Basically, I really love my Spanish speaking patients in every way. I'm talking about people born and raised outside of the United States. They have Old World manners, respect for elders, I love their family values. They really are great, and Americans can learn a lot from their old fashioned ways. I love the way they roll up their sleeves and care for their hospitalized family member.
I had a gentleman in his 50s, totally Spanish speaking, had been a farm worker but with too many health problems to work, most of which resulting from IDDM non-compliance leading to heart problems and renal insufficiency. Most of his family was back in Mexico, including his 7 (grown) children. He spoke very little English.
His nephew came in, he spoke English, he was nice as can be. He wanted to know more about what was going on, he gave me more background info. His Uncle had a greencard, wasn't able to work, had wanted to go back to Mexico but was only staying for the free medical care.
Ha ha, 'free medical care', I thought. . I think most Americans would disagree with that statement. I guess it is free for non-citizens with no means, and for other dirt poor people, but it's not really free, is it? It's really, actually, expensive.
Meanwhile, his uncle, who was very polite, appreciative, nice, was also irresponsible. According to the H&P he had been mostly non-compliant with his meds and treatment plan.
I think there is a disconnect in our system. There is very little personal accountablity. There is lots of talk about Patient Rights, and very little talk about Responsibilty. I'm not just talking about non-citizens who consider the U.S. the land of free medical care, but I'm talking about a system that rewards irresponsiblity.
If we ever get socialized medicine, I seriously doubt if the government will have the backbone to build in any system for accountability into it. I see people abuse their bodies to the point that they are unable to work, then expect the taxpayer to pick up the tab for their medical care, for life, while they sit back and complain what victims they are. I see this over and over again. It's a huge problem in America today, with no solution in sight.
Oh yes, I agree with you. As a former dog trainer, I have seen the desire for the quick fix again and again. People would rather slap a shock collar on their dog to make them obey than to take the time to learn about learning theory and build a relationship of trust with their companion.
I guess my point is, that this is human nature, and fighting it is like swimming upstream.
How I handle it on a professional level is to facilitate self efficacy, point it out and reward it when I see it, and in those situations where it is not forthcoming no matter what I do, just accept it instead of banging my head against a brick wall.
i agree .. and i couldn't of said it better myself... i accept it , i have attempted to educate my patients many times on how to improve their health .. but they really are going to do what they want ...
Yep, free healthcare in America today, for non-compliant foreigners and aging prisoners! Meanwhile, let's cut back on benefits for our young men and women returning from Iraq! And, forget about helping blue collar workers without health benefits!
I ask you, do you think our priorities are mixed up here?
Well, of course they are, but as a bedside nurse, I don't see my role as deciding who is deserving of compassionate care.
Not only that, but most of our money is really going to line the pockets of the richest 10% of the population. These guys you mention are small potatoes.
That's where I believe our medical system needs to step in and demand individual responsibity with systems in place.
Another example from yesterday is a prisoner whom I had as a patient. He was a manipulative, disgusting individual who considered his hospital stay a chance to be waited on hand and foot, until the guard stepped in and laid down the law for him on call light usage.
He was just starting cancer treatments, on top of all his other health problems (he was in his 70s).
Yep, free healthcare in America today, for non-compliant foreigners and aging prisoners! Meanwhile, let's cut back on benefits for our young men and women returning from Iraq! And, forget about helping blue collar workers without health benefits!
I ask you, do you think our priorities are mixed up here?
ooh yesss i've taken care of people like this patient before ... and they make a slave out of you.. i had a guy who was a heroin and etoh abuser last week and he just got out of the hooscow and he thought he was in a 5 star hotel.. no insurance , spoke only spanish .. although i think it was an act , because he knew how to ask for dilauded iv and popsicles, ice creme , choclate cake and pizza and lots of rootbeer and was on the call light 100 times for nothing.... yes , free health care .. we are the ones paying for his stay at the 5 star hotel , and believe me he just stayed in bed watched tv and had a vaction after being in jail, he had the SSN of 000-00-0000 and who knows how he got here , but he took up a much needed bed for a real sick person who wants to get better
Of all people who know better, how many nurses smoke? How many eat fast food on a regular basis? How many choose to sit in front of the TV rather than go to the gym?
and this has to do with what?
at least nurses financially contribute to the astronomical cost of healthcare...
as well as many more $$ they will pay r/t unhealthy habits.
I believe I, as a bedside nurse, have every right to have an opinion as to how limited healthcare dollars are distributed. I think I have an insiders point of view into how the system works, and as an American citizen my point of view is valuable.
at least nurses financially contribute to the astronomical cost of healthcare...
as well as many more $$ they will pay r/t unhealthy habits.
but at least they're paying.
leslie
Yes, I was thinking the same. Nurses work their tails off for their benefits, and pay hefty co-pays as well. Those who pay into the system pay more than their fair share, since they also pay tax dollars which pay for the medical indigents, plus their own insurance premiums.
