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!

[southernbeegirl, BSN, RN]

*respectfully snipped for length*

i can feel your frustration just by reading your post. there is something that you have to begin to understand though.

You can't love your mom better. She has to want to do it herself. Nothing you or anyone can say or do is going to change her until SHE is ready.

thats the hard part about loving someone with issues like this or drugs/alcohol. we love them so much that we keep hanging on to that rope thinking if we keep hanging on we can help them. but that rope will eventually strangle YOU.

the best way i can explain it is to use drugs/alcohol as an example. my family tried to help me for years. i lost job after job in nursing the first 2 years of my career alone due to stealing drugs. they even had me come back to work for them for a few years hoping it would help me get clean. my husband was on IV morphine so i didnt need those drugs at work. i had the good stuff at home!

my family did an intervention on me. my husband was in the hospital and he had locked his morphine up in a small safe and put it at his dad's girlfriend's house. that morning, i wanted drugs so bad that i drove to her house, broke in her house (and i wasnt good at it either, his dad immediately new someone had broke in) and i took the morphine from the safe. then after getting my drugs, i calmly drove to work (still working for my parents again) and acted as if nothing was wrong. my husband was on the phone with my dad when i walked in and he told me over the phone that our marriage was over. that he couldnt handle my addictions anymore. my parents packed me up and sent me to stay with my sister 200 miles away for 2 weeks.

i really wanted help. i told everyone i wanted help. and like your mom, i wished to be locked away somewhere to protect me from myself. i detoxed during those 2 weeks, came back home and jumped into AA/NA and stayed clean for about 3 months.

then i started drinking and within a few short months i was using drugs/alcohol and sex more than i ever had in my life.

my family eventually had to cut off communication with me because my behavior was killing the family. i hated them for that. thought they didnt care about me. but they had to do it to protect themselves, i know that now.

the point is...it doesnt matter how many interventions a person has, it doesnt matter how much you love them, until they reach their "true bottom" sotospeak and finally have that "teachable moment", they won't change.

you are only hurting yourself thinking that YOU can help change your mom. it breaks my heart to hear you say "if only...this....if only...that". you can "if only" till the cows come home, you can give your mom solution after solutions but it has to be HER that wants the help. she cant do it for YOU, she has to do it for herself. and thats hard for loved ones to understand.

we hear "if you loved me you'd....". we don't even love ourselves!! and you cant love her better.

one thing they did tell me in rehab was "let us love you till you learn to love yourself". when i finally understood that it was a huge AHA moment for me. i hated me. i hated me deep to my core. in treatment they refused to allow me to say negative things about myself. they showed me so much love with words of encouragement, a hug, anything positive...all the while forbiding me to voice anything negative.

but one thing they never did was judge me. it took me a while to believe it that they werent judging me but i finally understood it and was able to jump head first into my treatment. but *I* had to do it for myself. nobody could help me, nobody could do it for me.

the best thing you could do for your mom is walk away. dont give her solutions. let her dwell in her own consequences for her own behaviors. tell her you love her but you cant enable her behaviors any longer.

thats what family memebers want to do...save us from ourselves. DONT DO THAT! it's those consequences that will keep us clean/sober/not eating. let us have full advantage of the results of our behavior.

some won't make it and will die. but some, like me....might just suprise you and fight to survive.

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!".

read this post and put food where i talk about drugs/alcohol/sex/food and you can begin to maybe understand your mom. i promise you once you start to meet her where she is, your relationship will change and you can finally let go of that anger.

how do i know? i did it with my mom!

[southernbeegirl, BSN, RN]

As far as the MO, it took them their entire lifetime to become 600lb. I am not going to change a lifetime of experience in one eight hour shift. However, by being kind, accepting, and nonjudgmental in my interactions with them, maybe I can make a little bit of a difference.

I was sick last week and went to the urgent care (respiratory virus crap, yuck). i've been going to that clinic since before i got sober so they know me well.

i hadnt seen this particular doc in a few years (i have a PCP that i see usually). he's the one that originally sent me for a sleep study. as a result of that i got a bipap and boy has my life changed with just that right there!

so while im there he is asking me how i'm sleeping, am i compliant with my bipap and he commented on my almost 50lb weight loss since i'd been there.

i, immediately, was ashamed. put my head down saying "i know, it's not enough of weight lost". he let me have it when i said that! he was so sweet and made me accept that i had been steadily losing weight and havent gained in 2 yrs. he was so nonjudgemental with me and said "it took you 36 yrs to get to where you are, why do you think it will go away in 2 shourt years? thats crazy thinking". it sounds silly but it really did mean a lot to me and it made a big difference for me. i realized he was right. i have been steadily losing weight but that old shame and guilt that try to rule my life wouldnt let me see that. it took listening to someone that had no alterior motive at all, no judgement, no disgust, to hear it.

so the thing is...none of us will ever know what one little thing we say to a patient might make a difference...be it positive or negative. all we can do is try to be nonjudgemental and give care with love and let them be where they are and hope something we say helps.

but then we have to learn to walk away.

and i love how you put it about leaving our baggage at the door! i hope you dont mind if i steal that, lol.

