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.
It's great Michigan that at your hospital care is no different for the poor as others. Of course to be accurate wouldn't you have to compare them to patients at a different hospital where everyone is insured? Also I wonder how long before your hospital has financial difficulties like at other charity hospitals around the country with that philosophy?
Also I'm curious how often are you in the room when the docs are discussing whether or not to order a certain test or medication due to cost and ability to pay? It happens believe me because I was in the room, sometimes it was my job to try to find alternatives for the poor/uninsured. Remember I didn't say they got substandard care just different.
As for being treated differently because of ethnicity/race/weight/citizenship status/income you need look further than the comments on this board to know it probably happens.
I believe the hospital I work for is non-profit. Financially at the moment it is fine. I've never seen docs write orders for the "lower" cost meds because the patients they were writing them for were poor. I work in SICU. When the docs round on my patients, I round with them. The chart is in the room and I transcribe all of my orders. But I've never been asked to find the lower costing antibiotics or other drugs for my patients. I'm sure what you are talking about does happen, but I've never experienced it myself.
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?
The paragraph below is from an article titled "Debunking the myths of the US healthcare system" and equality of care for the uninsured vs the insured is one of the topics of discussion.
Multiple studies have shown that the uninsured receive less healthcare and have worse outcomes than the insured.[27,28] The Institute of Medicine reports that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in thehospital, even for acute situations like a motor vehicle crash.[27] After adjusting for age, gender, smoking, and education, lack of insurance alone increases risk of death by 25%.[29]
To view full article on the difference in quality of care and outcome visit
The paragraph below is from an article titled "Debunking the myths of the US healthcare system" and equality of care for the uninsured vs the insured is one of the topics of discussion.
Multiple studies have shown that the uninsured receive less healthcare and have worse outcomes than the insured.[27,28] The Institute of Medicine reports that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in thehospital, even for acute situations like a motor vehicle crash.[27] After adjusting for age, gender, smoking, and education, lack of insurance alone increases risk of death by 25%.[29]
To view full article on the difference in quality of care and outcome visit
Can honestly say that on my unit, I've never seen that happen. I was just reading the stats on the hospital where I work. In 2007, there was 132 million dollars in uncompensated medical care. We had a young man from mexico with severe liver disease be placed on the transplant list though he didn't need to have the transplant. He lived.He had no insurance. Had multiple patients with GSWs who had no insurance and had every bit of medical care possibly done in order to save them. We had a patient who received 80 stab wounds, she probably had her whole volume of blood replaced, she didn't have insurance and she lived.
I agree with Critter that it varies from hospital to hospital. At my hospital we don't withold certain procedures or tests just because someone can't pay for them.
"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."
Speechless here. Please tell me that very protective and proactive father had that doctor's a-- handed back to him and shipped back home.
Can honestly say that on my unit, I've never seen that happen. I was just reading the stats on the hospital where I work. In 2007, there was 132 million dollars in uncompensated medical care. We had a young man from mexico with severe liver disease be placed on the transplant list though he didn't need to have the transplant. He lived.He had no insurance. Had multiple patients with GSWs who had no insurance and had every bit of medical care possibly done in order to save them. We had a patient who received 80 stab wounds, she probably had her whole volume of blood replaced, she didn't have insurance and she lived.
I agree with Critter that it varies from hospital to hospital. At my hospital we don't withold certain procedures or tests just because someone can't pay for them.
The point is that it is happening and we should be outraged even if it not happening at our facility. The numbers don't lie.
The point is that it is happening and we should be outraged even if it not happening at our facility. The numbers don't lie.
Yes, I UNDERSTAND THAT. I did say that it varies. And I am outraged that doctors and nurses would treat someone differently based on the person's race, sex and whether or not they had insurance.
"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."
Speechless here. Please tell me that very protective and proactive father had that doctor's a-- handed back to him and shipped back home.
I don't know what happened to that doctor. I do know that this girl is about 12 years old and is in a program for gifted children with disabilities.
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.
This was just over 5 years ago now. The doctor was a middle-aged, white American. The hospital I was in was a suburban hospital in wealthy town. His only problem appeared to be with the fact that I was a woman.
Interestingly, the nurse who helped my husband get me into my car (I couldn't stand up without passing out!) directly told my husband to take me to the ER in another town about 10 miles down the road. They had me in a telemetry unit within 40 minutes of my arrival and initial evaluation. Saw a cardiologist that night, and had surgery two days later once they stabilized me. At the second hospital, they didn't even ask for my insurance details from my husband until about 3 hours after I had been on the Unit.
Although I do believe that there can be discrimination based on ability to pay, and other factors, I do still think there are just a lot of ignorant people out there who seem to lack basic common sense. I also think that there are less benign practitioners who will try to take advantage of people for whom they believe they can, although I have not seen this personally in my years in a hospital setting.
I work at a primary care teaching hospital, level I trauma center, etc.
What type of care you get depends on the doc/resident. Some are more aggressive, some less so. Some docs we really have to advocate for our patients on, and some docs don't need any prodding. It just really, truly, depends on the doc on call at the moment. I've seen that be more of a factor over the long run than any other issue. Not to say that discrimination on age/race/immigration status/insurance etc. never happens, but thankfully, I have seen it very little among our docs. And I'm pretty sensitive to stuff like that.
It seems like patients get somewhat equal treatment for acute illnesses...but unequal care for chronic illnesses. We do need to take into account a person's ability to pay - not to deny them treatment, but to provide them treatment that they can adhere to.
I volunteered at a free clinic, and I remember having a middle-aged male walk in one day. He had been discharged from the hospital a week earlier - he had a massive MI, underwent quadruple bypass, and received the best of care. He then was sent home with prescriptions for the best medications, none of which he could afford - his prescriptions would have run him over $700.00 out-of-pocket each month. I can't tell you how many times we have people come to our ED because they went to fill a prescription for an antibiotic, anti-emetic, etc from their PCP, only to find that it costs too much...and suddenly, they're unable to get an appointment with their PCP and are left without meds that they truly need.
Ability to pay should not be used to deny treatment; it should be used to provide the best individualized treatment for the patient. Obviously, if a patient needs vanco, amoxicillin won't do; but there are some ways to cut corners to help the patient receive the meds that they need.
:argue:
RN1982
3,362 Posts
I believe the hospital I work for is non-profit. Financially at the moment it is fine. I've never seen docs write orders for the "lower" cost meds because the patients they were writing them for were poor. I work in SICU. When the docs round on my patients, I round with them. The chart is in the room and I transcribe all of my orders. But I've never been asked to find the lower costing antibiotics or other drugs for my patients. I'm sure what you are talking about does happen, but I've never experienced it myself.