PATIENTS BECOMING MORE ABUSIVE?? anyone agree?

[nurseredd]

So I spend a good amount of time as a triage nurse outside of D.C. Since moving to this area, I've noticed patients are becoming more & more irrational, demanding & downright nasty. They argue about coming in for follow ups (sorry but you cannot have your statin when it has been 8 mos since your last CMP/Lipid Panel/LFTS') & state they "don't care" if this medication un-monitored can put them into renal failure. All they want is the quick fix - to break the nurse down until she refills that standing order. Is anyone else experiencing this? Despite the fact that nurses are more & more recognized as leaders in healthcare, there seems to the less and less respect on the forefront.

I have previously worked as an in-patient psychiatric nurse, and those patients at times were more reasonable then my patients now!

So nurses out there...and I alone in this?!?!

[brandy1017, ASN, RN]

This situation probably comes down to money. More and more people have been forced into high deductible insurance where they have to pay for the office visit. Even if they have regular insurance they still have to come up with copays. Again labs cost money and that may be why they are reluctant to come in. I myself am in a high deductible plan not by preference, and I too think twice about seeing a Dr because of the cost. What is so frustrating is the medical inflation built into every bill and the fact that you don't even know what you are going to be charged till after the fact! My employer self insures and contracts with an outside servicer. I can't tell you how many times I've had to argue with them to get them to pay their share of the bill. Time after time they try to push more of the bill onto us than is right. I've always won in the end, but it is not fun to have to fight just to get the insurance to pay the bills. I always wonder how many others just don't bother fighting and end up overpaying more than there fair share! I'm sure not everyone is as determined as I am.

[JWG223]

I have only been doing this for half a decade. I can't observe a trend. Just do whatever the patient wants as long as policy and laws of practice will cover it.

[Anonymous865]

My husband is one of those who feels the medical community, and particularly doctors, only want these repeated visits to get some more $$ out of the patient. I hear it all the time at home, the vituperate blaming.

I've learned to listen and say "hmmmm" and "huh". I do not feel obliged to try to explain every rationale to him because then I would be frustrated all the time, as it would be him arguing with me over something I have no control over.

I say, "Why don't you ask the doctor." It isn't my job or responsibility to break down his aversion to the process. At home, I am a wife, not a nurse.

I say he is a grown man and knows what he knows, even if he doesn't want to believe it.

i don't nag, because then I wouldn't have a very happy marriage. He is the way he is. While I don't actually support his attitude, I allow and accept his feelings. So he gets to squawk and I don't have to answer to every point he brings up.

Then, by the time he goes into the office for his appointment, he is much calmer and more reasonable (your welcome!) and he is able to discuss his displeasure or ask his "why" questions in a more non-confrontary manner.

You are a very wise wife.

[brownbook]

I guess maybe patients are more rude and demanding. I think it has to do with computers. You can get immediate access/answers to everything. It is hard to suddenly be told.....no I can't do that when the patient knows you are looking at all their health care information on a computer screen.

I don't understand your example. Are you a triage nurse in an ER? I have only heard of triage nurses working in ER's. If patients are coming into ER's to get meds refilled that is way beyond rude, that is stupid? Your ER needs a huge sign saying we do not do routine med refills.

If you are working in a Dr's office then I can understand the patients frustration. I almost ran out of my BP pills. (I know stupid mistake, they do happen.) I would probably get rude if the nurse in my Dr's office said....no you can't get a refill until you see the Dr.....our next appt is in two weeks. Yeah...I would get rude.There is going by the policy, and there is common sense!

[Farawyn]

They are more non compliant, and also more rude. They do know the healthcare "business" more and ask more questions and such.

Abusive? No. Not in my experience. My worst patient who threw a phone at me (a real phone, which he ripped out of the wall, not a cell phone) and cursed me out was over 10 years ago.

[missswiss44]

No, you are absolutely not alone. People can be very unreasonable and think that their lack of a medical degree does not mean anything, meaning they think they know everything. One of my pet peeves is when it is a patient's adult child making ridiculous medical decisions that could potentially harm the patient, for example when I had this patient who's daughter didn't want the patient to have any insulin for a blood sugar over 300 because she thought the patient's blood sugar would drop too much. Mind you the patient was eating jello packed full with SUGAR. It drives me crazy how people with no medical background think they know everything. Also, there was no pleasing this adult child and everything the medical staff did was wrong; the doctors weren't taking good enough care of her mother, the nurses weren't compassionate enough. I think people in general can be too ridiculous sometimes, not everyone but a good amount.

[canigraduate]

Being a patient, a wife, and a nurse, I've seen that a lot of the problem is two-sided.

I have to go with my husband to see his providers now because they treat him like poop. He is tall, scary-looking, and hard of hearing. He does not treat doctors with deference. He expects them to know their job and to treat him like a person, not a set of diagnoses. He also does not treat nurses with warmth. He expects them to be competent and professional.

