Ignorant Stupid Patients

getoverit, BSN, RN, EMT-P · May 14, 2009

I wish I had time to read all the posts but we've had a busy night and I'm just getting a chance to sit down.

To the nursing student who believes poverty has nothing to do with health status, I think you're mistaken. Your examples may be factual when it comes to the price and nutritional content of a McDs salad, but you have to take everything into account that comprises the environment of poverty...it's not just a monetary value.

People who don't take care of themselves do deserve healthcare, and I understand how frustrating that is sometimes. Your examples of diabetics who don't control their diabetes are classical. what about when they have a knee arthroplasty and can't recover from the anesthesia? think of the untold $$ that pile up quickly from that scenario. It usually all comes out of the same pocket (ours).

Also, what about people who engage in criminal behavior and need health care? specifically, cocaine abusers who have AMIs. Then get admitted a few weeks later, testing positive for cocaine and elevated enzymes again. how many times is enough? Can you honestly say 3 strikes and you're out to them? In theory it sounds good, but then you have to think about the actuality of your statement.

Just my opinion. Hope everyone has a great day!

rngolfer53 · May 14, 2009

: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!

While I agree with the general principle that we value free things according to the price we pay, I think if a Pt isn't motivated by losing a leg, paying some money won't make a lot of difference.

With most people, though, a good incentive program makes a lot of difference. There should be higher co-pays for instance, if this is the third time your own dog has bitten you, or you're in the hospital r/t COPD and you go outside in your gown, IV pole in tow, to puff away on a cig.

rngolfer53 · May 14, 2009

Also, what about people who engage in criminal behavior and need health care? specifically, cocaine abusers who have AMIs. Then get admitted a few weeks later, testing positive for cocaine and elevated enzymes again. how many times is enough? Can you honestly say 3 strikes and you're out to them? In theory it sounds good, but then you have to think about the actuality of your statement.
Just my opinion. Hope everyone has a great day!

By saying "Yes" to three strikes and you're out, you free up resources that have the potential to impact another life positively. That, too, is the actuality of the statement.

Otherwise, you're only working with half the equation.

getoverit, BSN, RN, EMT-P · May 14, 2009

By saying "Yes" to three strikes and you're out, you free up resources that have the potential to impact another life positively. That, too, is the actuality of the statement.
Otherwise, you're only working with half the equation.

You may be freeing up resources that would be used to a greater positive impact. But I don't think you're working with only half the equation....because if that were true then my question for you to answer about the other half is: where would you suggest the ungrateful and unmotivated go to die?

Because with what you propose, someone could show up at the ER with +ST change, elevated enzymes, etc...and if it was their third MI, then we'd just open the door and put them back on the street. and how would you account for people with genetic markers for cardiac disease as opposed to people with poor diets, or what if it's a mixture of both...how would you know for sure which is more of a contributing factor.

I agree with you about an incentive program and increasing co-pays for certain things, such as cigarette smoking, chronic alcohol abuse, even doing something obviously stupid that breaks your arm. But what about when they can't pay? You're right about someone who doesn't care about losing a leg isn't going to care if you charge him more money, because he isn't going to pay anyway. How do you squeeze $$ out of them who have none to begin with? I think the answer lies in a combination of increased access to appropriate healthcare resources and a different approach toward public education.

johnsboo · May 14, 2009

Working in healthcare means working with people. People of all walks of life. People with all levels of intelligence, different environments during childhood, full range of mental health issues, and views of life in general. As nurses, we are given orders from the Dr. to follow, and certain protocols for specific situations. As nurses, we are all wired a little differently, just as our patients are. Sometimes, we just have to step back after doing all that we can do for the patient, and know we did our best for them. We know that some patients are never going to change and we just have to accept that.

Look at it this way. How many nurses do you know that work on a Tele floor with COPD patients day in and day out, yet continue to smoke. Are they not educated in the dangers of smoking? Are they not exposed every day to the horrors of what their last days are going to look like? Yet do they continue in the same behaviors? It isn't about being stupid or just not caring. People are people. We need to go from a task oriented profession to a critical thinking profession. Things will change and perspectives will change and we will stop being quite so judgemental of others if we take a minute to realize we are all entitled to live the way we choose, wether that means poor judgement, or good choices. Consequences come with every choice. And some of our patients, no matter how much they might irritate us, they have to live day in and day out with those consequences.

