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?
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
You are much more patient than me.
I hope to NEVER be an NP in a clinical setting because people get on my nerves (I like acute care the best) and knowing me, I just won't give into stupidity--and knowing me, I would get into situations I'd much rather avoid. It takes a special person to deal with these idiots. Pardon my judgement. Oh, never mind, don't pardon me, they ARE IDIOTS.
Sometimes the ones that are so sick and can hardly talk are the best kinds of patients to have (not that you wish them ill) but at least you won't wish them harm.
I'd be hard-pressed to keep my mouth shut. Kudos to you, and may your halo (much earned as far as I am concerned ) stay round and not turn into devil's horns.
I work in an outpatient Cancer Clinic. It is very fulfilling for me to give samples (especially Effexor and Flomax=$$$) to pts who are undergoing chemo and/or radiation. One DOSE of chemo can cost upwards of $5000. One course of radiation therapy=$20,000.
I'm not about to 'police' who gets samples and who doesn't.
I have never felt these patients to have a sense of entitlement. Only gratitude for whatever help we can offer them.
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...
A hospital system in south texas has a doc that triages in the er, (or a nurse don't remember) and they actually turn people away if its not an emergency. Thats how the system should work. Have a doc triage, say no its not an emergency see your primary care doc. then maybe people would quit abusing
You bring up an interesting discussion. I have thought about this a lot and I have come to the conclusion, based upon opinion alone, that this is yet another symptom of several larger problems.
I'd like to share a few of my thoughts if I may.
I'd like to ask the nurses of allnurses.com to think about how often they utilize the Emergency Department for their healthcare needs? Based upon informal conversations I've had with my peers (MDs and Nurses alike), it would seem that we rarely use the ED for our care unless there is a significant urgent need. Many of the patients we see in the ED have no business being there, but the honest truth of the matter is where else would they go? Many of these patients present and demand far more services than those of us who have insurance would think to ask for, for example, CT scans, ultrasound, and a myriad of lab tests. The ED has become the primary care for the uninsured and underinsured of our country. I hope that healthcare reform, providing that it covers all citizens, will alleviate much of the financial and time constraints placed on hospitals across the country. Poverty and lack of education seems to have a significant relationship to over-utilization of healthcare-related services.
I often wonder if we are inadvertently encouraging and even positively rewarding this abuse of our already over-burdened system by honoring the unreasonable requests of some patients. Are you familiar with the article published in The New Yorker magazine entitled The Cost Conundrum: What a Texas town can teach us about health care? It is a curious condition that a town that has the lowest household income in the country also wins the prize of 2nd most expensive healthcare markets in the country!
Part of the problem seems to be related to provider overuse as well. In the example given from McAllen, Texas, it would seem that many providers are offering as many services as they will be reimbursed for even when the services may not be necessary for a given complaint. We have all witnessed this at some point or another. Every time I work, depending upon the physician working, I have wondered, "Why are we admitting this patient?" Surely this isn't my unique experience.
I was talking to an ED physician last night about this very same thing. He is from the Appalachia area and said that his hometown is a lot like McAllen, Texas. Most all of the families there are well below poverty and his personal opinion is that they seek treatment more than he has seen in any other locale!
I do believe that all citizens should have access to high-quality healthcare, but I also believe that we might benefit from modifications to the infrastructure that supports over-utilization of the system by both patients and providers. Over-utilization on both counts is no free ride since taxpayers will end up footing the bill in the end. For example, a cough and cold for me and any member of my family will be treated with OTC meds if absolutely necessary, plenty of rest, a lot of fluids, and TLC. If the symptoms worsen significantly then a visit to the doc/NP may be in order, but that is extremely rare. I can't even remember the last time I've taken antibiotics. I have no evidence to support it and it may be a slippery slope to even say this, but I have wondered if providing something absolutely free has resulted in abuse of the system. For myself, I will not access the system unless I absolutely have to because I need every penny I earn to pay my bills. That being said, even if the service were free to me, I highly doubt that I would over-utilize the system to a great degree anyway. This leads me to two logical conclusions:
1. Some folks over-utilize because they can.
2. Some folks over-utilize because they have a knowledge deficit regarding effective use of our healthcare system and the benefits they can expect to gain.
