Ignorant Stupid Patients - page 9

: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   MassED
    Quote from ~Mi Vida Loca~
    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."
  2. by   MassED
    Quote from VM85
    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....
  3. by   MassED
    Quote from ~Mi Vida Loca~
    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!!!
  4. by   MassED
    Quote from Valerie Salva
    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....
  5. by   ~Mi Vida Loca~RN
    Quote from MassED
    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."
    I don't think that is what they were talking about though, I mean surely there should be restrictions for the ER since after all, it's for Emergency's I am not sure actually what the poster was proposing though, since I never got an answer.
  6. by   ~Mi Vida Loca~RN
    Quote from MassED
    case managers!!!

    So they will determine whether or not someone is "worthy" of medical care??? Based on what?? The person relapses and therefor they aren't worthy?? Who is going to make up these standards?? It just doesn't seem realistic to me. Who is going to watch these pt's every moment to make sure they are exercising, and not cheating on their diet?? What if their body does something outside of the norm and they are accused of cheating when they really didn't. Do they just lose care as well because they aren't worthy.
  7. by   NursingStudent5548
    Mass Ed
    I am currently in another state, I am going through the wonderfully fun process of apply for medicaid here.
    I obviously qualify, unemployeed DESPERATELY SEEKING employment.
    I am glad though they are this through but it really stresses me out trying to do that, find a place to live, unpack, find a job, attempt to prepare for a new baby with no funds.

    I am SO thankfully that the baby's Aunt (BF's Sister) has had two children with a great OB/GYN here. She is expecting her third and did some name dropping. She explained my situation.

    He doesn't accept Medicaid. Yet, He is going to make an exception for me. So I will feel a lot less stressed once I have insurance and a job and can begin seeing him!!!

    I did on the other hand want and tried to report the other OB/GYN for his lack of treatment!!

    I believe this is at the very least a form of neglect and would hate to think he treats all his patients this way.
    Despite what type of insurance they are on...
  8. by   MassED
    Quote from ~Mi Vida Loca~
    I don't think that is what they were talking about though, I mean surely there should be restrictions for the ER since after all, it's for Emergency's I am not sure actually what the poster was proposing though, since I never got an answer.
    well, the 3 strikes and you're out could be used for any location - since I'm in the ER, that's where I applied that. Maybe OP will clarify the proposal.
  9. by   DeepFriedRN
    [quote=southernbeegirl;3625541]
    Quote from NursingStudent5548

    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!".
    THIS is exactly it! My issue, I mean. It's my total control-freak nature. As my mother would say, "So unattractive!!" LOL! I'm workin' on it! Sorry, off topic, but just wanted to acknowlege the truth to this sentiment. It is truly is frustrating to care for people who don't seem to care for themselves. I take exception to calling them stupid though. Not appropriate. We can express frustration without resorting to this.. I won't, however, say you need to change jobs or are a bad nurse. It irritates me when we say this kind of thing to each other. So I will say to OP and everyone else who's frustrated what I want to hear when I'm venting: Hang in there! Even though it sometimes feels like we are fighting a losing battle, we are making a difference, at least some of the time. It's hard to hold on to that(as it's not a whole heck of a lot), but it's something!
  10. by   MassED
    Quote from ~Mi Vida Loca~
    So they will determine whether or not someone is "worthy" of medical care??? Based on what?? The person relapses and therefor they aren't worthy?? Who is going to make up these standards?? It just doesn't seem realistic to me. Who is going to watch these pt's every moment to make sure they are exercising, and not cheating on their diet?? What if their body does something outside of the norm and they are accused of cheating when they really didn't. Do they just lose care as well because they aren't worthy.
    a case manager can be assigned to follow the patient's care and their compliance with a treatment plan. Provide resources (such as a taxi) to get them to their appointments, which is how that's done here in Massachusetts, for instance. Well you would have an inkling of a person's diet when there was a home visit, no? There should be guidelines in place, for Medicaid, patients, based in their diagnosis and individualized to their needs. Of course there's no fool proof way to force a person to change their ways, but you can provide a person with the resources. I'm sure many a disadvantaged aren't even sure of how to get healthier - you can't assume a patient thinks like you or I might.
  11. by   MassED
    Quote from NursingStudent5548
    Mass Ed
    I am currently in another state, I am going through the wonderfully fun process of apply for medicaid here.
    I obviously qualify, unemployeed DESPERATELY SEEKING employment.
    I am glad though they are this through but it really stresses me out trying to do that, find a place to live, unpack, find a job, attempt to prepare for a new baby with no funds.