And how many nurses continue to work fulltime merely to keep their health benefits, often at the expense of their own physical and mental well-being?
at least nurses financially contribute to the astronomical cost of healthcare...
as well as many more $$ they will pay r/t unhealthy habits.
but at least they're paying.
leslie
The point was personal responsibility. If you smoke and end up with COPD, are you not personally responsible for that consequence? Do you say to your COPD patients "Well, you shouldn't have smoked."? Do you say to your MI patients "You shouldn't have eaten all those Big Macs."? How can I say to an illegal immigrant "You shouldn't have been born in a corrupt nation where poverty is the norm and health care is essentially nonexistent, so therefore, you do not deserve this life saving treatment."?.
Maybe it does come down to an issue of core values. I do not see access to health care as a matter of who deserves it because they can pay. I'd rather my tax dollars go toward paying for those who cannot pay for health care than to fund the killing and maiming of people on the other side of the planet, and in doing so, lining the pockets of the richest of the rich who profit from war.
There but for the grace of God go I. Managing diabetes can be like a full time job in and of itself. And yet we expect these people with very little means, education, and support to do so, and if they are unsuccessful, we label them "noncompliant".
Of all people who know better, how many nurses smoke? How many eat fast food on a regular basis? How many choose to sit in front of the TV rather than go to the gym?
nanc, i have no problems w/paying healthcare for those who are truly needy and impoverished.
i do struggle w/supporting others who are noncompliant.
yes, noncompliant.
if these people had never received adequate education on their disease process, i would feel more lenient and forgiving...
so yeah, that is a possibility.
but for those who continue to abuse themselves then milk our system, i take issue with.
as for your contentions on the war et al, i agree.
but i am so trying to stick to the subject at hand...
very challenging for a scatterbrain such as myself.
I lived in south Florida for many years. During the winter months the "snowbirds" invade from all over the U.S. and from outside the U.S. to seek better climate. The healthcare system in south Fl. is saddled with an incredible amount of debt when the season ends. If you end up in the ER you will be waiting 10 hours plus because the system in Fl. is flogged. Our public hospitals serve anyone regardless on the ability to pay.
"Ability" takes on very different meanings to different people.
The thing is, that socioeconomic status and health status are inextricably intertwined. The very people we label as "non-compliant" are the same people who are impoverished. Statistically speaking, those with means are healthier. So, it is a catch-22.
How many elderly people on Medicare do we see come into the acute care setting with CHF or COPD exacerbations because they were "non-compliant", when it turns out that "non-compliant" means that they stopped taking their meds because they could not afford them? They had to choose between eating and taking their pills.
I guess I see the man in the original post in a similar light. How is someone with diabetes, who has no money, supposed to buy a glucometer, pay for the strips, test four times per day, administer insulin when they don't know when or where their next meal will come from? Where will they keep their insulin if they have no refrigerator? What happens when they get pulled over by the police with syringes on their person, and because of their limited English speaking ability, cannot explain that they are diabetic? There are so many issues.
My aunt who is now 60, married a man from England in 1980. They moved to London. He died several months later. She stayed, citing benefits too numerous to mention. She is still a US citizen, and has never returned to the US even for a visit. But she is reaping whatever benefits are available to her in England. I guess it happens on both sides of the pond.
How many elderly people on Medicare do we see come into the acute care setting with CHF or COPD exacerbations because they were "non-compliant", when it turns out that "non-compliant" means that they stopped taking their meds because they could not afford them? They had to choose between eating and taking their pills.
I guess I see the man in the original post in a similar light. How is someone with diabetes, who has no money, supposed to buy a glucometer, pay for the strips, test four times per day, administer insulin when they don't know when or where their next meal will come from? Where will they keep their insulin if they have no refrigerator? What happens when they get pulled over by the police with syringes on their person, and because of their limited English speaking ability, cannot explain that they are diabetic? There are so many issues.
great points, nancy.
and i agree with you.
i suppose there isn't any way to distinguish between those who cannot afford to maintain their health, vs those who are just plain defiant and irresponsible.
. I think most Americans would disagree with that statement. I guess it is free for non-citizens with no means, and for other dirt poor people, but it's not really free, is it? It's really, actually, expensive. 
ohmeowzer RN, RN
2,306 Posts
i agree .. and i couldn't of said it better myself... i accept it , i have attempted to educate my patients many times on how to improve their health .. but they really are going to do what they want ...