Ignorant Stupid Patients

johnsboo · May 14, 2009

I think compassion rather than anger, name calling(stupid patient), and judging without living that persons life, is the only real emotion that is called for in this case. Too many nurses have lost that compassion, and some never had it. There is nothing wrong with discussing the possibility of addiction with a patient and asking if they are willing to talk with someone about what they can do to help themselves. It is part of patient education. We can offer it, set it up, and help with it, but we can't force it and we can't show any kind of frustration with the patient for not accepting it. All patients have the right to refuse any kind of treatment for any reason. This is basic nursing skills. Basic Human skills really.

Curious_53 · May 14, 2009

BTW the healthy options at a lot of FF places are not that healthy and the portions are very small and un-fulfilling
Every salad at Mcdonalds has less than 400 calories. Every meal a person is allowed easily 500. As long as a person avoids the ranch and ceasar dressing. They will easily stay under 500 calories.
These salads are $5 or less
Alot of these salads have and entire days servings for vegetables
They are balanced containing
Vegetables
Meat/Protein
Grain
Fat/Oil (dressing)
Dairy
So pair with a minute maid apple juice and there is a balanced meal!! It is healthy and it is filling. If someone considers it not filling then they are eating too large portions.
It's all well and good to look at calories but you need to look at fat content too. There are very few salads that have less than 9g of fat in them - that's a huge amount! I mean, the hamburger has less than 500 calories but would you think it was a good idea if someone ate one of those for lunch everyday? There are so many important things to look at when choosing foods - fat being a big one, not calories alone. McDonald's rides on the fact that it has salads, this makes them seem healthy when in reality they are just as bad as a burger. A lot of the salads that are low in fat (I.E. 4g) are the ones that are served WITHOUT chicken! I couldn't stay full on that!
The bottom line is that you cannot eat healthy and eat fast food, I just do not believe it.
I DO believe however, that healthy food is much more expensive and that this is a large reason for the obesity in our country. When an apple is more expensive than a slice of pizza we have a problem.

flightnurse2b, LPN · May 14, 2009

i think it is very easy for us to judge patients when they become frustrating to us. i myself and guilty of wanting to just throw up my hands and say "IF YOU DON'T LISTEN... YOU ARE GOING TO DIE".

i agree with the other posters on here that suggested psych consults. i was way on the other end of the spectrum and spend months in the hospital actively dying of anorexia and bulimia. my parents had more than plenty resources--i starved myself, and when i got so sick i was in the hospital, my body was so used to being hungry, i didn't want to eat because it made me sick and i was scared to death of eating foods PO because i ended up projectile vomiting when i first started. my hair was falling out, my lytes were totally out of wack, and i didn't care. i actually was a horrible, horrible patient, pulled my IV's and my NGT out and even threw my slippers at a nurse who weighed me and mumbled something about me under her breath. i was addicted to starving... and at that point, nothing anyone said to me made a difference.

i've recently had a patient come in with DKA and stablized on an insulin drip, only to have her family come in with coffee coollata, a box of popeye's chicken and honey buns to feed her. i educated them.. and received the dreaded "it's ok, she's getting insulin through her IV, right?" it's ignorance, but it's all they knew... and it's what the patient wanted. dietician tried to educate, physicain tried to educate... this was the diet she was used to and what she wanted, and i doubt it was going to change.

you cannot change people who do not want to change themselves. period.

as for patients who are morbidly obese... we cannot judge them. seriously. binge eating and compulsive overeating are real, addiction to food is real.

whether or not people choose to act as a victim, be compliant or noncompliant, be proactive for their health, or give up on themselves, is all a big part of the way they feel about themselves and the world that is real to them-what they know and what they live in/will return to.

why would a person who has to stretch $100 of food stamps for a month spend $5 a meal on a mcdonald's salad when they can go to the dollar general and buy snacks, canned meats, soups, etc. and stretch that money out? yes, the snacks are high fat, high sodium, etc... but it fills up their bellies so they are not hungry and they are able to eat for a month and maybe have a bit left over to pay for the bus fare to get to and from work.