    I am SO thankfully that the baby's Aunt (BF's Sister) has had two children with a great OB/GYN here. She is expecting her third and did some name dropping. She explained my situation.

    He doesn't accept Medicaid. Yet, He is going to make an exception for me. So I will feel a lot less stressed once I have insurance and a job and can begin seeing him!!!

    I did on the other hand want and tried to report the other OB/GYN for his lack of treatment!!

    I believe this is at the very least a form of neglect and would hate to think he treats all his patients this way.
    Despite what type of insurance they are on...
    Yay you're getting a doc that will help you!!!!!!!!! Super excited for you!!! Give that doc a hug for me!
  12. by   ~Mi Vida Loca~RN
    Quote from MassED
    a case manager can be assigned to follow the patient's care and their compliance with a treatment plan. Provide resources (such as a taxi) to get them to their appointments, which is how that's done here in Massachusetts, for instance. Well you would have an inkling of a person's diet when there was a home visit, no? There should be guidelines in place, for Medicaid, patients, based in their diagnosis and individualized to their needs. Of course there's no fool proof way to force a person to change their ways, but you can provide a person with the resources. I'm sure many a disadvantaged aren't even sure of how to get healthier - you can't assume a patient thinks like you or I might.

    I completely understand that, and I think what you said sounds wonderful and something like that SHOULD be in place already. I am more so talking about, the 3 strikes and you loose treatment. There are so many factors to consider and someone can't be with the Pt. 24/7 w/o a huge cost there, just to make sure they are eating right and working out, so it leaves to much room for error in my opinion when it comes to cutting them off.

    That is more so what I am talking about.

    I think if you were to take your ideas, and also get people some serious counseling and support groups, it would make huge strides on a pathway to change.

    I know for myself, when I try to eat right, I start craving something I shouldn't have, it might not even be something I really like all that much, but it's like my brain is trying to sabotage me, and thankfully I distract myself to not fall in, but seriously, I will sit here and go WTH. I imagine that happens to a lot of people.

    I was just talking to a speech therapist friend of mine yesterday, she was talking about children having a habit of saying their R's or whatever letter it is a certain way, they have been doing this since the age of talking. Well now you are trying to teach them the proper way to say it. She said it takes something like practicing it 30thousand times for your brain to form a new neuro pathway so that the next time you go to say it, it will pull on that new pathway and let go of the old one. I didn't research this myself so I am not positive how accurate that is, but 30 THOUSAND TIMES????

    Take it from speech to something else, like with obesity, that is a LONG time to retrain yourself onto something new, that will take a lot of patience and support to achieve.
  13. by   MassED
    Quote from ~Mi Vida Loca~
    I completely understand that, and I think what you said sounds wonderful and something like that SHOULD be in place already. I am more so talking about, the 3 strikes and you loose treatment. There are so many factors to consider and someone can't be with the Pt. 24/7 w/o a huge cost there, just to make sure they are eating right and working out, so it leaves to much room for error in my opinion when it comes to cutting them off.

    That is more so what I am talking about.

    I think if you were to take your ideas, and also get people some serious counseling and support groups, it would make huge strides on a pathway to change.

    I know for myself, when I try to eat right, I start craving something I shouldn't have, it might not even be something I really like all that much, but it's like my brain is trying to sabotage me, and thankfully I distract myself to not fall in, but seriously, I will sit here and go WTH. I imagine that happens to a lot of people.

    I was just talking to a speech therapist friend of mine yesterday, she was talking about children having a habit of saying their R's or whatever letter it is a certain way, they have been doing this since the age of talking. Well now you are trying to teach them the proper way to say it. She said it takes something like practicing it 30thousand times for your brain to form a new neuro pathway so that the next time you go to say it, it will pull on that new pathway and let go of the old one. I didn't research this myself so I am not positive how accurate that is, but 30 THOUSAND TIMES????

    Take it from speech to something else, like with obesity, that is a LONG time to retrain yourself onto something new, that will take a lot of patience and support to achieve.
    we are still trying to RE-teach our 6 year old son how to undo some of the speech from when we lived in N.C. There's a drawl and a lazy way of speech that is very difficult to undo. I am constantly having him restate what he is trying to say, and say it CLEARLY!!! Of course he'll pick up some New England lingo and drop off the end letters of words, now!!! I'm hoping they have been repeating at LEAST 30,000 times by now. It certainly feels like it.

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