Ignorant Stupid Patients

[KY RN]

: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!

[KY RN]

Southernbeegirl,

What are you referring to when you ask,"then why do you keep doing it?

Are you referring to educating the client over and over? That is my job, to educate and teach. I presented the information to her in several different ways. She chose not to accept this. It does frustrate me, but I cannot change that.

[~Mi Vida Loca~RN, ASN, RN]

I would never presume to know what the patient is feeling and thinking. I treated the patient as I would treat any other patient, with respect and dignity.

I did not blame medicaid for the stupidity and ignorance. Stupidity and ignorance are seperate from the Medicaid issue.

However, I do believe there is a connection between accountablity, and paying for your own health care services.

I, personally, am more willing to be compliant when I pay for my own meds and treatments. I know that if I do not control my diabetes, I will have to pay for my own surgeries, should I need them. If I knew that someone else will pay for this medical treatment, I am less willing to be compliant. If I know that someone else is footing the bill, I would eat as many Snickers as I want to.

What about those that can't pay?? If they didn't have medicaid to cover the costs they probably just wouldn't go and things would get so much worse. I think accountability comes from upbringing and not from what one can afford. You teach your children to be accountable and usually they grow up to carry those same values. I don't have Ins. at the moment, I will have to get it in August, but for the past year I have not had it and I have had to pay around 400 dollars just to go to the Doc and have my blood drawn. The doc saw me for 20 mins. and drew my blood to test my Thyroid. My total bill was well over 400 dollars. I wouldn't be quick to assume you Pt.'s accountability comes from the type of Ins. they carry, and I would be willing to bet that it is more of a mental issue with them. (not mental as they are psycho or anything like that, but I mind can be our worst enemy and someone in her state has to be going through a lot emotionally).

I suppose their might be a small correlation, but I think you would find that the correlation is more so from their upbringing than it is their Ins. IMO.

[NursingStudent5548]

I truly understand the original poster's feelings here.

I enlisted in the Army to get my foot in the medical field; I was a combat medic.

I got my EMT certification, my CPR certification, my CNA, and CMA certifications as well.

I have all of these so I can get as much experience in the medical field while I finish my RN/BSN program.

I do have to say the last place I worked was a nursing home. I learned quickly I didn't like this at all. It was also my first time not working at a military hospital with the soldiers.

In the long term care facility, you have to care for people like this everyday. I get very frustrated because growing up I was always under the impression nurses/doctors helped people get better. When you step into the real world though that is not always the case. Patients Rights, in my opinion, have gone to far. Especially for those who are recieving assistance with their medical bills.

Some one suggested a 3 strikes your out policy. It may seem harsh to some but think about it.

For someone who is drawing unemployment they have to prove they are still looking for a job if able.

Why can't a similar rule apply for government funded insurance.

If you do not show your making an effort to improve your health then you should be able to lose that benefit as well.

I see your point that why should we continue to pay for someone's care if they don't care enough to get better.

I imagine this person will end up in a long term care facility to frustrate other nurses and CNA's until they eventually die from their behaviors. Sounds harsh but I see it alot.

If we were to think about it say that person lives 5 years in a LTC facility eating up $4k a month in medical expences.

Do the math people thats $240K in tax payer dollars so this person can gorge themselves.

Now think about all the people guilty of this... I had 4 guilty out of 46 in our facilty guilty of this exact offense.

This doesn't account for those who are too lazy to keep moving then end up wheel chair bound then bed bound. Nothing else is wrong with them just they sat around so long their muscles atrophied and they got contractures.

These people are in their 40's and 50's living in a nursing home.

Once I got over the initial medicaid people and the original poster admitted not all medicaid patients are that way.

I get what they are saying though... and I do think with the medicaid this should be an option.

Even if a person is booted off once twice or a million times if they make improvements and change then okay spend the tax dollars but it they are abusing them not so much!!

[southernbeegirl, BSN, RN]

Southernbeegirl,

What are you referring to when you ask,"then why do you keep doing it?

Are you referring to educating the client over and over? That is my job, to educate and teach. I presented the information to her in several different ways. She chose not to accept this. It does frustrate me, but I cannot change that.

you said in your post "doing the same thing over and over again and expecting different results is stupidity" (or something close to that). we say the same thing in AA only we call it insanity.

i realize that you were referring to the patient but i felt that it also could be something you ask yourself. if you know that repeatedly TELLING her what she should do is going to do no good, then why do you keep doing it and getting yourself all upset?

have you tried a different tactic with her? suggested a psych consult for the depression she probably feels?

and if nothing else, instead of repeatedly getting yourself all worked up and upset, try meeting a patient where they are in their life and not where you think they should be.

[KY RN]

To answer your question about the patients who cannot afford to pay, and who are not eligible for medicaid, I feel that any aid should be dependent upon the willingness of the pt. to comply with treatment and be proactive.

If the client is actively trying to improve their health, they should be given treatment.

If they continously refuse to follow treatments, why should more time and money be wasted on that patient?

This money could be better spent on vaccination programs, early intervention programs, and prevention programs.

