselves that way.

my sister for instance. she drives me nuts, lol. she is an addict just like me except she doesnt do drugs/alcohol/sex. she shops and eats. she FINALLY decided she would lissn to me and go to a therapist. after her first visit she calls me, furious, and saying "i'll never go back there! that guy is a quak!". she wass mad at him because he told her to take a step back when she was angry with her family and try to figure out where the anger was really coming from before she started yelling (a bad issue she has). she was honestly mad at him because he expected HER to be involved in her own therapy. i was laffing and asked her "well what did you think therapy was?" and she says "you are supposed to sit there and talk about yourself and THEY are supposed to tell you whats wrong with you and fix you". i wanted to beat my head on the wall because it would have been less painful than trying to get her to understand what therapy is. her only hope (in my opinion) is that she will get addicted to the xanax the doc put her on so i can send her to rehab, lol. so i keep encourageing her to take them, lol.

you pondered in another post how sexual abuse correlates with morbid obesity. i've been in a lot of support groups and what i've found is that the number is huge.

but in all that i've posted, what i'm NOT saying is that any of these things are an EXCUSE to be morbidly obese. and i do think a lot of people use their weight and their past as an excuse to do the things they do. i am very honest about myself and my weight. i've had people say "oh you are big because you were abused". no..i am big because i eat! there are reasons behind my eating but i'm fat because i eat no matter what the reasons. and THATS what i need to change. what drives us mad as nurses is that people dont want to change. or thats the way it seems. i think that if we could see inside their mind we would find that they DO want to change, they are tired of living full of guilt and shame but they dont know how to take that first step because it's scary to take that first step to want to get help. and that fear is stronger than the eating or drug abuse or drinking or sex, or it was for me.

but it's hard. i cant tell you the times that ive found myself standing in the kitchen binging and feel suddenly like "omg what am i doing? how did i get here?" and not even remember going in the kitchen in the first place. thats what my therapist is trying to help me change , the mindless eating that i do.

i highly recommend finding a food therapist for anyone obese.

well i've wandered off on a tangent again i believe. i dont mean to take this thread here. i should post this on the obese thread instead of here.

on topic...i work for a private pay/ins. LTC/rehab company. another nurse and I do the PAEs to get patients assistance. but i still stand by my opinion that i dont think pay source has anything to do with one's behavior. i think it is a RESULT of one's behavior.

Specializes in Wound care, Surgery,Infection control.

To Valerie Salva ,

I saw your reply and looked at your posts too ! This is my opinion of you : It appears that not only are you an experienced and well rounded nurse who cares about your patients , but you take the time and effort to help whenever you can : answering questions and encouraging new nurses . You and I have much in common . I got my RN in 1991 , first job was dialysis , traveled for a while etc . So from now on when I have a bad day I will use my time to post nasty messages and complaints about BOA and citibank on consumer forums . You are an asset and got my attention .

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