OK, something here that has been bugging me for a while (along with other, more recent events that rankle as well). I never noticed it as much as an RN, because I never worked at a clinic for any length of time, but I am beginning to be of the opinion that everyone that darkens our door in the healthcare setting is only out for what they can get, at no cost to them.
Back when I graduated NP school, I was working for a doc who had a sample closet the size of my laundry room. Not big enough to park a yacht in, mind you, but HUGE for what it was for. Floor-to-ceiling shelves just covered in sample meds. The drug reps came by frequently, brought lunch most days, and always tried to keep us stocked. It was unreal. This doc would bag up handfuls of meds for people, usually the entire stock of what had just been delivered, and hand it off. I was amazed at how nice this seemed, but whan I got into the workings of it, I was appalled.
I would say that roughly 90% of her patients would come in and ask for sample refills. AT LEAST that many, and probably more. People would come in for rechecks and ask for more samples. People would get fighting mad when we either did not have what they needed in samples or were out (I am so sorry that Septra is not in a sample, it's on the $4 list!). Add into that that we got into trouble for attempting to ration the samples, so that MORE patients could share the wealth. People would refuse to take anything unless they got samples, saying that they could not afford it, but yet would have an iPhone, iPod, ICarly, nails, hair done to a fare-thee-well, and all the other various accoutrements that you could buy a house with in possession.
Two cases stuck out in my mind:
* A man and his wife who were, shall we say, quite healthy, were frequent flyers here. They each had several major health concerns, mostly due to their respective weights. The male was taking a very new, very expensive medication that we were hard pressed to get samples of, and he knew that we would give him first dig. One day, doc handed me the 2 sample boxes to give to him, all we had, and when I walked in, I get a baleful look and "Just TWO boxes?" Now, what I SHOULD have done is snatch them right back and tell him that since he obviously does not appreciate it, then he does not get it, like you would a child. What I DID do was explain that that was all we had. Neither of these folks worked, they refused to take steps to better their health, and they expected everything to be handed to them.
*A very ill gentleman (and I use the term loosely) brought his mother in with him for his visit. He had an infection for which she prescribed Septra. The mother told me "Well, we'll need samples of that." I explained that it was a very old med, and that there were no samples available, and she replied that he would not be taking anything, then. I never heard how he did.
Again when I went to my family doc to precept, I was shocked. He actually had people call and complain because the samples were not BIG enough! I have seen the same man for 25 years, have never once asked for a sample, have been grateful for what I have been given, and went on my merry way. It never occurred to me to ask or complain. When I ran out of samples, if they worked, I asked for a script. I though that was how it went. Silly me.
This blows my mind. We go all out to prescribe whatever the cheapest, most effective med is for what ails them, and if it is not free, they don't want it.
I know it can't just be here. Is it this bad where everyone else works?
You know....maybe we should just have some of these folks work off the bill??? Go to the ER and don't have any$$$ How about coming in next week (when you are feeling better of course) and give a hand. Fetch the pop and ham sandwhich for bed B. Clean out the bedpan for bed A. Clean bed C for the next pt. You work it off we have a clean slate. Free ambulance ride?? Wash the truck on Sat. afternoon. No excuses here for not having money/ins. All this requires is time and it is free.
Sounds good but they would need taxi vouchers to get there and a good long lunch break with food provided of course!
The attitude of a lot of people we take care of these days simple blows my mind. Help me i wont help myself and do nothing to better my situation..... free samples should be reserved for those who ask not.... Not exactly the same situation but also people who call 911 to get a taxi ride to the er to for a fake cause and then ask the er doc for a script for their clonapin that they just ran out of .... **** some people!
I had a foreign physician explain the other day that she disagrees with all the reports of the healthcare system in the united states as not being up to par with healthcare in other countries as being wrong. She said that healthcare here is good, the care is good. There was some report, she did not remember the exact numbers but lets say for the stories sake that 1 in 4 hospitalized patients that die in the hospital (in the united states) have passed through the ICU; whereas in other countries, the statistic is more like 1 in 10 hospitalized patients that die in the hospital pass through the ICU. She says this statistic is not due to the treatments and the care being behind the medical care in other countries, but because in other countries the some of the patients would have never been sent to the ICU. Instead of intubating and doing dialysis on a 95 year old patient (who probably did not want any of this in the beginning, but their family did)with end stage pancreatic cancer that is now in hepatic and renal failure they may just tell the family that everything has been done, but the patient will probably die soon. The expectations of people in this country is that we should all live as long as possible and everything should be done to make this happen (regardless of what seems fair to the patient). It is expected that everything be done regardless of the cost, and if everything is being done and it is still no successful then the healthcare providers should go out and find something different to do. You do your best and people want more. For what reason? We have to be realistic. We are human beings and we live and die because death is a part of life. Also, the pot of money is going to run out some time.
No, hospital management generally sucks. Personally I think it's because most hospital managers got the job by the peter principle. Most don't know how to be effective managers. They are just yes men to doctors and other managers. What has always bothered me is the administrative people who think they know more then nurses do.
