Ignorant Stupid Patients - page 7

: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. ... Read More

  1. by   ~Mi Vida Loca~RN
    Quote from Curious_53
    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.
  2. by   johnsboo
    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?
  3. by   Teresag_CNS
    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.
  4. by   Virgo_RN
    Quote from blt3535
    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.
  5. by   flightnurse2b
    Quote from Virgo_RN
    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...
  6. by   Virgo_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.
  7. by   Purple_Scrubs
    Quote from southernbeegirl
    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.
    This is an excellent point and a great post, southernbeegirl. Thank you so much for sharing your story. This is a lesson we should all take to heart. When a patient evokes such strong emotion in you, it is wise to look INWARD to see what is behind that emotion rather than projecting that negativity onto your patient.

    OT, but this post gave me a light bulb moment about negative feelings I have for a 18 year old kid I know with a new baby at home. She constantly complains about having to grow up so fast and what this baby is costing her socially. I have been married 10 years and unable to become pregnant, yet we are emotionally & financially ready and want it badly. It does not take a rocket scientist to see where my anger comes from, but I did not realize it until this moment. Sorry for the OT but I had to get it off my chest.
  8. by   Virgo_RN
    I recently cared for a young person in with fulminant liver failure due to ETOH abuse. The person had been housebound for two months prior to admission.....now who was bringing them the liquor if they couldn't leave the house? Why, the fiance of course.

    None of these people live in a bubble. They are part of a system, and when looking at them, you cannot look at them as an isolated thing. You have to look at the whole system to which they belong.
  9. by   leslie :-D
    from the bottom of my heart, i truly believe that these "ignorant stupid patients" live in a black hole, where hopelessness and acceptance of their perceived destiny, is etched in their souls.
    that no matter how much we educate, their depression is such that they are going to 'enjoy' their vices, even if it costs them their lives....
    which sadly, many of these folks find acceptable.

    of course it's frustrating and at times, you want to shake some sense into them.
    but once we accept where they are at, it really does make caring for them, much more doable.
    are these folks ignorant?
    yes, as we all are in some form or another.
    no, i will not bring them a donut or a smoke, nor will i jump to get them their meds early.
    but just acknowledging the waste of life they feel doomed to, makes my job a lot easier.
    when they're not receptive to my information, i won't push it.
    but i do encourage them to do something about their depression...
    whether they admit it or not.
    i give them referrals to reputable therapists, and can hope they make that call.

    it's not our job to save a life.
    rather, we provide them w/all necessary information in hopes of them making the best choices.
    we should not be taking this so personally that it elicits emotional outrage.
    acceptance and a smile, will bring you far...
    and will ultimately benefit your pts much more than feeling pressured to make life changes they are not ready to make.

    i need to eat my chobani yogurt w/sliced banana.
    enjoy your day!

    leslie
  10. by   Virgo_RN
    Quote from flightnurse2b
    ....because most of the patients are medicaid/medicare and require alot of discharge planning and teaching starting even upon admission...
    Yep, I was taught that DC planning begins at admission. In order to do that, we need to understand what kind of situation they're coming from and what resources they have or lack access to.
  11. by   Virgo_RN
    Agree, Leslie. I also think that many of the morbidly obese feel a tremendous amount of shame about their bodies.
  12. by   southernbeegirl
    Quote from Purple_Scrubs
    This is an excellent point and a great post, southernbeegirl. Thank you so much for sharing your story. This is a lesson we should all take to heart. When a patient evokes such strong emotion in you, it is wise to look INWARD to see what is behind that emotion rather than projecting that negativity onto your patient.

    OT, but this post gave me a light bulb moment about negative feelings I have for a 18 year old kid I know with a new baby at home. She constantly complains about having to grow up so fast and what this baby is costing her socially. I have been married 10 years and unable to become pregnant, yet we are emotionally & financially ready and want it badly. It does not take a rocket scientist to see where my anger comes from, but I did not realize it until this moment. Sorry for the OT but I had to get it off my chest.
    i'm happy for you and your lightbulb moment! it's very eye opening to realize where emotions come from.

    my husband is a drug/alcohol counselor and he's very good at it. but he turns it around and uses my own words to help me learn lessons like this. and i could whop him on the head for it, lol.

    he always asks me "what is really making you so mad about this patient?" type stuff. but it really helps ME give them better care to at least know where my anger comes from.

    for instance...i am a very prejudiced woman against other morbidly obese women. or i used to be anyways. it took him a very long time to help me understand that what i hated in them were the very things i hate in myself. that was my lightbulb moment because that was exactly how i felt if i were to really admit it to someone besides God. it completely changed my own nursing with morbidly obese women. now i know how to put them at ease when i need to do procedures and the like. believe me, i would much rather have a fat woman putting a cath in me than some skinny little thing. and it wont be because i think the skinny little thing would think i'm disgusting (well that would be part of it) but the main part is the shame i feel.

    i havent had a pap smear in 5 years. i have PCOS so i have periods all the time. and when i lose even 5 lbs i immediately start bleeding. i'm an RN and I know i need to have one because my bleeding is abnormal and i have had a history of abnormal cells and had laser tx to remove HPV cells on my cervix when i was younger. i know all this but i cant go thru with the exam. the last one i had i cried all the way thru and was so ashamed i didnt leave my house for days.

    so if I feel that way and i'm actually working on my core issues and emotions...can you imagine how some others feel that have no idea why they eat like they do?

    thats what i try to keep in my mind.

    BUT! im not perfect either and i get frustrated at patients too. please dont think i dont cuz i do. sometimes i get on my own nerves when i read my posts because i think i sound sanctimonious or something when im just as bad as everyone else, lol. we gotta vent, right?
  13. by   Virgo_RN
    southernbeegirl,
    I don't think that as nurses we should have no biases, but I do think we should be able to identify our biases and question them. All human beings have biases, and nurses are human beings. It's when we are blind to them, or lack insight, so to speak, that these biases can affect us in the way we treat other people. Good for you for being able to identify and examine a bias of your own! I think it makes you a better person.

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