I have seen touchy-feely nurses get offended because he doesn't like being touched by strangers without them telling him why they're touching him. I have seen perky nurses get offended because he can't hear high, squeaky voices and they have to repeat things multiple times. I have seen new nurses treat him badly when he asks a lot of questions that they don't know the answers to. I have seen multiple people get frustrated when he asks for a different treatment that is equivalent but he is more comfortable with. Also, I have seen multiple people just give up and get mad when he does not follow what they want him to do like a trained dog. He gets frustrated and angry, which just makes them treat him worse.

However, he gets along well with older nurses who treat him professionally and with the doctors who don't try to shoehorn him in to a particular medication or treatment. He does well when things are explained clearly, with consequences and benefits outlined to him.

So, in your examples, make sure you are approaching your patients with a professional attitude. I don't know how you treat people, but a lot of your post sounds frustrated and irritated. If you are coming across to your patients that way, they are going to pick up on that and their attitudes will suffer.

I know none of us has time to nurse the way we want to, but it is a good idea to remember that the patient is just as unhappy with the situation as you are, and has way less idea of what's going on.

[brownbook]

Will you highly trained professional nurses stop saying poop!

[canigraduate]

Will you highly trained professional nurses stop saying poop!

LOL! It's the first term that came to mind that didn't violate TOS or require asterisks. Next time I'll say excrement, or maybe feces!

[scaredsilly, BSN, RN]

I work L&D, so most of our patients run the gamut from being abusive while in labor to being happy and helpful after the baby is here. Therefore my comments may not be valid from a nurse point of view.

I am going to throw in my two cents from a patient point of view however. My parents and grandparents have both voiced the same complaint. First, everything is hugely expensive (especially for older people on fixed incomes like my grands). Going in for a 10 minute exam and a blood draw is a 30$ copay, which may not seem like a lot to us, but to retired people it makes a difference in whether or not they keep their cable on this month. My parents are both still working and both of them have changed providers several times because of the wait. I don't disagree with them, having a 30 minute appointment is not a big deal, but waiting an hour or more to be seen for that appointment makes a huge difference if they need to get back to work.

I know there's not a lot that can be done about the cost, sadly it is what it is. However there is a lot to be done about the long wait times. It wouldn't be a big deal if it happened now and then, everyone understands emergencies, but for someone like my mom who has diabetes and needs to be seen every 3 months and had to change from a provider she loved because there was never less than a 45 minute wait, well that's completely out of line.

In short, perhaps patients are more demanding and a bit nasty, but in at least some cases it is our fault and there is a lot to be done to be better! I work in a hospital that pays a lot of attention to patient satisfaction surveys because of Medicare reimbursement, if clinics and Drs offices were forced to do the same, I bet things would change!

[VANurse2010]

I work L&D, so most of our patients run the gamut from being abusive while in labor to being happy and helpful after the baby is here. Therefore my comments may not be valid from a nurse point of view.

I am going to throw in my two cents from a patient point of view however. My parents and grandparents have both voiced the same complaint. First, everything is hugely expensive (especially for older people on fixed incomes like my grands). Going in for a 10 minute exam and a blood draw is a 30$ copay, which may not seem like a lot to us, but to retired people it makes a difference in whether or not they keep their cable on this month. My parents are both still working and both of them have changed providers several times because of the wait. I don't disagree with them, having a 30 minute appointment is not a big deal, but waiting an hour or more to be seen for that appointment makes a huge difference if they need to get back to work.

I know there's not a lot that can be done about the cost, sadly it is what it is. However there is a lot to be done about the long wait times. It wouldn't be a big deal if it happened now and then, everyone understands emergencies, but for someone like my mom who has diabetes and needs to be seen every 3 months and had to change from a provider she loved because there was never less than a 45 minute wait, well that's completely out of line.

In short, perhaps patients are more demanding and a bit nasty, but in at least some cases it is our fault and there is a lot to be done to be better! I work in a hospital that pays a lot of attention to patient satisfaction surveys because of Medicare reimbursement, if clinics and Drs offices were forced to do the same, I bet things would change!

I would have more sympathy for such complaints if the public at large were more supportive of universal coverage.

[No Stars In My Eyes]

My primary doc's office is absolutely stellar! A one doc practice; they use computer program with a patient portal. You don't have to go through phone-trees or multiple personnel. You can leave a message for the doc, ask a question, tell him whatever is going on. He answers within 2 hours! If you want an appt, even same day, you just go to the appt section of the pt portal and schedule yourself. It tells you all the appt times that are available and you type and click yourself your appt. When you get to office, seldom even have to wait 10 minutes, usually 5 min or less. Doc takes as much time with you as you need, no "hit+run" visits. It's amazing, and easy-peasy as can be. Plus he is a GREAT DOC! I have forbidden him to retire before I pass away!