poor people get poor tx?

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I am a new grad RN and I feel I work in one of the best hospitals in my city. I have mostly seen equal tx of all pt's and a good majority of our pt's do not have insurance- I believe we were told about 40% of our pt's do not have insurance. Although, there have been a few situations that have really peeved me off. I would like your opinions on the following.

1) A homeless pt was subjected to a new med student putting in an IJ when a PICC was actually called for. The doc wanted her to get the experience. The student finally got it inserted on her FOURTH try and after causing a significant deal of pain for the pt and not to mention, a seizure during the third attempt.

2) Pt's that come in with illegal substances in their system do not get adequate pain control. We have many many of these pt's. We were taught over and over again in school that addicts may have built up tolerance to opiods and we should advocate for them appropriately. Doesn't seem to work with the doc's at all. I've had so many pt's that were writhing in pain and probably withrawling at the same time and only have prescriptions for a lortab or even one pt with a children's dose of pain relief. Grrrr.

3) Pt came in w/seizure and fell on rocks face first. He had a CT and urinalysis and once those were cleared he was let go with ABX and 10 tylenol 3's. This was his first seizure ever, he had a suspected broken nose, an injured shoulder from the fall... no xrays ordered, and the blood was not cleaned off his face enough before discharge to even see that a rock had pierced through his lip completely. Grrr.

So, if these pt's were known to have insurance and/or did not have illegal drugs in their systems... would they have recieved this same tx? I know I am new and don't know a lot, but come on, even I can see there is something wrong here. My offering of a warm blanket or an ice pack is not going be enough for any of these mistreated pt's.

Thanks for letting me vent and I look forward to any and all comments.

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Specializes in ICU/Critical Care.

I work at a hospital in downtown detroit. Yes, it's an inner city hospital and I can honestly say that whether or not a patient is rich or poor, they receive the same level of medical care. I'd like to add that the hospital where I work gets many patients from the suburban hospitals because they don't want to deal with patients that have no money and insurance.

Just playing the devil's advocate. As for the med student you were speaking about, yes, she needs experience and she is getting it at a teaching hospital. She's a student, she's obviously not going to get an IJ placed on the first try. Would you be saying the same thing about a nursing student if she was the one putting in an IV on the fourth attempt? She's not intentionally trying to subject the patient to torture because the patient is homeless, she needs to learn. And for the patients that come in with illegal substances, were they placed on valium, ativan, serax or librium?

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Specializes in Ortho, Case Management, blabla.

2) Pt's that come in with illegal substances in their system do not get adequate pain control. We have many many of these pt's. We were taught over and over again in school that addicts may have built up tolerance to opiods and we should advocate for them appropriately. Doesn't seem to work with the doc's at all. I've had so many pt's that were writhing in pain and probably withrawling at the same time and only have prescriptions for a lortab or even one pt with a children's dose of pain relief. Grrrr.

That's when you need to page the doc and tell them that the pain medication IS NOT working. Be firm about it. insist on something stronger. It helps if you say, "Hey doc this lortab q4 isn't working can we try (insert med/strength/frequency here) instead?" Also, it is possible that there are pain protocols that exist in your hospital. Call up a med-surg floor. You might not even need a doc's order for stronger pain meds if there is already a protocol in place.

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Specializes in ICU/Critical Care.

When you need to advocate for your patient, you REALLY need to advocate for your patient. I don't agree withholding meds from patients but sometimes I understand why docs do it, epecially if the patient is sensitive to narcs. We all learned that pain is what the patient says it is, but to be honest, sometimes it's hard to believe a patient who has an extensive history of being admitted every other week for abdominal pain (all pertinent tests and labs being negative) and requesting i.v. narcs.

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Specializes in Peri-op/Sub-Acute ANP.

You don't have to be poor to be subjected to stereotypes and poor practice.

For example, I was once discharged from the ER by a doctor who told me to my face that if I was a man I would have been admitted. My (brief history) is that I was taken to ER after having collapsed in a mall. Once I gained consciousness I had chest pain and what felt like "palpitations". Orthostatic, the whole deal. Paramedics did an EKG and didn't like my heart rhythm so took me to the ER where my arrhythmia continued (including tachycardia at between 115 and 125). ER doctor, not a cardiologist mind you, said that it was "unlikely" that I really had a heart problem because statistically that would be unusual! Discharged me and referred me to a cardiologist. I bet you all can guess what the cardiologist said ......

Anyhoo, I have excellent medical insurance - they pay 100% on all treatment and drugs with no co-pay so there was never any issue about what would or would not be covered.

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Specializes in ICU/Critical Care.
You don't have to be poor to be subjected to stereotypes and poor practice.