[rngreenhorn]

I don't know why personal accountability is so out of vogue these days... But...

I've been a nurse now for 5 years. I've done hundreds of hours of teaching. And while it's hard to quantify the percentage of patients I've saved from THEMSELVES, I'm assuming the percentage is down around zero.

As far as the "lady of the Snickers". She has put herself in quite a place. She won't be able to walk to exercise. You can't fit a morbidly overweight person with prostesis. And even if she looses 200 pounds, she is still obese. That's one hell of a mountain to climb.

So, what has she got to look forward to? Dialysis, kidney failure, more infection, sitting in a chair and watching others live... AND a Snickers.

Talk to her about her health, support her, and do what you can to help.

Then--- when she doesn't listen, give her some extra insulin to cover the Snickers.

Then, go home and do everything in your power not to let yourself or a loved one get in that position.

[southernbeegirl, BSN, RN]

I don't know why personal accountability is so out of vogue these days... But...

I've been a nurse now for 5 years. I've done hundreds of hours of teaching. And while it's hard to quantify the percentage of patients I've saved from THEMSELVES, I'm assuming the percentage is down around zero.

As far as the "lady of the Snickers". She has put herself in quite a place. She won't be able to walk to exercise. You can't fit a morbidly overweight person with prostesis. And even if she looses 200 pounds, she is still obese. That's one hell of a mountain to climb.

So, what has she got to look forward to? Dialysis, kidney failure, more infection, sitting in a chair and watching others live... AND a Snickers.

Talk to her about her health, support her, and do what you can to help.

Then--- when she doesn't listen, give her some extra insulin to cover the Snickers.

Then, go home and do everything in your power not to let yourself or a loved one get in that position.

i like that, lol, "lady of the Snickers".

your post made me think of something. and it's something that infuriates me.

i'm suprised they havent done gastric bypass surgery on her.

in my state, the people on public assistance insurance get the bypass surgery with absolutely no cost to them. and that really burns me up!

i've decided against the surgery if possible and am trying to reteach myself good eating and lose weight without the surgery. BUT....if i did want it, even with insurance, the costs to me would be thousands and thousands of dollars.

but if i had no job, got state insurance, then i could get it for free!

i dont fault the people that have the surgery at all, i fault the government. it burns me up that i work my tail off 40 or more hours a week, pay for my own insurance,etc...provide for myself and family and i couldnt afford a life saving surgery without taking out a bank loan.

but "lady of the snickers" could probably snap her fingers and get it.

how's that for fair?

(i'm finally getting back to the topic of the thread. arent yall proud? lol)

i know of a lady that has 4 kids, has never worked, lives on welfare, food stamps, state insurance...the whole shebang. why doesnt she work? because she's fat and lazy. seriously! (thats what her sister tells me anyway). this girl has never worked and started on public assistance with the birth of her first child and has never stopped.

the whole family knows how to "work the system". mom/dad live on disablity for "back injuries". the whole family is "sue" happy. and now she's had an elective surgery that i personally ccant afford unless i sell my husband's butt on the street corner.

i hadnt thought of this at the first of the thread. but if i'm honest with myself and you guys, IT MAKES ME SO MAD!

nobody would ever know it (i've only told my husband and you guys so if anyone tells i said it...lemme just say, I know how to hide a body,k?)...but i dont think thats fair or right.

so now i'm in a quandry huh? i've just made a hypocrit out of myself. i hadnt thought about this situation until now but i dont think it's fair that she can have an elective surgery free of charge on MY tax dollars. why shouldnt she have to do like everyone else and show a long time period of honestly trying to lose weight. (which i would have to do if i ELECTED to have the surgery). she just went to the doc one day and the doc told her "hey, medicaid will pay for bypass surgery now..you want it?".

i think there should be a well documented trail of all her attempts to lose weight, including things like a therapist, a nutritionist, exercise regimen or even physical therapy (all of which i have done AND paid for myself). why should an elective, expensive surgery be a benefit that i myself cant have??

well hell, i sure did just make myself a hypocrit huh?

[SoundofMusic]

I think Snickers Ladies are a symptom of a much larger problem in society. We have just lost our moral compass overall. Families don't stay together, the government perpetuates a welfare/nanny state where kids grow up without fathers and there is a resulting lack of education and self control in the home. We are seeing things w/ people that never used to exist years ago.

People need to get OFF the government/Medicare/Medicaid teat. People need to get back to being accountable, responsible, self reliant. These are the things which made America great. The lack of these things is what is literally killing this country. We continue on this spiral and it just never stops. What WILL stop it?