[KatzchenLSW]

To answer your question about the patients who cannot afford to pay, and who are not eligible for medicaid, I feel that any aid should be dependent upon the willingness of the pt. to comply with treatment and be proactive.

And when their inability to comply is due to poverty? Should we cut them off then too?

I understand your frustrations, but you seem to fail to understand that there is often much more at play in these situations than ignorance and inability to change alone.

[travel50]

Interesting posts all of these. I sympathize with the original person posting. I really don't care what type of insurance, if any, a person has. It really isn't the insurance, it is what my son calls "voluntary stupidity". It irritates the stuffing out of me. I've had a patient much like this one in my nursing home. Guaranteed they will be the first ones to call the state with a bogus complaint. My son was on medicaid when he was 11 after nearly dying from rocky mountain spotted fever. The bill was unbelievable. I was so grateful for the help. At the time I hadn't been able to afford insurance. People cannot always help where they are. But they can help how they behave. And their behavior can make our jobs so very frustrating.

[kitti419]

Repeating the same action over and over, and expecting a different result is "stupidity."

Actually, I think that might be the definition of "insanity."

[NursingStudent5548]

Please provide me with one example of when poverty means someone cannot improve their health.

We are not saying they cannot recieve care and if they can't afford treatment that will make them better then okay.

If your insisting diet we have a program for that (food stamps).

If you have no home and have to sleep in the elements, we can find shelter for them.

Especially with the tax dollars saved on unnecessary medical care.

But in this case poverty has nothing to do with it.

6 candy bars for $.75, thats $4.50 that can buy a balanced meal.

Like a salad with chicken and low fat dressing

Not 1,596 calories

66 grams of fat

780 mg sodium

220g carbohydrates

So, the patient in this case needs psychological help, give them a psych consult.

Give them every chance to succeed, it won't matter though.

I had a resident who was so overly obese and disgusting, and has out of control diabetes. We did daily bath on her, consulted her about her diet and her diabetes. It didn't matter she is 51 in a nursing home and stinks of rotten flesh.

We dry all of her "crevaces" multiple times through out the day and apply nystatin powder.

The part that cracks me up most about the situation. This resident has a rotten part on one arm just above her elbow from a fat roll. She swears and will tell anyone who will listen its from the extra lage blood pressure cuff.

This resident has numerous psychological medicines and narcotics you name it been given every chance to get better in the world.

Yet, she still raids the kitchen and snack fridge every night when she thinks no one will notice, and will take

handfuls of ice cream cups, yogurt, sandwhiches, you name it back to her room and eat them all. We have seen her go through a half gallon of milk in one night mixing it with the chocolate syrup her husband brings in.

Now our facility charged $4K a month, this isn't including all of her prescriptions. She has been living there for 16 years.

Now tell me, why does she deserve to eat more in tax dollars every year than I have made in the last 6 years???

[NursingStudent5548]

Oh I forgot to mention... every year when the state comes through for their annual inspection.

She will literally cry to them and say every staff member picks on her for her weight and tries to starve her.

NOBODY, says anything to her or stops her from raiding the fridge etc.

The only things said to her are when she says statements like "I wish I wasn't so fat, and feel so crummy"

Then a staff member usually jumps at the opprotunity to help her develop a meal and exercise plan.

Those are the staff members I feel most sorry for because...they are the ones who get the lowered eyebrow and scowl from the state inspectors!!!

[Mommy_of_3_in_AL..RN]

a little off the original subject i guess, but in my facility i get most annoyed with the "VIP" patients (yes they are listed as such)...the patients who are in healthcare, have family that work in healthcare, hold a political or otherwise powerful position, or just people who know people that could get us in trouble...it is stressed to us that we are to take extra effort to cater to these patients so they wont whine and complain..i get that if the patient is a physician (as my patient today was) that yes, they know what is going on and you cant beat around the bush with them..but the quality of care given to a patient shouldnt be based on their status. All patients should be treated equally and receive our very best care..sorry..i am not going to ignore the request of patient A that needs the bedpan to get you a cup of fresh brewed coffee with cream and sugar..my patients are prioritized based on their needs, not their status. Basically, i wont kiss your tail cause your uncles cousin is a nurse..sorry..you are no more a person than the lady next door with no family and no money...all are treated equally important and receive the same level of care, which is the best i can provide. ok...thats my rant for the day :)

[~Mi Vida Loca~RN, ASN, RN]

To answer your question about the patients who cannot afford to pay, and who are not eligible for medicaid, I feel that any aid should be dependent upon the willingness of the pt. to comply with treatment and be proactive.

If the client is actively trying to improve their health, they should be given treatment.

If they continously refuse to follow treatments, why should more time and money be wasted on that patient?

This money could be better spent on vaccination programs, early intervention programs, and prevention programs.

So who is going to be determining whether or not the pt. is complying with treatment and being proactive. We will have people living with the Pt. to make sure they are being proactive?? Do we just expect that life long habits are going to change overnight and if the person struggles or relapses we say to bad? Whose standards are these people going to be liable too? Who will be the judge and jury if these patients are worthy enough or deserving enough?