For example, I was once discharged from the ER by a doctor who told me to my face that if I was a man I would have been admitted. My (brief history) is that I was taken to ER after having collapsed in a mall. Once I gained consciousness I had chest pain and what felt like "palpitations". Orthostatic, the whole deal. Paramedics did an EKG and didn't like my heart rhythm so took me to the ER where my arrhythmia continued (including tachycardia at between 115 and 125). ER doctor, not a cardiologist mind you, said that it was "unlikely" that I really had a heart problem because statistically that would be unusual! Discharged me and referred me to a cardiologist. I bet you all can guess what the cardiologist said ......

Anyhoo, I have excellent medical insurance - they pay 100% on all treatment and drugs with no co-pay so there was never any issue about what would or would not be covered.

DID he not care about the arrhytmia you were having? Gees, did he think you came into the ER to show him the funny thing you can do with your heart? What an idiot. I'm outraged.

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Specializes in Peri-op/Sub-Acute ANP.

Michigan,

Honestly, at the time I was too stunned (and sick) to respond. Had I felt even a little bit better than I did, I would have ripped him! His bottom line was that I was "statistically insignificant".

Apparently women in their 40s don't have heart problems, right!!!!

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Specializes in Peri-op/Sub-Acute ANP.

I guess my point is that all the insurance and money in the world can't cure stupid!

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Specializes in ICU/Critical Care.
Michigan,

Honestly, at the time I was too stunned (and sick) to respond. Had I felt even a little bit better than I did, I would have ripped him! His bottom line was that I was "statistically insignificant".

Apparently women in their 40s don't have heart problems, right!!!!

Women in their 40's have heart problems? NO way!!!! Sorry you went through all that.

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Specializes in ICU/Critical Care.
I guess my point is that all the insurance and money in the world can't cure stupid!

You're right, ya can't cure stupid.

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Specializes in Emergency.

For the most part, I feel that the patients who I've seen over the years get fair treatment. However, you will get some individuals who have their own way of treating patients, and they will adhere to their own prejudices and stereotypes.

If the med student was trying to get an IJ, I would have given them 2 tries - and then they're done. You have to speak up and be an advocate for your patient. Where I work, nurses are allowed 2 IV sticks - and if they still are not successful, then they are supposed to have another nurse attempt IV access (instead of poking them again, and again, and again...). The same rule should apply to doctors too. Med students will have plenty of opportunities to try different skills, and its not going to be at the expense of my patient's comfort.

Some docs that I know will glance at a patient's face sheet to see if they have any type of insurance. If they don't have insurance, they will write prescriptions for meds that the patient can afford (like substituting compazine for zofran). I did work with one doc who would give patients with private insurance "the good pain meds" (percocet, etc), because he felt that "they work hard for a living, so I'll hook them up". One of these days, his way of treating patients will bite him in the rear.

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You don't have to be poor to be subjected to stereotypes and poor practice.

For example, I was once discharged from the ER by a doctor who told me to my face that if I was a man I would have been admitted. My (brief history) is that I was taken to ER after having collapsed in a mall. Once I gained consciousness I had chest pain and what felt like "palpitations". Orthostatic, the whole deal. Paramedics did an EKG and didn't like my heart rhythm so took me to the ER where my arrhythmia continued (including tachycardia at between 115 and 125). ER doctor, not a cardiologist mind you, said that it was "unlikely" that I really had a heart problem because statistically that would be unusual! Discharged me and referred me to a cardiologist. I bet you all can guess what the cardiologist said ......

Anyhoo, I have excellent medical insurance - they pay 100% on all treatment and drugs with no co-pay so there was never any issue about what would or would not be covered.

:eek: :argue:

How long ago was this? And was the doctor American? Doctors from some foreign countries who aren't Americanized might be tempted to give substandard care to female patients. Example: A family I know has a daughter who was born with numerous birth defects. A foreign doctor said, "She probably won't live through the night. Since it's a girl, it's no big deal." Her father signed her out AMA, strapped her in the car seat they hadn't intended to use for a few more days, and drove to a university hospital 50 miles away in less than 30 minutes.

Just about the only organ that isn't affected is her brain, and her IQ is NOT normal; it's in the genius range, to everyone's complete shock because she has a large cyst where part of her brain is supposed to be. On top of it all, she's totally deaf.

When I worked in retail pharmacy, more than once I worked with other pharmacists who did things like tell Medicaid people it would be an hour and then make them wait an hour even if it wasn't busy, they were obviously sick, had a very sick child with them, etc. :angthts: In one case, I was told by other store personnel that they had seen him taking liquid medications into the bathroom; he didn't do that when I was there but if he had been caught, it would likely have cost him his license.

We have lots of Amish patients and they never have insurance, although they somehow always find a way to pay the bill. Otherwise, we don't know what insurance they have (although if they're 65 or over, it's a pretty safe bet that they have Medicare) and we don't care.

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