I feel like we are rapidly reaching jump ship level. My own sister (in her 40s with 4 kids and natural born Texas/US citizen) is actively migrating her family to Canada next year. Her daughter with a clef pallet cost her family 90K last year WITH insurance. Her husband makes $150K a year, so they managed...but Christ! My sister is so serious that she already submitted all her immigration papers and is waiting to hear back.
I work in a clinic. The ER at the hospital I work for has sent critical patients to our clinic because they 1) apparently have no staff that know how to evaluate for a emergency (I say this having 8 years ER experience under my belt). I had a patient go to the ER twice in 24 hours for urinary pain, bleeding 1 week post op. They sent him to the clinic pale AF, orthostatic blood pressure 80/40, bladder scan showed 330 after voiding (ended up being a giant number of clots that I got to try to hand irrigate in the OFFICE!). The ER did a UA at both visits and NOTHING ELSE.
You might want to say this is my institution in particular...however I haven't held a job at 1 institution for more than 3 years. I've traveled. So, yes, there are better and worse.....but they are ALL getting worse. Process improvement usually involve trying to make up care gaps with unlicensed, under educated, unqualified people OR have one qualified person do the work of 3-4 people (both of which create gross care gaps).
I wish I could go with my sister. This has only gotten worse in the 15 years I've been a nurse. I'm not proud of my field.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Hoosier_RN said:
I agree, but want to add that pharmaceutical advertising also adds to the expectations as well. As a child of the 60s/70s, I don't remember prescription medications being marketed, much less at the at the intensity at which the marketing occurs now.
I'm really tired of admins who expect us to provide hotel level service, with barebones staffing and supplies. "It's my pleasure to serve you, because I have the time" ??
Marketing hospitals for niche care and fancy lobbies is a symptom of a capitalist health system. Same with pharmaceutical marketing.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
toomuchbaloney said:
At this point in time, insurers make our system more expensive, more complicated, more inequitable, and add zero value to our health system while siphoning millions of dollars for their own profit stream. They are a portion of the reason our system is so fractured and dangerous. IMV insurers in the USA have too much power.
I don't blame people for wanting basic healthcare and the ability to access health professionals outside of the acute care or emergency room setting. In my view, that's the largest expectation, that American citizens can get basic but necessary care when they need it
The health professionals and for profit industry created the expectations for care. There's lots of money to be made on treatments and devices, even when they don't improve quality of life or increase life expectancy. In my professional lifetime I've seen just as many unrealistic providers making unrealistic care recommendations to family at end of life as I have seen families demanding unrealistic care. Maybe more. Observing the health system from a Hospice and palliative care perspective near the end of my career, in several states, was enlightening in that regard.
I agree with everything you have said. We over sell what devices can do for ill patients BECAUSE we let device companies sell us on the devices. Healthcare is a train wreck right now.
I feel like we are rapidly reaching jump ship level. My own sister (in her 40s with 4 kids and natural born Texas/US citizen) is actively migrating her family to Canada next year. Her daughter with a clef pallet cost her family 90K last year WITH insurance. Her husband makes $150K a year, so they managed...but Christ! My sister is so serious that she already submitted all her immigration papers and is waiting to hear back.
I work in a clinic. The ER at the hospital I work for has sent critical patients to our clinic because they 1) apparently have no staff that know how to evaluate for a emergency (I say this having 8 years ER experience under my belt). I had a patient go to the ER twice in 24 hours for urinary pain, bleeding 1 week post op. They sent him to the clinic pale AF, orthostatic blood pressure 80/40, bladder scan showed 330 after voiding (ended up being a giant number of clots that I got to try to hand irrigate in the OFFICE!). The ER did a UA at both visits and NOTHING ELSE.
You might want to say this is my institution in particular...however I haven't held a job at 1 institution for more than 3 years. I've traveled. So, yes, there are better and worse.....but they are ALL getting worse. Process improvement usually involve trying to make up care gaps with unlicensed, under educated, unqualified people OR have one qualified person do the work of 3-4 people (both of which create gross care gaps).
I wish I could go with my sister. This has only gotten worse in the 15 years I've been a nurse. I'm not proud of my field.
Also, operating with not enough nurse and no techs. So nurses are doing the work of 3-4 people, but the hospitals have the money to pay the doctors, pay lawsuits, give the housekeepers breaks, but when it comes to the nurses, no one knows anything about it.
Specializes in NICU, PICU, Transport, L&D, Hospice.
The thing that puts patients in hospitals for a stay is access to nursing assessment and care. That's also the thing that hospitals are very stingy with in their budgeting. That is an intentional decision. This has been a business model for a very long time now. These decisions matter in our health outcomes.
I need to add another aspect of the failing system. As Americans we surely are accustomed to better healthcare than many other nations that struggle to have even facilities and supplies, let alone advanced, up to date care. However, I am worried that the services we do have are going to decline even further.
