What factors do you think have changed that has an impact on healthcare

[nursingsteph]

It is interesting to me how much has changed in nursing. What factors do you feel have changed or impacted the health care system?

[leslie :-D]

Whether you are the patient or the healthcare professional....it's what is best for the patient, not just a matter of cost!

JMHO

Maisy

i 'think' one of jolie's points, was that pts/consumers need to start exercising more responsible choices.

you just can't go through life eating crappy food, clicking on a remote, smoking/drinking, high stress levels, little sleep, and not have that catch up to you.

we DO have to start taking some responsibility...

and, should not expect the hcp to 'clean up this mess'.

i very much understand jolie's concerns of our entitled society.

not only do we make poor choices and expect instant cure, we also expect for others to pay for our messes.

am i talking about everyone?

hell no.

but a good chunk of our society operates on these premises.

and to be even more unrealistic, i've noticed that healthcare is becoming an assembly line of one stop shopping...

everything in our society caters to convenience.

with insurance companies/govt programs streamlining many services to day surgery or minimal hospital stays, everything seems to be headed towards a fast track of care, despite the complexity and chronicity of these medical problems.

there is not just 1 answer.

but it has to start with the right attitude.

consumers need to start looking at their own behaviors before casting the first stone.

and, before demanding a quality fix on a measly dime.

yes, we need to help those out who are truly needy.

as for the rest, we need to call them on their habits and lifestyles.

it's not only the healthcare administration, insurance industries and govt programs that need fixing.

that, i can promise you.

leslie

[MAISY, RN-ER, BSN, RN]

Leslie,

I get the personal responsibility point, however, how is your day as a nurse?

Are you stress free? Can you eat healthy meals? Do you have enough time to exercise?

I can honestly say "NO" to all of those questions. I work 4-13hour days, spend one day a week in school and have a family, house and life outside of work. I have to squeeze alot into my "FREE TIME"-that would also include sleep.

Now imagine all of the families where one or two parents work 1 or 2 jobs-the kids need homework help-they can't go outside and play- because no one is home. Dinner is fast all of the time. Lots of reasons for not being healthy. Money is tight-good food isn't cheap.

I have to be honest, the only attitude of entitlement I have gotten is from those who want customer service, not because of medical care. Personally, I don't think there is anything wrong with one-stop shopping. I am a nurse, and I can't get a damned doctor's appointment when I need one. So, my medical needs go unanswered, because everything becomes more important than me! Personally I'd like to go somewhere where my needs will be met! I can honestly say I don't like the attitudes of the doctors recently....the not my job, you need to see a specialist line is getting old....WHY WOULD I NEED THEM THEN? I no longer use a PMD because of this crap!

So for those of you who say cut your hours, take care of you....I'd like to, however, my debt ratio for three college educations is weighing both my husband and I down! I can't. I will also not quit school, as I see this as a necessary evil to get those LETTERS behind my NAME!

Habits are easily broken, a lifetime of poor food choices, lack of exercise, and whatever else is not addressed by our medical systems-they aren't habits... they are ingrained. OH BUT, counseling is not included as medical care...

Why is there so much judgement? God knows, sometimes I am judgemental, but I try to put myself into peoples shoes, alleviate their fears, and answer their questions honestly. Not much time for that in the ER, but I TRY.

If nurses can't be empathetic...then who will be? Surely, not the doctors...or the insurance companies. When we consider people as us and they.....where is the morality....a helping hand goes a long way with personal commitment, but first the education and the path need to paved.

Maisy

[Jolie, BSN]

You are right, let's forget the advancements we've had in medicine....if you can't pay....OH WELL!

Finally, if a medication works....then use it! There are many medications like Zofran that were expensive and finally came off of patent. It was the best med for the job....held back due to cost....so are you saying people should suffer if the right med is available? If so, that is not advocating. Whether you are the patient or the healthcare professional....it's what is best for the patient, not just a matter of cost!

Maisy,

I think you largely missed the point of my post.

I don't advocate abandoning the advancements we've made in medicine, but I do question the attitude that "newest and more" is better, and that everyone needs "newest and more", when other safe and effective alternatives have not yet been tried.

For example, how many people do you see in the ER with minor complaints (N+V, fever, rash, sore throat, etc.) of less than 24 hours duration that they have not attempted to treat at home? How many parents tell you that they are there because they need to (fill in the blank) go back to work, send the child to daycare or school, get on a plane for a trip, etc.? Their presence in the ER has nothing to do with serious illness and everything to do with wanting a quick fix, regardless of the cost. How irresponsible that it costs hundreds of dollars in ER charges for them to learn that no quick fix exists.

Another example: I have had migraines for over 20 years. The very first Rx I took 20+ years ago is the only one that has ever been effective for me. It is generic, cheap and effective. About 10 years ago, we moved and I had to change doctors. I requested that my new doc refill my Rx. and she declined to do so, insisting that I try a new type of migraine drug that was very expensive. I didn't want to, but she insisted. I went thru 3 different drugs in that class, suffering from miserable, unrelieved headaches before she finally relented and refilled my old, cheap Rx. I asked her what her reasoning was, and she could not offer a good explanation other than it was the newest, latest, and greatest, not to mention most expensive drug on the market.

Another example: A good friend recently started on B/P medication. His doc chose an expensive, new drug that is essentially a combination of 2 older, generic meds. He had been on it for a few months and was concerned with some minor side effects that his doc wanted him to "tough out". He went last month to refill the Rx. and was told by the pharmacy that the drug was temporarily unavailable. They called his doc's office which OK'd a temporary switch to the generic form of the 2 drugs. The generics cost a fraction of the original prescription, and he's not had the side effects.

I realize that there are advancements in healthcare that have improved patients' quality of life, and Zofran is an excellent example of that. I don't advocate cutting corners that impact on quality of care and quality of life. But neither do I advocate the biggest, best, newest and most simply for the sake of novelty when it offers no improvement to the patient.

[RNsRWe, ASN, RN]

It is interesting to me how much has changed in nursing. What factors do you feel have changed or impacted the health care system?

By any chance, are we providing you with your research and sources for a school paper? Your question, the first one out of the box, sounds alot like a question one of my instructors posed some years ago...

[mshultz]

On a positive note, look at the EMS system. When I was growing up, they used Cadillac ambulances, and the attendants had little training. My city upgraded to all paramedics some years ago.

I live in a township with a volunteer fire / ems service. When they picked me up in 2003, there were 3 paramedics and 1 EMT-B.

Although we have no trauma centers in my county, they are available in the larger cities now. This is another advance within my lifetime.

[rita359]

I think the biggest factor that has changed healthcare is insurance. First it was "I can have that done and stay in the hospital because I have insurance". It has become how can I have it done and have insurance cover it. The second major factor is medical advances that keep sicker and sicker patients alive.

[mshultz]

Here is another positive. I just got a brochure in the mail from the local hospital. They are trying to seek certification as a Primary Stroke Center. 20 years ago when I did my EMT-A training time in the ED of this hospital, a patient was brought in. The family was told the patient had a stroke, and to take him back home.

[lpnflorida]

I see the PPS ( the prospective pay system) along with insurances dictating patient care as one of the biggest changes I have seen over 30 years. Next has been higher patient accuity with shorter hospital stays.