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 RN Education, OB, ED, Administration.
You know....maybe we should just have some of these folks work off the bill??? Go to the ER and don't have any$$$ How about coming in next week (when you are feeling better of course) and give a hand. Fetch the pop and ham sandwhich for bed B. Clean out the bedpan for bed A. Clean bed C for the next pt. You work it off we have a clean slate. Free ambulance ride?? Wash the truck on Sat. afternoon. No excuses here for not having money/ins. All this requires is time and it is free.
Specializes in med-surg, psych, ER, school nurse-CRNP.
You know....maybe we should just have some of these folks work off the bill??? Go to the ER and don't have any$$$ 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.
I like this, but it would never fly. More like, most people would be highly offended that we expcted them to lift a finger, complain to admin, and get all their care free and probably an apology to boot.
I know, "How dare you ask me to actually WORK/EARN something rather than have it handed to me.."
This of course, is directed at the ones who expect, demand and abuse, rather then generally need, appreciate and make it a point to learn about preventative health measures...
Tort reform is one way to attack over-utilization. If people going to the ER with a stubbed toe knew that they would be turned away AND that there would be no profitable trip to the lawyer if they were turned away, then I dare say that they would think twice before demanding care for non-acute problems in an ED.
But most folks overseas pay taxes to the tune of about 60% so they can have government healthcare. Our system needs reform, but I would like to see reform coupled with TIMELY QUALITY care. Is this scenario possible or even probable in some other countries: Friday night chest pain at home and trip to ER at 10 PM; evaluated by cardiologist same night; in surgical ward to await cath by 0300; worked into cath schedule within 12 hours; surgical team alerted to possible CABG sent home by lunch on Sunday with new meds and follow-up appointments. I hate a lot of things about our system, but I don't think that would have occured in many places.
I see far more people who do not have the money to pay for prescriptions, co-pays, transportation to the doctor, DME or even food. I knew of a 90-year old lady who picks up cans to supplement her meager income since she and her 86-year old sister never married and outlived their savings and had no other family. I know of another 93-year old lady with CHF who was living off of canned sardines and soup. Not everyone who is poor is that way due to poor choices or lack of planning.
For some reason, I almost never see vent threads about these unfortunate souls. I wonder why that doesn't **** people off like patients getting free samples from the extremely profitable pharmaceutical companies?
I see the same thing in my ER- it drives me nuts. I just can't say we don't have samples- they then want 'take homes' meds. I feel like the cashier at the food court, would you like that for here or to go? Parents want bottles of tylenol/motrin 'to go', everyone wants pain medicine 'to go', I even have requests for BP meds 'to go'. We are not a pharmacy- really, we don't have all the designer drugs. I know it's hard to believe, but we ony have the basics and emergency meds in our ER, lol.
I have advocated for meds for the needy. I have bought groceries for some of my neediest pts, not that anyone knows about it. I understand poor, but slack is a whole 'nother story.
But most folks overseas pay taxes to the tune of about 60% so they can have government healthcare. Our system needs reform, but I would like to see reform coupled with TIMELY QUALITY care. Is this scenario possible or even probable in some other countries: Friday night chest pain at home and trip to ER at 10 PM; evaluated by cardiologist same night; in surgical ward to await cath by 0300; worked into cath schedule within 12 hours; surgical team alerted to possible CABG sent home by lunch on Sunday with new meds and follow-up appointments. I hate a lot of things about our system, but I don't think that would have occured in many places.
I can guarentee it does happen in the UK and you pay 1/3 of your monthly salary in taxes and towards socialised medicine not 60%. Plus you do not pay healthcare insurance or benefits out of your salary
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
OMG, if that could happen everywhere, think of the healthcare dollars saved......but many don't have a PCP, and urgent care centers want a minimum payment up front. It's a hard balance, but I wish it would occur more places. The ER cannot refuse to serve anyone who is having a TRUE EMERGENCY. This doesn't cover the chronic painer who ran out of meds. To them, yes an emergency, but to others, wellllll, a whole 'nuther story!
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.
Now this is an idea.....How many do you think we'd see then?
But most folks overseas pay taxes to the tune of about 60% so they can have government healthcare. Our system needs reform, but I would like to see reform coupled with TIMELY QUALITY care. Is this scenario possible or even probable in some other countries: Friday night chest pain at home and trip to ER at 10 PM; evaluated by cardiologist same night; in surgical ward to await cath by 0300; worked into cath schedule within 12 hours; surgical team alerted to possible CABG sent home by lunch on Sunday with new meds and follow-up appointments. I hate a lot of things about our system, but I don't think that would have occured in many places.
I've seen it NOT happen in our system as well. People who think that everyone gets equal treatment needs to open their eyes and start looking a little harder. The better the insurance, the better the treatments. We as nurses may not know who has what insurance, but the MDs and their staff sure do. I've actually heard more than 1 doc say "she has medicaid, so we're not going to......" but the same situation with good insurance gets the whole gamut of tests, labs, and treatments. And sometimes both and sometimes neither need any of the previously said. Many docs, especially old timers, know down to the cent what they can get off of each patient. I've heard them brag to each other in the dictation room. It seriously ****** me off! And don't even get me started on medically futile care as an expectation, just because we have the technology, we should keep 102 yr old with stage 4 lung CA alive as long as possible. Patient just had basic medicare, and some of the treatments they wanted were not covered, according to our social services group, and there were no funds to cover. The family of course, did not want to pay and said "hospital is wealthy, let them eat the cost!" Unfortunately, we've "eaten the cost" so many times, we're going broke!
angelamccaskill
4 Posts
This is ONE reason why working overseas in countries with different healthcare systems is so fabulous. VERY LITTLE sense of entitlement!!!!