I hope not to offend anyone out there, but I would appreciate some feedback on taking care of young to middle-aged adults who are on medicaid. It seems that so many (I realize not all) are some of the most difficult patients to care for; they often are rude, demanding, and unappreciative of nursing care. I have cared for many who demand tests/procedures/an extra day or two in the hospital/supplies that they don't really need; doctors often admit to just giving them what they want, rather than arguing. I have had medicaid patients say to me after I suggest to them, they can probably purchase an item for cheaper at the store, "Oh I don't care, I'm on Medicaid". Recently, a woman openly admitted that she had another child because she wanted more Medicaid money. When a woman has six kids by different men, and lives off Medicaid, I asked myself, "how does this happen"; aren't there people out there monitoring this system". About a year or so ago, I was taking care of a woman - and because the census was extremely low, patient-nurse ratio was 2:1 (unusual but nice). Anyway, I took so much extra time visiting with, caring for and going way beyond what I really needed to do to ensure quality nursing care, and at lunch, her Diet Pepsi wasn't on her tray. She gets on the phone and proceeds to rant and rave about this to a friend. I could hear her end of the conversation. Yes, she was a Medicaid patient.
Wow, I was blown away and got quite upset. I can't believe these are isolated incidences. Many nurses I work with are able to identify Medicaid patients just by their behavior.
As I said earlier, I don't mean to offend, but I am interested to learn if others out there in the nursing world encounter the same type of thing. I realize it is not right to label or generalize people, and I don't let it affect how I care for people; I certainly don't like the way I feel when confronted with this behavior. Any responses are welcome.
Well, as many a parent and grandparent has said: never judge another until you have walked a mile in his moccasins.
Rude, demanding, disrespectful, energy-sapping patients come from all walks of life and every socioeconomic class. So do the kind and thoughtful ones. Making assumptions about patients based on their insurance status (or lack thereof) is intellectually lazy and, to my mind, morally repugnant.
What right do we have to judge our patients anyway---are we health care providers, or the morality police? I'd hate to think that there are nurses who, when they get a rude or demanding patient, actually look up insurance status and burn with self-righteous indignation because "my tax dollars are paying for this, etc. etc." Otherwise, how do we know what their payment source is? And why does it matter?
Pardon my irritation, but treating people differently because of financial status has long been a pet peeve of mine; in fact, it's bothered me ever since my own family and I were on Medicaid ourselves back in the late '80s and early '90s. Looking at us today, you'd never know we used to scrape by on foodstamps and welfare payments, or that we once went two years without a car or a home phone. But believe me, we were about as poor as poor can get in these United States.........so if I were your patient, why would you regard me differently now that I have enough of everything to get by in life? I'm the same person I was back then---maybe a little grayer and a little wiser, but the same human being I was when we didn't have two nickels to rub together.
Yet it continues to amaze me, how differently I'm treated now that I have good health insurance and a solid middle-class lifestyle. I literally couldn't get admitted to the hospital with status asthmaticus and an O2 sat of 85% on room air when I was on Medicaid; they just gave me 3 or 4 breathing treatments and a bottle of prednisone and sent me home. Then when I had my lap chole years later, they actually kept me overnight because I couldn't keep my sats up for the first hour after surgery. I was OK before I was ever transferred to the floor, but they kept me. What a difference a few numbers make, no?
So..........the take-home lesson here is, never generalize about patients, or ANYONE for that matter. If you don't know the person's circumstances, if you don't know how they came to be the way they are, you can't judge. I know it's perfectly frustrating to have a patient who does nothing but kvetch, nag, whine, cry, demand, complain, and otherwise treat us like something they scraped off the bottom of their shoe, but why bring socioeconomic status into it and point fingers at the less fortunate just because they don't usually fight back? Just because we can?
Coming down off the ol' soapbox now.
Last edit by VivaLasViejas on Aug 29, '07
: Reason: dang typos!
Hmmmmmmm.........I guess I missed the notice that August is National Pooh-Pooh-the-Poor month.
There are already two threads elsewhere in the forums that serve the same function. While we encourage vigorous debate---and realize that there is a wide variety of opinions on this as well as many other social issues---we ask that the discussion be kept polite and respectful toward all.
Thank you in advance for your cooperation.
Last edit by VivaLasViejas on Aug 29, '07
Aug 29, '07
I have seen both. When I worked in a family practice I saw people on medi-cal (like medicaid but in California) drive up in 30,000 pick-up trucks and then proceed to complain to me that their wife is trying to get half of the selling price of their house ($250,000) in the divorce. I have seen people come in smelling like a $5 pack of cigarettes to get a scrip of OTC meds because if it is on the doctors Rx pad they get it from the pharmacy for free....
I also worked on a mobile medical unit that used motor homes to go to the homeless shelters and give medical care ; these people were some of the most THANKFUL people I ever met, and they really had nothing.
Last edit by HeartsOpenWide on Aug 29, '07