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!

[travel50]

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

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

But here's the problem from where I work (LTC). We are required by the state to keep repeating the same action and saying the same thing over and over and over, no matter if it doesn't do any good. If we don't the state surveyors will say, "well, how do you know that just b/c it did no good in Jan. that it wouldn't have helped in Feb.?" And just as the last person posted, these pts will be the first to nab a surveyor and complain that they are mistreated. So I can't say that we are insane for repeating things. I can agree that some of the regulations are insane.

[Valerie Salva, BSN, RN]

I can empathize with the OP, and I have to defend her post-

I recently cared for a pt who was hospitalized three times in one month due to her total non-compliance and her blaming everyone else for what she caused herself. When I tried to do some pt teaching with her (again) she said to me "It's is all your fault I keep going to the hospital because you never have anything positive to say to me." WTH?

Our tax dollars pay for this woman's three times weekly outpt dialysis tx (about $10,000. a month) plus all of her frequent hospitalizations for critical high K+ levels, and extreme fluid overload because she refuses to follow her renal diet & fluid restriction. The doc, the RD and I have all repeatedly tried to teach her without effect.

She wouldn't be on dialysis in the first place if she had been compliant with taking her free BP meds.

It is more frustrating when a Medicaide pt is so non-compliant because they are wasting our money.

Let's not gild the lily- some pts are "ignorant and stupid!" And they co$t us a fortune.

[WarmBlanket]

It seems as if the majority of health care professionals who put so much thought and caring into a variety of solutions , will have this problem of " Ignorant Stupid Patients " solved relatively soon . Just keep treating them with disdain , and disgust . Ignore the fact that each of them are someones mother , father , sister , brother . Never touch them unless you are wearing gloves . Roll your eyes and act bothered at every request . Since they are stupid and ignorant they need you to confirm that they are losers . If you do a good enough job , they will meet all your expectations and you can ship them off to another unit .

Please don't give me your "non-compliant " excuses . If you don't like your assignment or the PEOPLE you have been entrusted to take care of , quit ! I am not telling you this because I want you to find a job you will enjoy : I am telling you this because you have no right to continue working with your crappy , superior views .

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

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???

Poverty and Education play a huge part in this. Do you know that most FF places will target poor areas to open up shop?? Same with the Payday loans (which should be illegal). They market the poor areas because usually when you are poor you get desperate, you need to turn your lights back on so you go w/o something else and you live in a constant state of catch up. Mom might be working double shift with no time to cook meals, so they stop off at McDonalds which is conveniently located right next door and is a lot easier than trying to carry many bags of groceries on the bus since you don't have a vehicle. Which you don't want a vehicle because if you do have a vehicle even if it's a beater because that is considered a luxury and than you might not get help because the state will say you can sell your vehicle. Eating healthy as in Fresh Veggies and Produce is not cheap. Now if your talking about beans and rice and stuff, yes that stuff is cheaper (although I wouldn't say it's healthy although better than a Big Mac) but again, when 1 person is trying to work 2 jobs to support their family, time isn't always on their side and convenience is, now throw in activity, in a poor area the funding to maintain parks and recreation are not there. Children need a safe place to be active. Try finding a safe place in the impoverished areas. It's a very very bitter cycle and one someone could not possibly understand unless they have lived it.

This may not be the case for the lady, but absolutely poverty and lack of education (which usually comes with poverty) plays a HUGE role in the obesity epidemic and obesity related diseases our country faces.

Poor people are not the only ones overweight though, so it is not the ONLY role. But than again, wealthy people aren't receiving medicaid yet still make up part of our obese population. Do they just get a free pass though from judgment because they are wealthy and can afford the 800+ dollars a month for Ins. for their family.

I am basing that off what I was quoted to provide mediocre health Ins. for my family. It was over 800 dollars a month with a 5000 dollar family deductible. So I am not poor enough for free health ins. but I am to poor to pay for it.

[KatzchenLSW]

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.

What an ignorant statement! Poverty can have everything to do with it. If you have a patient/ client living in a hotel without access to fridge or microwave or a car and the 7-11 is the only place to buy food, their choices regarding purchasing healthy food are severely limited by their poverty. The same is true for those who live in inner city neighborhoods with no grocery stores nearby and a limit on the number of bags they can carry on the bus.

Food stamps often go much farther on junk food than on healthier alternatives. Here a single adult gets about $79 a month in food stamps. With that money they could buy lots of frozen dinners for lunch and dinner at $1 each (if you have a way to reheat them) and a box of cereal for breakfast or you could eat healthily for two - three weeks and then go hungry.

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.

So in short if we can't use a pill to fix it and the client doesn't overcome all of his or her barriers their life is worthless? Would you feel the same way about an anorexic/bulimic patient? Because based on the info in your post your patient most likely has an eating disorder in addition to several other mental health issues, not of which will be cured overnight or even over years with medication or dietary education.

[Curious_53]

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

So, I'm not really sure how I feel about this idea or not... but IF i were for it... how on earth would you track something like that? How do you measure effort? What if, as someone suggested about the women in the OP's post, she IS addicted to food? What if she has been putting forth an effort, and the reason she answered snarky ("oh I do understand how to control my bs") was because she was embarrassed?