Absolutely not. I appreciate your bringing this subject up. On my medsurg unit, every day I encounter a patient or family member who is ENTITLED to anything and EVERYTHING his/her heart desires. And by that I mean, when they come in the hospital, they know that if they throw a fit and act like a badly spoiled 10 year old not getting their way, they know that mgmt will say, "What a bad nurse! How DARE she/he not fluff your pillows, not disregard your NPO orders, not order trays for your 20 family members! Shame on her! She will be disciplined!" Maybe it's just management at my hospital.
Let me concede that we all know it is not the dying, truly ill patient that is this way. It is the one that's in for the 4th time this month for their demerol/Diet Pepsi/get me through till the check comes in/you must bow to me because it's your job and I can get you fired if I want to person. Understand, I have the utmost compassion and am willing to bend over backwards for the patient that truly needs it.
A similar, fitting statement that I read on another post a while back: What if these same people came into McDonald's and screamed, cussed, threw things, demanded, etc.? Do you think McD's mgmt would offer them a coupon for a free Big Mac? Of course not. They would call the police.
It seems to me that a big part of the entitlement problem is our society's general attitude of laziness and selfishness. These people do not know how to think of others that might be worse off. I try to remember that all they know is rudeness and hatefulness and being demanding. Sure is hard sometimes.
Another big component is the doctors' willingness to hand out whatever treatments it takes to grease the squeaky wheel (but I absolutely think that patients should be their own advocates). Until some, not all, doctors grow a backbone, the demands will only increase.
And, like so many of you, I am SO frustrated that the ones who really need us the most can't get help because of all the Gimmie Jimmies out there.
I am an NP, and at a clinic where I used to work (for the uninsired/underinsured) we had many pts. on pt assistance programs. They would come in with their Blackberries, cigarettes, fancy fingernails, and complain that they had to pay $10.00 for 3 Advair diskus (about $240.00 worth of meds.) Go figure.
It's not so funny when you are in the position I and millions of other Americans find ourselves.
That's why it's so important that the Reform of Health Care bill passes! Please call your senators right away(numbers are in the front of your telephone book, usually), and tell them that you want them to support the bill, and that you're a nurse. If/when it passes, life will become far easier for those who not only suffer from their disease(s), but also financially from its treatment. Many are given drugs that lack necessary components, as they're cheaper.
By the way, one of my pet peeves is the cry from pharmaceutical companies about "their" research expenses. I know that every new drug was funded by grants when in the discovery phase, as years ago, I sat on Boards that awarded the grants! So not only do those companies not have to claim the grant money as income, on their taxes and financial statements - they double dip tax wise and claim tax deductions for the expenses, for which they have already been funded!!!
When I asked for the samples at first, I wanted to hide behind a rock. Having to pay for the medicine often meant the difference between eating or medicating.. I was uninsured because I lost jobs due to my age. (Insurance companies charge far higher premiums for anyone over 55 years of age.)
The stress of getting jobs (6-8 in 10 years) and then being fired at the end of probation, was monumental! I had to fill in my birth date on the insurance application. Employers insist that new employees complete that, (even when I'd state that I already had health insurance). I'd get the positions for which I applied, as I didn't look my age and have experience and education.... It all started the year I was 55 and a trumped up situation caused the loss of a job I'd had for 6 years.
For Fuzzy, did you know that the cost of the medicine sold by veterinarians is obscenely inflated? My cocker spaniel needs eye drops (he's a senior with glaucoma, too) and each veterinarian to whom I took him, charged $32. for each of 2 different kinds. When one vet ran out of one of them, she said that the (expensive) pharmacy (for humans) across the road would fill it, and she'd call them. They wanted $32., too.
Realizing now, that all pharmacies can dispense products used by humans as well as animals, I called Costco to see how much they charged. Each med was by the same manufacturer as the human ones, and cost $3.50!!! (I got them today, and the price had gone up to $4.50 for each......)
So if you have an animal, get their meds if needed, anywhere but at your veterinarian's office - what a racket!
Health care has become a huge racket, which could have mob connections..... think about it.......cold, calculating insurance companies inflate health care costs. Thry decide whether people can be covered, have treatment, the right medicine, etc., and even whether life or death occurs, based on their greed for gigantic profit! They often have hospitals and doctors in their pockets, too due to their shared lobbying expenses; and they contribute to politicians' campaigns to get into office.
Those pharmaceutical reps make me sick!!! I did a clinical (nsg school) in a endocrinologist office and the RN told all about how they work and their motives. She knew which pts were most in need of samples and would make sure they were the ones who got them. Also, when the reps brought in lunch (every day) she would give them guilt trips about how much their drugs cost and would give examples of the pt's who couldn't afford them, ect. She was an awesome nurse!!