you just don't know until you've walked someone's path. we are no one to judge who deserves health care and who doesn't--regardless of how much money or space or whatevr we thnk they are taking up. we are human beings before we are nurses--and sometimes people like this don't need us to be nurse and lecture and get frustrated... you can tell a COPD'er that "if you don't stop smoking, you will die a horrible death because you are basically going to gasp for air until you stop breathing"... don't you think they know they are already gasping for air? don't you think it sucks to drag around an oxygen tank?

chronically ill patients are complex cases, much more than just medicine, sometimes their spirit so beaten down.... they need us to get down and be more like a friend, talk to them in ways they understand and make them feel like they are not getting judged by their health care team and that they are not a burden.

jmho.

blt3535 · May 14, 2009

Wow- I have been reading this thread and I don't really know what to say.

I am a nursing student right now, and it amazes me that people are starting to lose their compassion and maybe aren't giving the best care to people that are receiving government help due to things that may have been completely out of their control.

And actually this thread hits too close to home. This is my job. I work in the hospitals and go up and see private pay patients and if they are eligible, help them by applying for disability and medicaid on their behalf. You may even call me an enabler, and sometimes I have to give myself a reality check that this is what our government has come to. Sometimes its really frustrating because you see the people that are in constantly and choose never to turn their verifications back in because they don't care, even if they qualify. BUT you also see the people who really need the assistance. Do you know how many times I have had someone cry to me because they don't have the money for prescriptions or they are homeless and have a serious problem that has nothing to do with being healthy or not- sometimes its the luck of the draw.

I have had to tell myself many times when i get upset with 15 year olds that are living on the street that they did this to themself, but then you have to think, people just get into really bad spots in life and its our job to care for them, no matter how much many they have or how entitled they may feel.

One last thought- nurses and doctors honestly shouldn't even know if the pt is there with insurance or medicaid, thats a need to know basis. I know at my hospital only the financial counselors and or care managers who place these pts in rehab or with home health are supposed to know the pts financial situation. Could be a hippa situation don't you think? And don't we have better things to do than worry about someones financial situation- im sure they are worrying enough for the both of you...

southernbeegirl, BSN, RN · May 14, 2009

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!!!

when i read your other long post about how disgusting your obese patient is i was disgusted with YOUR behavior. but then i read this post.

the anger you feel inside is largely based on your experience with your own mother's noncompliance and you are angry. that anger IS going to affect your nursing when you graduate. my advice would be to get a therapist and work thru that anger you feel towards your mother. if you dont, it WILL manifest itself in other ways in your life and your career.

i was angry when i read that first long post about your disgusting patient. search my name and you will find that i am morbidly obese and have a food addiction. i also have a drug/alcohol/sex addiction of which i went to treatment for and thankfully have 5 years of recovery now. but this food addiciton i have....it. is. hell. so when i read opinions like yours i take it to heart and get mad.

but then i read this post and i am going to give you something that you obviously wouldnt give me...some understanding and tolerance. unlike you, after reading this post, i understand why you are so angry and obese, noncompliant people, esp. women.

you can't change your mom's behavior any more than you can change a patient's. and that pees you off. what you see is your mom killing herself and yes, she probably is, and there's nothing you can do about it until SHE wants to do something about it.

it's the same for your patients. you can talk till you are blue in the face about what they SHOULD do to get healthy but until they are ready, inside, to do it....your words will continue to fall on deaf ears. it's psychological with them, with your mom, and with me. we don't sit and eat because we want to. we hate ourselves. we hate who and what we see in the mirror. why do you think we hide in our houses and eat? WE HATE OURSELVES. food is our drug. thats why we binge on it. for whatever reason (everyone is different), we have grown up with food being the one comforting thing in our life. for me, after my mom beat the hell out of me or my grandmother sexually abused me, i would run to my nanny's house and she would cook for me. so i grew up with food as my friend that didnt hurt me. if i get mad...i eat, if i get sad...i eat, if i am happy...i celebrate by eating. the point is...it is an addiciton. and nothing you say to me is going to stop me.