hyalophora09 · May 14, 2009

Maybe this can be helpful,I probably shouldn't post this ,but here it goes.Would the 3 strike's rule apply to me?I can see the frustration in your face.I am everything you guys have talked about except the ritz hotel thing and complaining.I was 525lbs. at my biggest,diabetic,on medicaid,non-compliant,binge eater,etc,etc...Ihad received numerous attempts to educate me on diabeties control and my diet with no success.Then one day ,my doctor said something to me that seemed to make sense to me and a dietitian that was honest with me and didn't judge me.I thought I could find this happiness and feel better about myself like everyone was telling me about.I went on a severe diet(my own) and walked alot.I did this for 2 years and lost over 300lbs.I thought I was doing great,everyone was happy with me,I was doing what everyone wanted me too.I kept thinking just a few more pounds here a few there.Now,I'm no longer diabetic,no more high blood pressure,I guess I'm thin now,even though I still feel fat.I don't feel any better about myself,my heartrates drop into the 40's,my blood pressure bottoms out,I'm constantly freezing cold,etc,etc,...I'm anorexic now.When I started this, I didn't think I had an eating disorder.After reading up on it,I realize I've had one all along.How would I be judged?I am curious what you think and can except your replies.I don't think it has anything to do with poverty.I realize now it was something that happened to me when I was a child.I don't want therapy,I don't think I should have to share my experience with anyone.Should I be cut off from future care.Should I be forced by law to relive what I went though?I can understand your frustration,I have felt that way with myself many times.It's not because I'm ignorant or stupid,it might be that it's easier than admitting to yourself that you might have a problem.Hopefully this will help you understand why someone like me could be so non-compliant.Denial is a powerful drug.I'd rather be eating those 6 snicker's bars right now and settlin' in for that nice blood sugar BUZZZ!,but instead I'll go for a walk.

getoverit, BSN, RN, EMT-P · May 14, 2009

First of all, I hope you get the additional help you need.

I'd be interested to hear what rngolfer53 has to say about your story.

johnsboo · May 14, 2009

This person's response just reinforces what I was saying. The patients aren't necessarily stupid. They are who they are, and as nurses, it is up to us to do our best with them. We all want to "fix" our patient and have great patient outcomes. But this is not a perfect world folks. Nor a perfect profession. We are not perfect people either! We also want to go to work and do patient care not paperwork, when was the last time you did a shift of patient care without paperwork? When was the last time you went patient to patient, spent the amount of time necessary to perform your duties without any distractions and went home saying, gee, another perfect day in nursing? Just caring for patients and visiting with families, educating the patient to care for themselves after discharge, etc. It's a crazy crazy world this nursing profession, we just need to realize that and carry on the best we can.

RNperdiem, RN · May 14, 2009

There are some unintended consequences of living in the land of plenty.

A massively obese, double amputee from a background of poverty just wouldn't have existed 100 years ago.

Food is so cheap now that even poor people (in this country) can become so overweight that their health is in danger.

We have medication to control diabetes so diabetics can survive.

We have medical care that can rescue people from bad choices over and over again.

NurseLoveJoy88, ASN, RN · May 14, 2009

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.

Maybe your pt. is not stupid or ignorant. What if she really can't control what she eats. She may actually have an addiction to those types of food or food in general. Drug addicts know they can die from doing drugs. Smokers know they can get cancer and die from smoking. Some obese women with DM know they are at risk for getting an amp. and or dying. My point is that when addiction is in the picture the pt. may know the consequences but still can't seem to break away from their addiction. I don't think this women chose to get her leg amp. just over snickers bars, she clearly is addicted to food and perhaps should be referred to a weight clinic or dietician. I can see where you are coming from and I can see why you are fustrated. I've been there not as a nurse but a neice to my aunt who died of cancers because she just couldnt stop that smoking. She smoked all the way up to her dealth. Addiction is real.

johnsboo · May 14, 2009

a dietician or nutritionist isn't going to help with an addiction, a psychologist would be more in line with the treatment. But all of the specialists in the world cannot help someone that just isn't ready to be helped. Addiction can only be overcome by the addict coming to terms and accepting they need to do something to help themselves. Many never do.

Elizabeth Oliva · May 14, 2009

Ummm is this in response to my signature??? If so, it's just that, my signature, it's not directed at any specific person.

LOL....my appologies. I noticed afterwards that your quote was attatched on previous blogs. I jumped the gun.