But mainly... It stinks that people don't want to take care of themselves, but especially in an American society, we don't want to put forth the work it takes to maintain our health.

The best we can do is a good vent thread

[NursingStudent5548]

Okay so you don't have a car, you can only car so many groceries you can carry, you have no time working two jobs.

No playgrounds for children to be active.

None of these are still excuses for poor eating habits, and poor life style choices.

Lack of education, yes I agree not their fault... I am saying our country would be wiser to invest more in educating these people than to pay hundreds of thousands even millions on these people for medical issues that could have been avoiding.

No car, take a city bus. With 4-6 bags of groceries a person can eat for 2-3 weeks.

Limit of groceries is also solved with this issue.

No time Mcdonalds has a side salad and grilled chicken snack wrap which are balanced and healthy for $2 per meal.

Almost every fast food place has cheap and healthy options such as these. They are also quick for those who don't have time.

No playgrounds, wow really are you serious. Children can still go outside and play a game of tag with each other. Please also supervise your children when outside always!!

So a pill doesn't fix it then, does she have the right to make decisions for herself if she doesn't have the cognitive ability to stop herself from her destructive habits.

Please don't spend my tax dollars for a specialty weight loss facility. Our facility could have easily had our dietician make a strict diet plan for her to adhere to. Should she have the right to raid the fridgerator. Should she have the right to refuse light moderate exercises with our physical therapist??

Everyone of you continues to quote the definition of insanity.

I think it is insane to continue with this same situation for 16 years and have no progress...

My mother is in the same situtation, she has declined down hill for the last year and a half.

She has spent the last 20 years couped up in her basement snacking and watching TV all night.

She never exercises.

She has developed non-insulin dependent diabetes. She takes medications to control her blood sugars.

Yet on days she snacks on more savory snacks she gets ill because her blood sugar goes low.

She could easily not have diabetes and need medications for this if she changed her diet.

She has high BP 20 years of cholestrol ridden snacks have begun clogging arteries and causing high blood pressure.

She has had 3 strokes in the last year. With a brain scan she found she has a 70% blockage in numerous arteries in her brain.

NOW you may think I am radical, harsh or insane. But the family members of these patients would probably have no problem with changes being made to help this person to get them better. Even if it meant taking away their rights.

My mother left the hospital AMA. Do you think she is sane enough to make decisions for herself.

Do you think she deserves to continue living like this eating everyones tax dollars??

Do you think I want to see her do this to herself, when I am just as helpless as a family member as the medical workers who care for her.

So before you call me ignorant and stupid.... maybe you should think about it from this perspective as well.

Would you want your own mother who is 43 living like this!!

No I wish there was laws that prohibited this. If my mother was healthier and felt spry. She would have the support at home and would come out of her depressed self-pity mind set and could live a long and healthy life.

Thats if something is done soon about this...if not she will probably die within 10 years!!!

[KatzchenLSW]

No car, take a city bus. With 4-6 bags of groceries a person can eat for 2-3 weeks.

Limit of groceries is also solved with this issue.

No time Mcdonalds has a side salad and grilled chicken snack wrap which are balanced and healthy for $2 per meal.

Almost every fast food place has cheap and healthy options such as these. They are also quick for those who don't have time.

Unless your city has no public transport or you have no refrigerator or the bus limits you to two grocery bags...

Honestly if you saw the barriers to a healthy lifestyle that most of my clients faced on a daily basis you'd be amazed that any of them are relatively healthy.

I'm not saying that clients like the one you referenced are blameless, but that a little understanding about the challenges of mental illnesses, addictions and living in poverty would go a long way.

(Honestly, how would you feel if you knew that almost every one you know, including the nurse caring for you thinks you are disgusting, stupid, lazy and worthless just because you are obese, ill and couldn't get your life in order on their timeline? )

[nghtfltguy, BSN, RN]

i read your post.. don't have time to read all the respnoses!!!.... looks like quite a few pages...

i agree w/ you!!!!... some pt's are just plain stupid!!!!!!!

[CreoleFromtheBoot]

Some might think this is off topic (actually all of you might) but bare with me, it's late. I knew this girl, a beautiful girl, but when it came to romance she was clueless. She would tell me how much she wanted to be married but would always chase men away. We would have long talks about what she should do and what behaviors to avoid. Most of the time she agreed but sometimes she didn't. She actually tried to convince me (or herself) that it's ok to show up at a guy's house unannounced or blowing up his phone or checking his voicemails. I tried to explain to her that her stalker behavior is very unattractive. She wouldn't listen. Even when the guys would tell her she still believed that they were "just trippin" and it's just a sign of love.

This type of behavior is called denial. The reason why I bring all this up is because some people need to be reminded that although you know better than to eat six snickers while lying in the hospital, you might be chasing a guy that wants nothing to do with you but it's too difficult for you to let go because you insist on only believing you two were meant to be (see, denial). See, this type of behavior is not isolated to just medicaid recipients. Most people have had to deal with this (being stuck in denial, that is) at some point in their lives. So...The moral of the story is... DON'T JUDGE! We all have a lot more in common than you think...

