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 Emergency Dept. Trauma. Pediatrics.
I can understand the 3 strikes and your out... we had a patient, god love him, who came in LITERALLY every other day for narcotics for pain control - he had chronic health issues, but would never see his PCP. We always liked seeing HIM, but the reasons he came in were above and beyond what the ER could do for him. Sometimes he wanted to be admitted. At a certain point, the docs said "no more treatment for you (unless emergent, obviously)" - and his PCP was notified. For those reasons, I say yes to the 3 strikes and your out, or some other reasonable time limit for patronizing the ER for nonsense stuff (and a million dollar workup, I might add) - it had nothing to do with the fact that, though he was disabled and on Medicaid, he used the ambulance (for non emergency reasons) to get to the ER (because he couldn't drive) - it was just silly that he came so frequently for something the docs would never "fix."

I don't think that is what they were talking about though, I mean surely there should be restrictions for the ER since after all, it's for Emergency's I am not sure actually what the poster was proposing though, since I never got an answer.

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Specializes in Emergency Dept. Trauma. Pediatrics.
case managers!!!

So they will determine whether or not someone is "worthy" of medical care??? Based on what?? The person relapses and therefor they aren't worthy?? Who is going to make up these standards?? It just doesn't seem realistic to me. Who is going to watch these pt's every moment to make sure they are exercising, and not cheating on their diet?? What if their body does something outside of the norm and they are accused of cheating when they really didn't. Do they just lose care as well because they aren't worthy.

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Mass Ed

I am currently in another state, I am going through the wonderfully fun process of apply for medicaid here.

I obviously qualify, unemployeed DESPERATELY SEEKING employment.

I am glad though they are this through but it really stresses me out trying to do that, find a place to live, unpack, find a job, attempt to prepare for a new baby with no funds.

I am SO thankfully that the baby's Aunt (BF's Sister) has had two children with a great OB/GYN here. She is expecting her third and did some name dropping. She explained my situation.

He doesn't accept Medicaid. Yet, He is going to make an exception for me. So I will feel a lot less stressed once I have insurance and a job and can begin seeing him!!!

I did on the other hand want and tried to report the other OB/GYN for his lack of treatment!!

I believe this is at the very least a form of neglect and would hate to think he treats all his patients this way.

Despite what type of insurance they are on...

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Specializes in ER.
I don't think that is what they were talking about though, I mean surely there should be restrictions for the ER since after all, it's for Emergency's I am not sure actually what the poster was proposing though, since I never got an answer.

well, the 3 strikes and you're out could be used for any location - since I'm in the ER, that's where I applied that. Maybe OP will clarify the proposal.

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i tell you all that to tell you this (yes i know, i talk way too much)....it really does all boil down to the fact that we have to let people be where they are in their life and not where WE think they should be. and thats way easier said than done but it's how we have to treat all our patients, loved ones or friends...no matter how we think "if they'd only lissn to me i could help them!".

THIS is exactly it! My issue, I mean. It's my total control-freak nature. As my mother would say, "So unattractive!!" LOL! I'm workin' on it! Sorry, off topic, but just wanted to acknowlege the truth to this sentiment. It is truly is frustrating to care for people who don't seem to care for themselves. I take exception to calling them stupid though. Not appropriate. We can express frustration without resorting to this.. I won't, however, say you need to change jobs or are a bad nurse. It irritates me when we say this kind of thing to each other. So I will say to OP and everyone else who's frustrated what I want to hear when I'm venting: Hang in there! Even though it sometimes feels like we are fighting a losing battle, we are making a difference, at least some of the time. It's hard to hold on to that(as it's not a whole heck of a lot), but it's something!

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Specializes in ER.
So they will determine whether or not someone is "worthy" of medical care??? Based on what?? The person relapses and therefor they aren't worthy?? Who is going to make up these standards?? It just doesn't seem realistic to me. Who is going to watch these pt's every moment to make sure they are exercising, and not cheating on their diet?? What if their body does something outside of the norm and they are accused of cheating when they really didn't. Do they just lose care as well because they aren't worthy.

a case manager can be assigned to follow the patient's care and their compliance with a treatment plan. Provide resources (such as a taxi) to get them to their appointments, which is how that's done here in Massachusetts, for instance. Well you would have an inkling of a person's diet when there was a home visit, no? There should be guidelines in place, for Medicaid, patients, based in their diagnosis and individualized to their needs. Of course there's no fool proof way to force a person to change their ways, but you can provide a person with the resources. I'm sure many a disadvantaged aren't even sure of how to get healthier - you can't assume a patient thinks like you or I might.

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Specializes in ER.
Mass Ed

I am currently in another state, I am going through the wonderfully fun process of apply for medicaid here.

I obviously qualify, unemployeed DESPERATELY SEEKING employment.

I am glad though they are this through but it really stresses me out trying to do that, find a place to live, unpack, find a job, attempt to prepare for a new baby with no funds.

I am SO thankfully that the baby's Aunt (BF's Sister) has had two children with a great OB/GYN here. She is expecting her third and did some name dropping. She explained my situation.

He doesn't accept Medicaid. Yet, He is going to make an exception for me. So I will feel a lot less stressed once I have insurance and a job and can begin seeing him!!!

I did on the other hand want and tried to report the other OB/GYN for his lack of treatment!!

I believe this is at the very least a form of neglect and would hate to think he treats all his patients this way.

Despite what type of insurance they are on...

Yay you're getting a doc that will help you!!!!!!!!! Super excited for you!!! Give that doc a hug for me!