I don't feel one bit sorry for people like this. It's not fair to me, the responsible tax payer, to have to pay for their behaviors. I didn't grow up rich, I grew up lower middle class. But I chose to better myself. It's about choices. We all pay for the horrid choices of others in this country -- constantly. It's ruining healthcare, the economy, education, everything. We can try to protect the poor with better legislation, but to a point, the poor are going to have to be allowed to protect themselves. We create dependence -- and it's wrong. Feeling sorry for them is NOT going to do them any good.

I may not be for three strikes, but I may be for ten. There has GOT to be a limit, or we'll all be dead from it.

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

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.

There is a strong link with it, obviously like with everything, not ever child sexually abused grows up to be morbidly obese, but there is a strong correlation, the child will cope by eating, feeling that comfort from food. In some cases the child tried to become overweight in hopes that that would keep their predator at bay, that they wouldn't find them as attractive and so on. Than the child goes to school and is overweight and I think most people here that has been in any, at least American JHS or HS knows how cruel kids can be, especially to the obese, so it only further effects their mental health and so the cycle continues.

[MassED, BSN, RN]

*breathe woman, breathe!*

i share your frustration with people that are on public assistance and expect to be treated as if they are royalty. and i love it when they tell me that they pay my salary. makes my day, doesnt it for you?

but in the post above i dont know if the patient having to pay for her care would change anything. she probably did work and have insurance before she had that first BKA or gained the first 100 pounds. problems like she has is probably a lot more than just poor choices. given that she weighs 600 lbs, she's probably a food addict.

NOT that i'm excusing her behavior mind you! i'm just thinking that it is probably a compounded problem and her being on public assistance might be the result instead of the reason.

but then again, anything is possible.

I had a prisoner come in, tell me he wanted "such and such" meal tray ordered - I said, "yeah, I'll see what they have in their standard tray." He says, "I pay your salary." I said, "no, you don't. I pay for YOU in prison." eeeek! Give me a break. Crackers and water should be all he got.

[MassED, BSN, RN]

I would have disagree, I understand that people make poor choices.

I do have to say though, I disagree. I wouldn't say it is just those on medicaid or assistant programs.

I am on medicaid for pregnancy, I lost my job in Oklahoma due to the facility I worked for (private owned nursing home) went under.

I have recieved terrible care through out my pregnancy. I have never had my urine tested for proteins to insure I am not at risk for pre eclampsia. I have high blood pressure, and a heart murmur so this is a very real possibility.

I also went to the ER for severe back, stomach, and leg pain. I couldn't walk. This was on a thursday night. A urine sample was collected. I had WBC's, trace proteins, large amounts of blood, and large unidentified debride.

I went to my regular schedule OB/GYN appointment that Monday and took the lab results and informed my OB/GYN. He thought nothing of this, and never did a thing. I am a college student and that Thursday a week after the initial urinalysis, we did a urinalysis in my Physiology lab. All of the abnormal results had escalated.

I have also not been tested for Gestation diabetes, this is a routine test done between 24-28 weeks. I am 30 weeks.

I have tried to trade OB/GYN but this late...nobody will accept you.

So please be considerate and treat every patient equally. Despite what insurance they are on...

I do understand the frustration with this patient, I have had patients like this!!!

You follow your doctor's treatment, or lack thereof it seems. You are being ignored by your provider - for basic prenatal care! Wow. Can you switch providers at this point???

You are not in the same category - I think the offenders are those that are non compliant and abuse the system.

[MassED, BSN, RN]

What do you mean by 3 strikes and your out? Out of what?? (serious question here, I am trying to understand what you are proposing)

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."

[MassED, BSN, RN]

the whole situation may be aggrivating, i agree- but i disagree and think that you are stereotyping people. Not all poor people, or people that qualify for assistance think that staying at a hospital is like the Ritz. Im sure the hospital is the last place they want to be! And she has a RIGHT to refuse any thing she wants, including your teaching. And while it may be detramental to her health, its HER health, her legs that had just been amputated- and all you can do is try to get it through to her and her family. I cant imagine being in the hospital for that and maybe that has something to do with her being controlling and wanting help, she has no legs to do it herself! And yeah maybe she wasnt complient with everything at that moment, but as a previous poster said, you dont know what led up to this amputation- maybe she was complient or maybe theres an underlying problem where she doesnt care about what she eats, shes already lost so much, whats left? I just think, althought hings can irritate you, it shouldnt be things that dont have to do with your care- noone is better than anyone, no matter how much money, how many cars and houses a person has....we all come in the same way and go the same way!

and some patients DO like to be in the hospital and love to use their call lights for silly things. Move my blanket off my big toe kind of calls. I have seen many many many patients who LOVE LOVE LOVE coming to the hospital. I've felt that some of these patients are noncomliant for that very reason - to come in, be doted on (to a certain extent), have attention, be fed....

[MassED, BSN, RN]

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?

case managers!!!

[MassED, 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.

denial is also quite powerful in many of these types of patients (BKA, AKA, etc). Depression and denial. Fierce denial on a patient's part can be viewed as ignorance, but selective ignorance. You can only lead a horse to water, after all....