Does EVERY LIFE really count??

[deeDawntee, RN]

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.

[Nightcrawler, BSN, RN]

You know, we always talk about this issue, but I have thankfully never run across it in person. If anything I have seen heroic measures and every possible resource used to save people, uninsured, noncompliant, disabled and all.

I am sorry that this seems to be happening at your hospital.

[FireStarterRN, BSN, RN]

How do I deal with it? I might make a suggestion or ask questions, but basically I go with the flow. I can only fight so many battles. I will call the doctor , report my findings and document those calls.

[luvschoolnursing, LPN]

Wow. Not really sure I've seen what you're talking about but getting my name up so I'll see when this thread is updated. Sounds like a tough topic. I may throw in my .02 later in the day when I'm more awake.

[mauxtav8r]

Ok, this is very much like when a person is in the hospital without a family member present. The staff knows it, the patient knows it, and even though no one is exactly trying to slight the pt in terms of care, the risk is real.

As a student I had a pt who had not had a bm in 7 days (since admit for cellulitis to lower extremities). Bed ridden but a&oX3, she was quite animated when I asked "Is this correct that you haven't . . ." She was on diarrhea meds because on admit she said "yes" do "Do you have h/o loose stool?"

t/c to physician + d/c diarrhea meds + enema = one bm + happy 90-year-old.

Many if's with this scenario. If the pt had questioned her meds, if the nurses or doc had read the chart (as I had the luxury of time to do), even if the techs could have picked up on this situation.

[TheCommuter, BSN, RN]

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.

Unfortunately, the quality of healthcare that one receives is often intertwined with their social class and ability to pay. I was treated wonderfully by doctors when I had private health insurance. When I became uninsured, I was subjected to receiving substandard care at cash clinics where the physicians were either quacks or had cold bedside manners, and all of the office personnel simply assumed you were a loser.

In addition, mentally-ill or poverty-stricken patients might be unsophisticated about liability issues, and some doctors may very well know this. Therefore, the doctors who lack integrity will not treat these patients' health conditions as aggressively as they should, because they're almost certain that no litigation will occur if the patient dies or worsens.

[classicdame, MSN, EdD]

actually, that is not all you can do. You have a chain of command and you have an obligation to be your patient's advocate.

[Almabella]

Looks like we're in the same neck of the woods! I'm not sure specifically what type of scenario you're talking about -- inpatient or outpatient mental health care? Treatment of the uninsured?

We are lucky in that here in the TC there are a wealth of non profit agencies and government run programs for disadvantaged pts. Health care for the homeless; red door clinic; several free and sliding scale clinics; just to name a few. Depending on what you're talking about, you might want to keep a list of resources handy for quick referral.

I can completely commiserate with your frustration. We had a woman come in to our clinic recently with a screaming baby who, IMO, evidenced some serious neglect. Way too far below normal weight for my comfort. Another nurse dealt with her and, after talking to her, sent her on her way with a pamphlet for the crisis nursery. Didn't get any demographic information or anything so we could follow up, do a PHN referral. She was not an established pt so we didn't have this information already. She did offer her an appt with the MD, but of course the mom refused.

To me, it seems like this was just the easy way out, and because of one person's laziness, an opportunity to help this baby was squandered. This has really been haunting me lately, and I wish I would have gotten more involved and not worried about stepping on the other nurse's toes...

oh, and by the way, afterwards this nurse said to me (and has said this before), "well, we can't save everyone..." :angryfire

Another thought -- if you work in a hospital, is there a hospital ombudsman you could contact?

[cmo421]

Actually, I believe that in your state ,you r covered by the medical whistle blowers act. I could be wrong. But if you feel strongly enough, and have a strong backbone, report it to the health department or the medicare hotline.

This medical neglect is everywhere and will only get worse with the decreasing reimbursement from medicare.

As nurses, we can only try and get the best we can for our pt's. We can questions doc's and maybe get their concious to kick in. Always an uphill battle and with poor facility treatment and minimal beds available for the psych pts. we will see more and more.

Good luck, and try to let it roll off ur back when u can. Sadly, Its a constant that will be here for along time to come.

[Kyrshamarks, BSN, RN]

After 20 years I see it as the poor schmuck with insurance that gets slighted in the area of healthcare. I see all the time the docs go to heroic measures to save someone with no insurance whiole the guy who has insurance gets treated and that is all.

[Balder_LPN, LPN]

How do I deal with it? I might make a suggestion or ask questions, but basically I go with the flow. I can only fight so many battles. I will call the doctor , report my findings and document those calls.

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?

[deeDawntee, RN]

Thanks for the responses so far. I do feel that we have some very good Intensivists in the ICU where I work and I have seen some really good treatment from them, but there are those few patients where they really did let the ball drop. Was it intentional?? for example: a patient for whom a bivad could have saved her life...but it wasn't instituted, it is very rarely done at my hospital, but we do have trained staff and the patient should have had one, IMHO. She was down for an undiscerned amt of time, do think that is why it wasn't tried? I asked an ICU nurse with 30+ years experience at many different hospitals and she also feels that we don't do "balls to the wall" kind of medicine...(her words). Why not? Are they getting hounded by the financial gate keepers??

A patient with mental retardation, with sepsis and pneumonia, the parents were debating whether to intubate and the Doc blew them off. Oh my God, that has my head spinning in frustration and anger. The parents needed his input in a kind and unrushed way. But he had "other patients to see". Honest to God, I don't think it would have happened that way if there was not a disability in the picture.

I don't know all that has transpired on that case, but I will go somewhere with it. You can count on it. I don't want to go into any details, as I don't know how it has turned out and I don't want the patient identified.