I understand drug reps can be frustrating. However, please keep in mind that they are just trying to do their jobs. They do not have any control over how much the drugs cost, which managed care plans offer favorable coverage, etc. They are the "low men on the totem pole." While I understand that your nurse coworker was probably frustrated with the costs of the drugs, it is wrong for her to take out her frustrations on the reps. Yes, there are many patients who cannot afford the drugs because of their high costs...but what about the patients who cannot afford a doctor's visit because they are not insured? Do you give the doctors a guilt trip for charging $100+ for a 10-min assessment?
The entire health care system is broken...the only way we can truly begin to change things is to work together and unite towards the common goal of ensuring quality, affordable and accessible health care for all. Throwing blame at one party or another will solve nothing, especially throwing blame at a "lowly" drug rep. Sniping at drug reps only misdirects anger and blame, and it is unfair to the reps who are trying to make a living.
If your coworker is TRULY concerned with the high cost of prescription drugs, she should engage in advocacy; write the state representatives, start a letter to the editor campaign in the local newspaper. Do something that advocates for CHANGE. Because, honestly, what does being mean and rude and giving guilt trips to a pharma rep solve? Absolutely nothing, and it makes the health care field an even more broken place to work than it already is.
My doctor tied to give me a big box of synthroid samples once and I told him, "No, I can afford it. Save it for someone who needs it." (it's a really poor county and I'm sure there WAS someone who needed it more). The doctor looked so confused, it was funny. But then again, not funny if you think about it too hard...
I had the same thing happen once. I worked for the county at the time and our generic drugs cost $3 and name brand cost $10. I was like "seriously, I don't need these. Please save them for someone who does". My Dr looked shocked and confused as well.
Yes, Yes, Yes! There is a noticeable difference in the upcoming generation! I am a nursing instructor and I am saddened by what seems to be a desire for instant gratification. I can be very humorous at times, and the younger generation is quite difficult to impress. It isn't all that surprising. Here are a few things that make me chuckle. How many of you remember actually walking up to the television and turning the knob to change the channel and adjust the volume? Many of the new generation have never known what it is like to have less than 300 channels to choose from! How about using the oven and stove to heat up all of your food? How many of you remember when you did your research for term papers in the public library? Never even have to leave your home computer to conduct scholarly research these days.
I have noticed that the younger generation has a markedly different level of respect for authority as well. It has seemed to me that some of these students are waiting for the information to be handed to them and blame others when they don't "get it." I have worked diligently to instill a sense of responsibility in my students to get the information for themselves. After all, who will "give" them the information once they graduate? A nurse who is incapable of thinking for himself or herself scares me more than anything.
Best!
Tabitha
Just remember where the younger generation learned such things. From their parents, schools etc. From us, IOW.
When I was trying to find the right antidepressant, my doctor gave me samples of several brands in order to find the right one. He would give me enough for a three month supply.
Wow.. giving a depressed patient three months' worth of "several brands" of antidepressants... doesn't sound like a smart idea to me!
>>>For Fuzzy, did you know that the cost of the medicine sold by veterinarians is obscenely inflated? My cocker spaniel needs eye drops (he's a senior with glaucoma, too) and each veterinarian to whom I took him, charged $32. for each of 2 different kinds. When one vet ran out of one of them, she said that the (expensive) pharmacy (for humans) across the road would fill it, and she'd call them. They wanted $32., too.
Realizing now, that all pharmacies can dispense products used by humans as well as animals, I called Costco to see how much they charged. Each med was by the same manufacturer as the human ones, and cost $3.50!!! (I got them today, and the price had gone up to $4.50 for each......)
So if you have an animal, get their meds if needed, anywhere but at your veterinarian's office - what a racket!
There are not many medical doctors that keep a pharmacy on the premises for their patients but yet most veterinarians do. They do this for the convenince of the client. However many are getting away from this and are writing prescriptions for medications that have a human counterpart. There are many pets that are now on the $4.00 drug program that is offered at Wal-Mart. It is now up to the client to get the prescription filled and not up to us.
This is good because it saves us the storage and the ordering costs/hassels of keeping the drugs on our shelves. We still need to keep the smaller sizes as there aren't many 3# children out there but a lot of 3# ferrets. Of course they need a smaller dose and most pharmacies will not mess with the tiny amounts that they require. If a pharmacy has to compound a drug, it dose cost the client quite a bit of money per tablet. I'm not sure if Wal-Mart and Costco do much compounding of common $4 medications or not. Yes some people see this as a racket (and I agree some of it is).
I must say that veterinary medicine seems to care for the patients alot better. The clients actually gets called right away regarding lab work, testing and diagnosis. Getting labwork results from my own MD is like pulling teeth and it seems like it takes at least a week for a test that I know was done in a day. Likewise I can take a dog into the vet hospital for a thorough exam for under $50 in most areas of the country. I mean a thorough exam. If I go in for a doctor's exam, I'm lucky to get my temperature taken. Yet I cannot get out of there for less than $100 and I still have to go to the pharmacy. If I need labwork or x-rays then the price really goes up. Remember I'm self pay so I get to pay the actual price. So yes there's a few rackets in human medicine too.
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bjaeram
229 Posts
Sounds good but they would need taxi vouchers to get there and a good long lunch break with food provided of course!