I am in my clinicals and I had this very interesting patient for a few days and he told me some stuff that i'm not sure if I should tell anyone but he claimed he does not take his medicine or insulin purposely which makes his diabetes go into DKA so he can have a stay in the hospital because he enjoys being here and loves the treatment and food. He is not a frequent flyer as this is his first time here
I know patients have a right to refuse medicine but is this something i should bring to anyone's attention.
Honestly, who wants to be in a hospital bed for days on end watching peoples court and hearing beeping sounds and have cords all over
He said he wants to make his glucose go over 1000 to see what happens. He says he is just curious
It sucks, but you won't either. The only way I've found to keep my temper with such people is to disinvest and kiss it up to God. Sometimes, when I'm really feeling evil, I fantasize about how shocked they'll be when they wake up dead. Miscalculating and overshooting the mark is the downside of being a professional patient.
Sometimes all all you can do is try to minimize the time-suck and avoid malpractice.
Specializes in Pediatrics, Women's Health, Education.
I'm curious how old the patient is, is this adult or pedi side? Most importantly, don't judge the patient. We don't know what is going on in a person's life that makes them do things that don't agree with our value system. Our job is to help them, keep them informed, and keep on trying if they're non-adherent. They might not listen this time, but they might on the 100th try. I work with diabetic patients teaching them self-management skills and I see my share of return visitors. Sometimes they just don't get it, some of the teenagers think they're invincible and simply cannot absorb the fact that they are at risk for long-term sequelae (similar to people who start smoking), and sometimes things are so bad at home that the hospital is a refuge for them. They may lack food, love, or other resources. I had a patient who felt so hopeless he stopped testing and stopped his meds, even though his mother lost a leg and his grandma went blind from diabetes. He was convinced it was inevitable for him too. It was very sad. And he said he felt better when his sugars were high, some patients get acclimated to how it feels to be hyperglycemic and normal levels make them feel weird.
And for the uninsured, it's cheaper for them to go to the hospital and not pay the bill than to try to buy insulin and glucose test strips as outpatients.
As a student, all you can do is tell the nurse and your instructor. But if you were licensed, you would tell the MD/NP and anticipate a psych consult like previous posters have said.
I've had more than a few patients divulge that they are happier being in the hospital than dealing with their illnesses in the outpatient setting. And a crappy life--self-inflicted or not--is more pleasant when you're being waited on.
Sadly, the hospital experience is as special as some of these folks will ever feel in their entire life.
They are usually patients that have zero financial resources or liabilities.
If i'm not mistaken, hospitals bill $1000 for a tooth brush?
You are mistaken. Where did you get this from? Also, the amount the hospital bills is rarely the amount the hospital is reimbursed from the insurance company. Especially Medicaid.
As far as to the question in your OP, Psych consult.
I see this a lot, never been told straight up that they want to see how high the sugars can get though. Lots of malingering in the hospital system for one reason or another. I like the response from a prior poster regarding how being in the hospital is a lot better than their home life. I've seen an influx of homeless patients come in with uncontrolled whatever they have when it gets over 100 or below 30. They are hot/freezing and miserable being outside and let their disease process get out of hand at convenient times.
And when their disability or whatever other checks run out, they come to the Psych ER and c/o being suicidal.
When it's close to the next check arriving, they're all better and want to be released.
While I do feel sorry for them, I wonder sometimes why the doctors keep going along with this. I guess no one wants to gamble with suicidals, no one wants to spend time going to court to testify, but why not send them to Rehab instead of back to the street when they want to be discharged?
Honestly, probably nothing. Once you graduate you may understand this better. I doubt even Florence Nightingale herself could do much to change this.
Perhaps losing a limb, a couple fingers or toes, his eyesight, renal disease, or DKA with coma may change his curiosity and bring him around to a more compliant way of thinking.
I agree with the other posters on this thread that a psych consult is probably in order.
Pass the info on to your clinical instructor, and the nurse you are working with who's team the pt is on before this guy makes a mess of himself.
No offense, but there are numerous people who are sick due to no fault of their own, and are compliant with their medical advice too. I bet they'd love the chance to feel better if they could. It's really too bad there is no such thing as "scared straight" for patients with chronic health conditions. It just may save this guy's life.