i'm one of the lucky ones because i finally was able to get clean/sober. i'm able to work thru my eating the same way i worked thru all my other addictions. i'm trying to learn to eat "like a normal person" but it is hell.

my food therapist had me keep this list one week and it is the one thing that opened my eyes to the fact that my eating is emotionally motivated. she had me keep a sheet of paper with only 2 columns on it. one column said "belly hunger" (actual hunger i felt cuz my belly was growling) and the other column said "mouth hunger". all i had to do for a solid week was check in the appropriate column what i was feeling every time i ate. i didnt have to write down anything i ate...just made a check. at the end of the week do you know what i saw? in one whole week i had only made TWO checks in the column for actual hunger. TWO TIMES.

so now i am trying to work on only eating when my body is hungry. i didnt even know what it really felt like to actually be hungry because i always ate!

food addiction is a battle you fight every day, all day. you mind is always saying "eat this....eat that", it is all you think about many times. just like drugs were for me.

i gained 80 pounds the first year i was off drugs. i have lost half of that now. but thats took 2 years.

like i said, i am one of the lucky ones. i know what is going on in my crazy mind and i can try to fight it. but it's a battle that never stops.

your mom and those "disgusting" obese patients you have? i betcha they have the same problem.

can you imagine looking in the mirror every single day and saying "i hate you! i wish you would die!"? because thats what addicts do. we are trying to cover all our feelings with SOMETHING...be it drugs/alcohol/sex/food/shopping and many other things.

i have a very good friend who is anorexic. i used to secretly envy her. you see...anorexia (although deadly) is acceptable in our culture. people really want to try to help anorexics gain weight and work on their core issues. think about it and you know it's true. i used to wish i could be anorexic. and dammed if i havent tried to be, lol. i just cant do it. i cant NOT eat and she CANT eat. we are a pair thats for sure, lol. if you watched us when we go out to eat you would have to laff at me eating everything and her pushing her food around. one day i told her she was lucky that she was anorexic. we had our first ever argument because she let me have it when i told her that! after finally talking to someone honestly, the both of us figured out that we are just alike. we are both addicts...drugs/alcohol/sex/shopping and food. our addictions just manifest themselves differently in our bodies. it was eye opening for me because i had always thought anorexics were lucky.

i shared way too much in this post but ya know what? if one person reading this thread reads this and even begins to have one like inkling of understanding, then it was worth it.

Lovely_RN, MSN · May 14, 2009

I think that organic foods are very costly but non-organic foods that are healthy are cheaper than fast food junk meals.

It comes down to being educated about making the correct food choices and individual preferences. I look at my own DH as an example. He would rather eat a value meal from McDonald's washed down with a beer or two then eat my whole wheat spaghetti with meatless "meatballs" in tomato sauce. The bag of meatballs was $3.99, the pasta $1.69, and the can of tomato sauce 28oz was $1.49 on sale. I used half of the meatballs and it was enough pasta and sauce for dinner and lunch the next day. The total for the the ingredients for my pasta meal was $7.17 for a meal with enough servings for lunch and dinner for my family of 4 with meatballs left for another meal.

His extra value meal from McDonald's cost over $6 bucks and his two Heineken 12 oz beers were $1.25 each just to feed himself. When my family of four go to a place like McDonald's or Wendy's the bill is usually btwn $15 and $25 depending if the items are from the dollar menu or the regular menu. How can that possibly be cheaper than buying and cooking our own food at home?

I think that when people talk about eating crappy cheap foods they are talking about foods like 99 cent baloney, white bread, and kool-aid. If these foods are cheaper than healthier alternatives than it's not by more than a nickel or two.