I have a friend who went to an ER (large medical center), via 911. Excruciating HA, blurred vision, dizziness and vomiting, 4 days following a complex TMJ surgery. She waited in that ER for approximately 30 hours with very minimal monitoring or ongoing assessment. It was discovered she had a stroke WHILE IN THE ER. Had blood clots r/t her surgery, on a heparin drip with the same sub par monitoring or intervention. She waited 2 more days waiting for a bed to open up in-patient. She survived with permanent hearing loss and chronic HA's. I've heard several stories of people dying while in the ER. It didn't used to be this way, and I know there are multiple factors that can play into this. However, the fact that insurances companies, pharma, corporate owned systems who are profit driven have everything to do with the decline for patient outcomes and services.
I'd really like to know why this has been allowed to happen? Have no clue how to go about fixing it. Obviously, staffing shortages in several disciplines are a key factor in the lack of services and care that is available. I don't believe Baby boomers retiring is the main cause.
Also, operating with not enough nurse and no techs. So nurses are doing the work of 3-4 people, but the hospitals have the money to pay the doctors, pay lawsuits, give the housekeepers breaks, but when it comes to the nurses, no one knows anything about it.
And the drug companies have all this money for advertising to an audience who has no idea what they're talking about. This, of course, is money totally wasted in a corrupt system which brings us drugs that aren't particularly novel or useful (like the ones advertised on TV) at the cost of research into orphan or more novel drugs.
And the drug companies have all this money for advertising to an audience who has no idea what they're talking about. This, of course, is money totally wasted in a corrupt system which brings us drugs that aren't particularly novel or useful (like the ones advertised on TV) at the cost of research into orphan or more novel drugs.
If the money on advertising was wasted, drug companies would not do it. Advertising to lay people appears to drive sales by encouraging people to ask about various treatments.
Orphan drugs are another matter however. The motivation to develop them will always be dependent upon .gov research grants and special tax incentives simply due to the limited customer base.
I highly doubt a publicly traded company with shareholders would take the money earmarked for advertising and put it into orphan drug research if they were no longer able to advertise. I do think that R&D into novel medications is a priority since novel medications typically means $$$.
If the money on advertising was wasted, drug companies would not do it. Advertising to lay people appears to drive sales by encouraging people to ask about various treatments.
Orphan drugs are another matter however. The motivation to develop them will always be dependent upon .gov research grants and special tax incentives simply due to the limited customer base.
I highly doubt a publicly traded company with shareholders would take the money earmarked for advertising and put it into orphan drug research if they were no longer able to advertise. I do think that R&D into novel medications is a priority since novel medications typically means $$$.
It may not be money wasted for the drug companies, but it's disturbing that the public has to pay more to provide advertising. It is a waste of OUR money to have to pay for their advertising. It's a driver of the failing system.
It may not be money wasted for the drug companies, but it's disturbing that the public has to pay more to provide advertising. It is a waste of OUR money to have to pay for their advertising. It's a driver of the failing system.
Are you under the impression that if the pharmaceutical company saved money on advertising they would pass those savings onto the patient? Maybe, somehow I bet profits and bonuses would just be larger than normal.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Asystole RN said:
Are you under the impression that if the pharmaceutical company saved money on advertising they would pass those savings onto the patient? Maybe, somehow I bet profits and bonuses would just be larger than normal.
I don't think that's what she implied or said, at all.
Are you under the impression that if the pharmaceutical company saved money on advertising they would pass those savings onto the patient? Maybe, somehow I bet profits and bonuses would just be larger than normal.
No, no no, That's money that could go to patients without means to pay for the six figure tabs. I know that drug companies advertise that they supply such a service. Perhaps we need a new paradigm for drug production in the US. What we have isn't working if they have too much money and blow it on advertising rather than putting into the health care system they depend on for profits. Let the drug price negotiations begin!
No, no no, That's money that could go to patients without means to pay for the six figure tabs. I know that drug companies advertise that they supply such a service. Perhaps we need a new paradigm for drug production in the US. What we have isn't working if they have too much money and blow it on advertising rather than putting into the health care system they depend on for profits. Let the drug price negotiations begin!
I agree. I am a little torn on what the best policy is to control drug prices in the United States. In the UK the government regulates profits to be a max of just under 30% for a drug. This is problematic in controlling since most of the drug companies are multinationals, making auditing challenging. Like Australia, they also mandate prices be decreased over a period of time so that the older the drug the cheaper it becomes. The thing I think I like the best is that there is an assessment and negotiation regarding the clinical benefit of a medication. The more clinically beneficial the higher the price can be.
Currently in the U.S. there is no federal regulation on the price of medications. The primary pushback to regulating prices is that the less profitable a drug becomes, the less incentive there is to develop something new. Personally I think there should be a balance between incentivizing drug development and regulating prices.
toomuchbaloney
16,033 Posts
Marketing hospitals for niche care and fancy lobbies is a symptom of a capitalist health system. Same with pharmaceutical marketing.