I had a patient once who was a frequent flyer, she was a young girl with a heart defect who was constantly being admitted with her PT/INR totally out of whack. It was pretty much determined that she was deliberately either not taking her Coumadin, or over taking it, so that she could go into the hospital and have lots of attention.
Having been the product of what from all outside appearances was a "normal middle class home life" but was really a pit of despair in a private, abusive hell all my own at the hands of an alcohol-indulgent (but not alcoholic) stepfather, I can tell you (not you specifically, just an overall general "you") that you don't have to be homeless, destitute, without financial resources, or chronically ill, to find being in the hospital far away from everything and everyone you fear and despise more appealing than not.
I was not a chronic whiner, and made myself quite educated regarding the functions and malfunctions of the human body at a much earlier age than my peers. Being an already precocious child to begin with didn't hurt either, when discovered reading medically-related books and articles, or having already professed a deep, abiding interest in becoming a nurse after high school.
But, sometimes events, or even just the anticipation of circumstances which would make certain events more likely to occur, would be enough to push me over the edge and I would suddenly and mysteriously become acutely ill, requiring a visit to the Emergency Room, and frequently an admission for "further testing and follow-up." (Back in the days before insurance companies began practicing medicine.) Of course, these events never occurred during regular doctor's office hours, or other more convenient times for treatment. I learned early on that timing was everything. It even got to the point during one rather protracted admission, where I was presented with the probability of an exploratory laparotomy (in the late 60's and early 70's, MRIs and CT scans had yet to be invented) and in my panicked state of mind, I almost accepted that as another way to extend my stay far away from the things I hated, and remain under the care of those lovely Angels in White, who made me feel so safe. But, I think that was just a test of my resolve and my psychological well being, because I suddenly made a miraculous recovery, and went back home again without any surgeries or scars.
Still, nobody knew why I did what I did, or what was causing all these mysterious episodes of acute ill health which seemed to vanish as quickly as they came. And nobody asked. The whole situation went on for a good five years, before I had a minor nervous breakdown in my Sophomore biology class one morning, and I ended up in the guidance counselor's office in hysterics and tears, following another confrontation that morning. It was after my mother had left for work, my three much younger siblings had departed for grade school or the baby sitter, and I was left to finish getting ready for high school, with the stepfather still in the house.
Fortunately, I had at least the presence of mind to put the hot steam iron I was using on a blouse between me and his advances, and I left very soon afterwards, even though the bus wasn't due for another 25 minutes. I spent that time walking to a more distant bus stop to finish waiting. When the "spit hit the spam" so to speak, things really went all to hell, but at least I was believed, and he was removed from the house forthwith, while I spent the following several days with a favorite aunt, uncle, and cousins, WAY across town and out of anybody's reach. And they didn't ask why, or even want to know anything. I needed them, and that was good enough for them, and I was welcome as long as I wanted to stay.
But, that was many years ago, and many things have changed since then. Some for the better - me - and others for the worse - him. But I won't belabor the point any further. Just to give another perspective to the storyline. You don't have to be living on the streets, or an addict in search of more meds, or chronically ill with even a real "disease," to be seeking out shelter from your own personal storm.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I won't belabor the point any further. Just to give another perspective to the storyline. You don't have to be living on the streets, or an addict in search of more meds, or chronically ill with even a real "disease," to be seeking out shelter from your own personal storm.
A close friend of mine explained what I had always wondered about: Why are ERs so busy with minor, non-emergent complaints at 2am on Friday and Saturday nights? Because that's when the bars close and the man of the house comes home all likkered up and looking for a punching bag. Suddenly that ear infection that Junior has had for weeks becomes an urgent matter to a mother looking to take herself and her kids out of the danger zone until he passes out.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think he is mentally ill, no joke. He craves and enjoys the "attention" being in the hospital gets him. I have come across people like this in my days working the hospital. Frustrating and challenging, but at the end of the day, all I could do was teach, emphasize, and reinforce. And then let it go and go home, glad I am healthy.
heron, ASN, RN
4,638 Posts
It sucks, but you won't either. The only way I've found to keep my temper with such people is to disinvest and kiss it up to God. Sometimes, when I'm really feeling evil, I fantasize about how shocked they'll be when they wake up dead. Miscalculating and overshooting the mark is the downside of being a professional patient.
Sometimes all all you can do is try to minimize the time-suck and avoid malpractice.