Again it comes down to being educated about food choices and individual preference. My DH is not the only person I know who just hates vegetables. A 10 oz box of store brand frozen veggies cost 99cents just like the baloney but it provides a much better nutritional value than that baloney. However to a person who hates veggies it wouldn't matter if you were giving the stuff away...they ain't gonna eat it cuz they will say it tastes like crap.

Trust me I live in an urban area and I've been seriously broke before. I can't tell you how many times I have bought a large package of chicken parts (leg and thigh combos stuff like that) taken off the skin baked it up with a side of veggies for a really small amount of money. The difference is that a person like my DH would want the chicken fried with the skin on, no veggies or maybe corn, and a some white rice...washed down with a big old glass of Pepsi to boot.

Trying to teach him about nutrition and what he is doing to his body gets me nothing but eyerolls and a "Yes mom...thank you mom" so I give up on him. If he doesn't give me attitude for "lecturing" him then he whines about how he doesn't like veggies because they are gross. It's like trying to reason with a two year old there is no reasoning with him.

One thing I notice about him and people with attitudes like his are that they are in deep denial that what they are doing will ever have any affect on their health. When I warn him about his diet, sedentary lifestyle, and other bad habits he gets annoyed with me and asks if I want bad things to happen to him. Like my saying it will bring it on. It's like he thinks that bringing up the issue will curse him or something.

I don't know what the solution is to this problem but it seems to me that people are going to do what they want to do regardless of the outcome. It's too bad that so much money is wasted on avoidable health care problems and at some point the well is going to run dry but what can we do but try to educate people and not take it personally?

~Mi Vida Loca~RN, ASN, RN · May 14, 2009

It's all well and good to look at calories but you need to look at fat content too. There are very few salads that have less than 9g of fat in them - that's a huge amount! I mean, the hamburger has less than 500 calories but would you think it was a good idea if someone ate one of those for lunch everyday? There are so many important things to look at when choosing foods - fat being a big one, not calories alone. McDonald's rides on the fact that it has salads, this makes them seem healthy when in reality they are just as bad as a burger. A lot of the salads that are low in fat (I.E. 4g) are the ones that are served WITHOUT chicken! I couldn't stay full on that!
The bottom line is that you cannot eat healthy and eat fast food, I just do not believe it.
I DO believe however, that healthy food is much more expensive and that this is a large reason for the obesity in our country. When an apple is more expensive than a slice of pizza we have a problem.

Not sure why name showed when you quoted this post but I wanted to clarify it was NOT my post. I checked the Nutrition Label and I stand by what I had said that it was NOT healthy. Some of those salads were 300 calories with 140 calories from FAT. That was WITHOUT dressing. Absurd!!!

Anyway, on another note, people seem to forget to, you don't become 600 lbs overnight. A lot of these people that are living in poverty and obese, I would be willing to bet a lot have been obese since childhood. It is not a childs fault they are obese, it's the caregivers fault unless it is a medical reason for the obesity, which is often NOT the case, at least not according to statistics. I don't have my Thesis paper right by me but I believe the % of childhood obesity caused from a medical reason was in the single digit %.

So when a person has been this way since childhood, these values and habits have been there since the get go. As have the self coping mechanism to deal with the depression of being Overweight which is often EATING. We can not just change people that have been beat their whole childhood. Even with a lot of mental help, those scars still run deep, the urge to flinch when someone yells, is still there, well with these pt. the coping mechanisms are still there. When you enter adult hood and you are already 100 plus pounds over weight, it can seem hopeless.

johnsboo · May 14, 2009

We are nurses! We are NOT Judge, Jury, and Executioner! Nurses Care, Sympathize, and Assist wherever we can. If Compassion is not your PASSION, Why are you a nurse?

Teresag_CNS · May 14, 2009

In what way was the woman with the BKA asking for special treatment? I agree her health maintenance habits were not up to par, but I think you've mischaracterized her behavior.