That's my:twocents:. Im going to bed now... Good Night AN!!

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

Okay so you don't have a car, you can only car so many groceries you can carry, you have no time working two jobs.

No playgrounds for children to be active.

None of these are still excuses for poor eating habits, and poor life style choices.

Lack of education, yes I agree not their fault... I am saying our country would be wiser to invest more in educating these people than to pay hundreds of thousands even millions on these people for medical issues that could have been avoiding.

No car, take a city bus. With 4-6 bags of groceries a person can eat for 2-3 weeks.

Limit of groceries is also solved with this issue.

No time Mcdonalds has a side salad and grilled chicken snack wrap which are balanced and healthy for $2 per meal.

Almost every fast food place has cheap and healthy options such as these. They are also quick for those who don't have time.

No playgrounds, wow really are you serious. Children can still go outside and play a game of tag with each other. Please also supervise your children when outside always!!

So a pill doesn't fix it then, does she have the right to make decisions for herself if she doesn't have the cognitive ability to stop herself from her destructive habits.

Please don't spend my tax dollars for a specialty weight loss facility. Our facility could have easily had our dietician make a strict diet plan for her to adhere to. Should she have the right to raid the fridgerator. Should she have the right to refuse light moderate exercises with our physical therapist??

Everyone of you continues to quote the definition of insanity.

I think it is insane to continue with this same situation for 16 years and have no progress...

My mother is in the same situtation, she has declined down hill for the last year and a half.

She has spent the last 20 years couped up in her basement snacking and watching TV all night.

She never exercises.

She has developed non-insulin dependent diabetes. She takes medications to control her blood sugars.

Yet on days she snacks on more savory snacks she gets ill because her blood sugar goes low.

She could easily not have diabetes and need medications for this if she changed her diet.

She has high BP 20 years of cholestrol ridden snacks have begun clogging arteries and causing high blood pressure.

She has had 3 strokes in the last year. With a brain scan she found she has a 70% blockage in numerous arteries in her brain.

NOW you may think I am radical, harsh or insane. But the family members of these patients would probably have no problem with changes being made to help this person to get them better. Even if it meant taking away their rights.

My mother left the hospital AMA. Do you think she is sane enough to make decisions for herself.

Do you think she deserves to continue living like this eating everyones tax dollars??

Do you think I want to see her do this to herself, when I am just as helpless as a family member as the medical workers who care for her.

So before you call me ignorant and stupid.... maybe you should think about it from this perspective as well.

Would you want your own mother who is 43 living like this!!

No I wish there was laws that prohibited this. If my mother was healthier and felt spry. She would have the support at home and would come out of her depressed self-pity mind set and could live a long and healthy life.

Thats if something is done soon about this...if not she will probably die within 10 years!!!

On some of your solutions, it must be nice to live in your bubble. The reality is quiet different. I am not even going to get into it because it's pointless, people will only see what they chose to see and that will never change. BTW the healthy options at a lot of FF places are not that healthy and the portions are very small and un-fulfilling

I will be sure to tell the kids living in the projects to just get outside and play tag while dodging bullets, or the kids that live in unmaintained poor neighborhoods with a high incidence of crime, and unsafe streets, to just go outside and play tag. No to worry about the crack heads on the corner, the needles in the gutter or dirty condoms left laying around, the cars that don't watch for kids and so on.

I just did my Nutrition Thesis on Childhood obesity and it entailed a LOT of research on the subject at hand, add to that, I lived in one of these neighborhoods as a child. Your solutions while idealistic are not necessarily realistic in some of these cases.

Oh and in some of these neighborhoods, good luck getting your groceries from the bus to where you are living safely.

BTW, I wouldn't call you stupid or ignorant, I don't know you well enough to form an opinion like that about you. I also won't even get into "my bio mom" in here.

I am one of the last people to judge others on many things because I have lived a life and experienced things many, thankfully haven't had to. It has given me a insight to a lot of things.

[NursingStudent5548]

I like the denial analogy.

Yet your assuming we are judging....I am not judging. A person in denial is helpless unless for some odd miracle they realize the behaviour and can actually make the changes.

My mother, the intial patient, the patient in my example will not get better unless someone forces them into facing the issues. Once they begin to feel better they might stop denying the issues and begin to continue the treatment plan on their own.

Many of you may argue they don't need such extreme actions. I will say you may be right but do they have the time to do trial and error and maybe stumble upon a method that is less extreme and works.

I don't think so every day sooner my mom is getting the treatment she needs, forcefully or not is better.

She would be thankful in the end. My mom is a person that knows she needs forced to do these things.

I, my siblings, my step-father, and other family members would be so thankful as well.

Desperation, and denial call for extreme actions. Some patients may fight initially and then be thankful.

Other may not fight at all. Finally there are those who will fight the entire time (so ethical standards may be an issue and need to be set) this would give these patients an out...