I'm not sure what can be done about the first conclusion. Perhaps extensive reform is necessary in our medicare/medicaid system. For example, what about having triage nurses in the CMS system that function to evaluate recipients health-related complaints and to make recommendations for follow-up. I know this idea is wrought with variables that would make this a mess from the start!
I used to work in L&D and I had a patient once who came to be evaluated in triage for onset of labor. She arrived via ambulance. When I called the MD to give her report on this patient, she was enraged that the patient had taken an ambulance to the hospital. She had just seen the patient in the office and had told her to go to the hospital at some point in the day to be evaluated but only because the patient insisted that she was having contractions. There were no signs that she was in actual labor. The patient asked the doctor to call EMS for transport, but the doctor said that since there was no actual emergency that this wasn't necessary. We have a widely available public transportation system in the metro area. The patient left the office and immediately called an ambulance to bring her to the hospital. I also work in the ED and we receive patients all the time via EMS who have no business using ambulance services for minor complaints. OP, I'm just not sure what to do about this pervasive problem except to educate. In the case of EMS, I'd suggest a nominal fee to transport non-emergent patients. This would certainly cut down on this awful abuse. It is a significant contributor to burnout in the profession because these same patients have been known to make unreasonable requests and also occupy beds that could be utilized for sicker patients. In addition, the problem can lead to overgeneralization and stereotyping within this demographic. This could lead to assumptions and lessor care. There was a recent study that found that uninsured trauma patients had a higher mortality rate than their insured counterparts. http://www.msnbc.msn.com/id/33971846/ns/health-health_care/
We had a patient come in three times yesterday via EMS with the same unfounded complaint. What a mess!
In terms of handing out gobs of samples, many major healthcare systems across the country have moved away from accepting samples from drug reps at all. I can see the merit of offering samples to those who simply couldn't afford their medications at all, however, in most cases, there is a suitable alternative on the $4 list.
Now, and in the future, we are going to have to insist on patients becoming partners in care. What is going to happen when more and more Pay-for-Performance measures are implemented with regard to dealing with patients who are non-compliant with their therapeutic regimens? I would be hard-pressed as a provider to continue a relationship with a patient who was unwilling to partner with me. I can imagine that I would be inclined to make this known from the onset of the relationship.
I feel your pain!
As a nurse, I would also be inclined to sit down with patients and look at their overall expenditures and talk around what they would be able to cut out (cell phones, cable, etc.) in order to afford their medications. I wish there was an easy answer but until patients are required to responsibly utilize healthcare services and providers stop over-utilizing, I just have no idea. I hope all of this is being extensively evaluated on Capitol Hill.
This is not something that is unique to the healthcare field. I feel, that it appears to be a sign of a much broader problem.
My husband owns a business and it is not in the healthcare field, I have also worked in other industries, and people will do whatever they can to get something for free. Most of the time, it is an expectation. For instance, in my husbands business, people feel that they are entitled to call up and get extensive technical support for a product that was not purchased from him nor serviced by him for nothing. They expect that he will talk them through the issue over the phone, no matter how long, then hang up, the end.
They also expect to be treated first. We see people come in needing something serviced or repaired when they enquire when and we advise that there are 6 people ahead then we get abuse.
People will come into the shop and ask for advice, then go and purchase a system from somewhere else, then expect us to talk them through the setup over the phone.
People in general, not just health care recipients, not just low socioeconomic (in fact sometimes it appears to be those who are in the higher wage bracket that are more prevalent) want something for nothing.
Not everyone, obviously, but the portion is increasing.
A lot of my friends have teen children, and are experiencing a lot of difficulties, which I know isn't abnormal, but one thing I will hear repeated over and over is "We made sure that they had every opportunity, all the things that we didn't have" etc.
And it makes me wonder. By taking away peoples opportunity to earn/work for something are we in fact enabling the entitlement that they feel?