The brief scenario you described sounds to me like family dynamics gone awry. They may think they're taking care of her by bringing her sweets. Snickers bars might mean love to them, as twisted as that sounds. Maldaptive family behaviors are really tough to change, but kudos to nurses for trying.

Virgo_RN, BSN, RN · May 14, 2009

One last thought- nurses and doctors honestly shouldn't even know if the pt is there with insurance or medicaid, thats a need to know basis. I know at my hospital only the financial counselors and or care managers who place these pts in rehab or with home health are supposed to know the pts financial situation. Could be a hippa situation don't you think? And don't we have better things to do than worry about someones financial situation- im sure they are worrying enough for the both of you...

At my hospital, nurses (and many doctors) identify uninsured patients at admission and connect them with medical social workers who can help them identify resources to avoid falling through the cracks, be able to obtain medications and treatments, and set them up with a payment plan for their medical expenses. Whether a patient has insurance or is uninsured, or is on medicaid or medicare, is an important piece of the entire picture that we, as nurses, are supposed to be aware of in the course of caring for each patient. It should not affect how we treat them in regards to respect, dignity, and compassion, but it does affect other aspects, such as knowing that if they are being discharged on Plavix, that they are not likely to take it due to expense; or knowing that if they are homeless, they are not likely to be able to manage their diabetes due to lack of access to proper insulin storage and lack of access to regular meals, and so on. We are expected to catch these things and connect the patient with help to overcome such barriers before discharge.

flightnurse2b, LPN · May 14, 2009

At my hospital, nurses (and many doctors) identify uninsured patients at admission and connect them with medical social workers who can help them identify resources to avoid falling through the cracks, be able to obtain medications and treatments, and set them up with a payment plan for their medical expenses. Whether a patient has insurance or is uninsured, or is on medicaid or medicare, is an important piece of the entire picture that we, as nurses, are supposed to be aware of in the course of caring for each patient. It should not affect how we treat them in regards to respect, dignity, and compassion, but it does affect other aspects, such as knowing that if they are being discharged on Plavix, that they are not likely to take it due to expense; or knowing that if they are homeless, they are not likely to be able to manage their diabetes due to lack of access to proper insulin storage and lack of access to regular meals, and so on. We are expected to catch these things and connect the patient with help to overcome such barriers before discharge.

this is the same at our facility. it is part of our admission history screen. it is a very important aspect of care where i work, because most of the patients are medicaid/medicare and require alot of discharge planning and teaching starting even upon admission...

Virgo_RN, BSN, RN · May 14, 2009

What about the family in this picture? They are enabling her poor choices. None of us lives in a vacuum; we learn our behaviors and attitudes primarily from our family group, and by extension from peer groups and other social groups to which we belong. This patient's life was shaped by her family and society. That's not to say that she has no free will or any choices to make, but let's not discount the fact that we are all products of our family, culture, and society.

Have you ever eaten a cheeseburger with fries? Maybe had a nice chocolate milkshake along with it? What a terribly unhealthy meal. But it's okay, because you're not a morbidly obese diabetic, right? Well, you still have coronary arteries, and as we speak, plaque could be depositing itself inside your Left Main or your RCA. If you have a body, you have some sort of disease process occurring, or you will at some point in your life. When you end up in the system, do you want to be judged for having CAD, colon cancer, or breast cancer, because you know, there are choices that you can make to lower your risks for these diseases.

I've often wondered about the correlation between morbid obesity and childhood sexual abuse or other traumas. I'd be interested to see some data on that.

I've also noticed that patients who feel terribly about themselves tend to behave in certain ways. They may appear cavalier, or find ways in which they are superior to those that they most feel judged by, such as the thin, pretty nurse who's lecturing them on their eating choices, or the CNA who has to clean their bottom because they cannot reach it for themselves. They feel so ashamed of their body that they cover up their shame by behaving as if they really don't care, by putting others down, and sometimes being just plain unpleasant to be around.