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Specializes in Emergency Dept. Trauma. Pediatrics.
a case manager can be assigned to follow the patient's care and their compliance with a treatment plan. Provide resources (such as a taxi) to get them to their appointments, which is how that's done here in Massachusetts, for instance. Well you would have an inkling of a person's diet when there was a home visit, no? There should be guidelines in place, for Medicaid, patients, based in their diagnosis and individualized to their needs. Of course there's no fool proof way to force a person to change their ways, but you can provide a person with the resources. I'm sure many a disadvantaged aren't even sure of how to get healthier - you can't assume a patient thinks like you or I might.

I completely understand that, and I think what you said sounds wonderful and something like that SHOULD be in place already. I am more so talking about, the 3 strikes and you loose treatment. There are so many factors to consider and someone can't be with the Pt. 24/7 w/o a huge cost there, just to make sure they are eating right and working out, so it leaves to much room for error in my opinion when it comes to cutting them off.

That is more so what I am talking about.

I think if you were to take your ideas, and also get people some serious counseling and support groups, it would make huge strides on a pathway to change.

I know for myself, when I try to eat right, I start craving something I shouldn't have, it might not even be something I really like all that much, but it's like my brain is trying to sabotage me, and thankfully I distract myself to not fall in, but seriously, I will sit here and go WTH. I imagine that happens to a lot of people.

I was just talking to a speech therapist friend of mine yesterday, she was talking about children having a habit of saying their R's or whatever letter it is a certain way, they have been doing this since the age of talking. Well now you are trying to teach them the proper way to say it. She said it takes something like practicing it 30thousand times for your brain to form a new neuro pathway so that the next time you go to say it, it will pull on that new pathway and let go of the old one. I didn't research this myself so I am not positive how accurate that is, but 30 THOUSAND TIMES????

Take it from speech to something else, like with obesity, that is a LONG time to retrain yourself onto something new, that will take a lot of patience and support to achieve.

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Specializes in ER.
I completely understand that, and I think what you said sounds wonderful and something like that SHOULD be in place already. I am more so talking about, the 3 strikes and you loose treatment. There are so many factors to consider and someone can't be with the Pt. 24/7 w/o a huge cost there, just to make sure they are eating right and working out, so it leaves to much room for error in my opinion when it comes to cutting them off.

That is more so what I am talking about.

I think if you were to take your ideas, and also get people some serious counseling and support groups, it would make huge strides on a pathway to change.

I know for myself, when I try to eat right, I start craving something I shouldn't have, it might not even be something I really like all that much, but it's like my brain is trying to sabotage me, and thankfully I distract myself to not fall in, but seriously, I will sit here and go WTH. I imagine that happens to a lot of people.

I was just talking to a speech therapist friend of mine yesterday, she was talking about children having a habit of saying their R's or whatever letter it is a certain way, they have been doing this since the age of talking. Well now you are trying to teach them the proper way to say it. She said it takes something like practicing it 30thousand times for your brain to form a new neuro pathway so that the next time you go to say it, it will pull on that new pathway and let go of the old one. I didn't research this myself so I am not positive how accurate that is, but 30 THOUSAND TIMES????

Take it from speech to something else, like with obesity, that is a LONG time to retrain yourself onto something new, that will take a lot of patience and support to achieve.

we are still trying to RE-teach our 6 year old son how to undo some of the speech from when we lived in N.C. There's a drawl and a lazy way of speech that is very difficult to undo. I am constantly having him restate what he is trying to say, and say it CLEARLY!!! Of course he'll pick up some New England lingo and drop off the end letters of words, now!!! I'm hoping they have been repeating at LEAST 30,000 times by now. It certainly feels like it.

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Specializes in Emergency Dept. Trauma. Pediatrics.
we are still trying to RE-teach our 6 year old son how to undo some of the speech from when we lived in N.C. There's a drawl and a lazy way of speech that is very difficult to undo. I am constantly having him restate what he is trying to say, and say it CLEARLY!!! Of course he'll pick up some New England lingo and drop off the end letters of words, now!!! I'm hoping they have been repeating at LEAST 30,000 times by now. It certainly feels like it.

Two of my sons are in speech, my 2 year old daughter just got discharged, her speech problems were just delayed speaking, she would say very few words but than she turned two and now you can't get her to shut up LOL.

But my 2 sons 1st and 3rd grade are in speech, they go once a week for 30 mins. They have made great progress from the beginning but I was totally surprised to hear that. It takes a lot to ad up to 30 thousand even though it feels different LOL.

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Some patients like that do stick in your memory, but keep it in perspective.

For every seemingly hopeless patient like that, there are many who do care about their health, they are motivated and able to change.

Patients who are so self-destructive are the minority.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

:angryfire:angryfire I am so sick and tired of this undertone in many of these posts that suggests various versions of "they don't know any better" or "no one ever told them the difference between an apple and a Twinkie". It is precisely because they are NOT stupid(low IQ) or ignorant(never been exposed to healthy choices) that we have to allow people the same autonomy as anybody else. I work in a lower income area as well, and I have seen amazing creativity, social networking, and on and on. They resent the assumptions people make about their lifestyle choices and personal hygeine habits. How would you feel if the City Council of YOUR neighborhood passed a law banning fast-food because you couldn't be trusted to choose your own diet properly?

However, I don't see how there is any practical way to deny care based on compliance/non-compliance. In most cases there are too many factors to consider (both medical and psychological) to prove a definate cause-effect relationship. It would be hugely expensive and unwieldy to monitor that. I don't suppose anybody wants to see their tax dollars spent on somebody hell-bent on destroying themselves, but private insurance premiums go up too based on the bazillions of dollars spent on caring for people who have lifestyle related conditions.:spbox: OK, stepping down:)

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