It is an interesting sociological issue, and I have only been on this planet for 30 yrs. I see what is happening in my generation and below, but what about those of you with more experience?
Specializes in med-surg, psych, ER, school nurse-CRNP.
I work in an outpatient Cancer Clinic. It is very fulfilling for me to give samples (especially Effexor and Flomax=$$$) to pts who are undergoing chemo and/or radiation. One DOSE of chemo can cost upwards of $5000. One course of radiation therapy=$20,000.
I'm not about to 'police' who gets samples and who doesn't.
I have never felt these patients to have a sense of entitlement. Only gratitude for whatever help we can offer them.
Best,
Diane
Well, Diane, if all patients were as grateful and appreciative for the samples, I would not have posted what I did. I wish it were that way. I, too, have seen undying appreciation and gratitude from patients over free samples. But, sadly, they were in the minority.
It's a sad fact that this is not isolated to the healthcare field, as has been mentioned. My own DH stunned me a couple days back when we were eating out and he made the comment that he could get his meal for free anytime he so desired, all he had to do was raise a ruckus. Well, y'all know me (most of you) and y'all know my mouth. After I got finished with him, and after a few choice expletives pertaining to his character (namely one that started with "jack"), he made one last feeble attempt to explain by saying "It's a SERVICE industry".
I then told him that what I do for a living is also considered a service industry, but that neither I nor those poor waiters and waitresses were his servants. I asked him how he would feel if one of my patients were to raise sand over nothing just so they would not have to pay me. Well, he got mad. No one's going to abuse his baby! LOL
He never thought about the fact that those "servants" were somebody's "baby" as well. At least I KNOW how he came to be this way. His whole male family is like this.
Case in point:
A few years back, we went to eat with his family in their neck of the woods at some little hole-in-the-wall. As the little waitress brought out drinks, we had an oopsie, and long story short, I got baptized with a WHOLE TRAY of iced tea. Well, I was soaked (there were about 20 of us eating), the waitress was hysterical, the whole dining room was rolling, and every male at that table had blood in their eye. My SIL took me to change clothes, and we came back to find the rest of the party demanding free food. I was the one who nearly got drowned, and they thought that meant they could go ape. The poor waitress ( who was probably all of 16) was in the corner sobbing her eyes out as a manager went to town on her, so I walked over and gave her a hug and told her it was all right. We did get free appetizers, but that was all I would let the restaurant do. Like I explained to the table at large, this happened to ME. I am the one who should be mad, and I am not mad, so neither should you be.
That was 5 years ago, and we still talk about it every Christmas.
Specializes in Community Health, Med-Surg, Home Health.
This is an enlightening thread. I work in a community hospital and I had a person assume that we had a free book on their condition. I gave literature, but this person demanded an entire book (something we did not have). For self pays with no insurance, we have literature for discount glucometers (about $10 for the machine, $5 for 100 strips, $5 for lancets). Patient screamed at me "I want FREE!" With this economy, we are fortunate to still remain open due to charging our self pays $20 for a visit (which includes labs) and anywhere from $2 to $5 for their prescriptions. It does make one sick...
Specializes in RN Education, OB, ED, Administration.
My doc was great when I was in nursing school and didn't have health insurance. He would actually apologize if he didn't have samples.
It was nice when I went in a couple months ago and was able to refuse the samples of a very expensive medication he was prescribing me since I have insurance.
Samples should be given to those in need, not to convince you to fill your prescription.
This is what I love about our system--It is there to help when you need it. It's wonderful when citizens like yourself leave the freebies for others who are truly in need. I remember my nursing school days when I used federal and state assistance for my children and myself and was grateful for the day that I no longer needed the aid. Tabitha
Specializes in RN Education, OB, ED, Administration.
This attitude of entitlement is glaringly apparent in the ED. I am still continually amazed at the people who call the ambulance for a stubbed toe, then carry on loudly their entire time in the ED, while there is another patient down the hall who is actually dying, has received a diagnosis of terminal cancer, or who is extremely sick, who is demanding nothing. For some people, it is all about me, me, me.
It would be one thing if this were an anomaly, but on the contrary, it seems so pervasive.
Hi Virgo:
I couldn't agree with you more. I have witnessed this sort of carrying on each and every time I go to work to one degree or another. I have to remind myself--in order to remain compassionate and objective--that if these patients really understood just how inappropriate their behaviors were, they would absolutely make different choices. I left the ED for a time and returned to L&D just to have a break from all the misuse and abuse. I've now returned with a different attitude. I try to always remember that each and every patient came into the world naked, innocent, and perfect. Someone along the way created those people who have very ineffective coping skills. We all see the world through our own rose-colored glasses. Perception is reality, so it seems. These are just my thoughts and they keep me sane! My personal rose-colored glasses, if you will!
Specializes in Community Health, Med-Surg, Home Health.
I remember once, a patient passed out in the middle of our clinic. Staff ran towards the patient, each with an item...stretcher, glucometer, smelling salts, sheets, etc...and a patient stands in front of the victim blocking some of us from getting to him demanding that we see HIM (not the poor guy on the floor) first! If I could have done it legally, I would have kicked him in his selfish face.
Specializes in RN Education, OB, ED, Administration.
call me crazy..
i was always under the impression that the main 'purpose' of a sample was to ensure that a patient did not have some type of reaction before they went and shelled out money for the rx.
it would suck to try a new med, then realize you could not take it, for whatever reason, and then have to shell out more money for another rx.
my doctor gave me a sample of a new asthma med and said "try this, if you like it and it works well you can fill the rx. if it is not working out call me, and we can try something else."
this phrase is thrown out a lot, but in some cases it is very accurate. some people feel a sense of "entitlement", for whatever reason.
another great use of sample medications include those that are given to patients who are waiting for prior-authorization approval from their insurance companies. enbrel is a good example (injectable for rheumatoid arthritis). these medications require the patient to subcutaneously inject the medication at home on a regular basis. most insurance companies won't shell out payment for the medication until the prescriber submits paperwork justifying the need. this is a very expensive medication and with some insurance companies, patients will often have to wait for their supply to be mailed to their home. i love that samples are available to give while the patients wait as the costs are nearly prohibitive.
however, this brings up another discussion! the costs of prescription medications are out of control! enough said.
I couldn't agree with you more. I have witnessed this sort of carrying on each and every time I go to work to one degree or another. I have to remind myself--in order to remain compassionate and objective--that if these patients really understood just how inappropriate their behaviors were, they would absolutely make different choices. I left the ED for a time and returned to L&D just to have a break from all the misuse and abuse. I've now returned with a different attitude. I try to always remember that each and every patient came into the world naked, innocent, and perfect. Someone along the way created those people who have very ineffective coping skills. We all see the world through our own rose-colored glasses. Perception is reality, so it seems. These are just my thoughts and they keep me sane! My personal rose-colored glasses, if you will!
Best!
Tabitha
That's nice that you are able to give people the benefit of the doubt that if they had any insight, they'd behave differently. I'm not so sure. I think that may be true for some, but I think selfishness is ingrained into our individualistic society to a certain extent. I think it takes more work for people to think of others than to focus on their own interests, and people are lazy. It seems that those that behave otherwise are in the minority. But perhaps my POV is skewed considering the area I work in.
PostOpPrincess, BSN, RN
2,211 Posts
You are much more patient than me.
I hope to NEVER be an NP in a clinical setting because people get on my nerves (I like acute care the best) and knowing me, I just won't give into stupidity--and knowing me, I would get into situations I'd much rather avoid. It takes a special person to deal with these idiots. Pardon my judgement. Oh, never mind, don't pardon me, they ARE IDIOTS.
Sometimes the ones that are so sick and can hardly talk are the best kinds of patients to have (not that you wish them ill) but at least you won't wish them harm.
I'd be hard-pressed to keep my mouth shut. Kudos to you, and may your halo (much earned as far as I am concerned ) stay round and not turn into devil's horns.