Witchcraft Resurgence

CharleeFoxtrot, BSN, RN · Jan 29, 2020

11 hours ago, TriciaJ said:
Maybe it wasn't the best analogy. I think the point being made is that it is usually not one's place to disparage the beliefs of others, especially in healthcare. Yes, there are exceptions; we all know examples of dangerous behaviour based on beliefs held by tiny minorities of people.

Take the nursing education out of it. My McDs metaphor infers it is nunya business how someone else lives their lives. The metaphor isn't about nutrition, it's about being condescending about another person's choice that doesn't directly impact them.

Tacocat, ASN, RN · Jan 29, 2020

On 1/27/2020 at 7:18 PM, HelpfulNatureHopeful said:
Nah you wouldn’t catch me in MCDs. Can that “food” even be considered food? Maybe if people didn’t put garbage like that into their bodies they wouldn’t need medical OR “holistic” care. But they drank a Diet Coke, so it’s fine.

Don’t get me started on fast food. Along with smoking there should be a plan to work towards a complete ban. Bloomberg did a great job by limiting the soda sizes but we need more follow up.

But people are going to put whatever they want in their bodies and there's nothing you can do to stop them.

I was an addictions professional for many years, and one of the philosophies regarding substance use treatment is harm reduction. As in, we can give them support and tools they need to help them achieve sobriety, but if that isn't possible for them for whatever reason we can make it safer. We had kits with Narcan, clean syringes, cottons, ascorbic acid and sterile water for patients to take. And giving them clean works helps prevent HIV, Hep C and abscesses.

Some people thought it was encouraging drug use. But the reality was some of these people were going to use heroin no matter what, so if there was a way to help prevent the spread of infection and infectious diseases, why not?

You can educate to the best of your ability and provide support and resources and the bottom line is people are going to do what they're going to do. You can't force someone to change. And as a nurse or doctor, you won't necessarily understand WHY someone can't or won't change, just that they aren't changing.

And you need to accept that without making them feel stupid. A patient that should be making lifestyle changes won't go far with a condescending provider. They'll leave and never come back and you'll lose your opportunity to continue to educate and support them. And the patient will miss out on the continued education and support that might have eventually sunk in.

HelpfulNatureHopeful · Jan 30, 2020

Well if they don’t want to make changes, that’s fine. I wouldn’t want to waste either of our time. Give me patients that want to get better.

Editorial Team / Admin · Jan 30, 2020

3 minutes ago, HelpfulNatureHopeful said:
Give me patients that want to get better.

That is not going to be the vast majority of patients. They may want to get better, but they don't want to do the required changes and work.

HelpfulNatureHopeful · Jan 30, 2020

If you’re not willing to make the changes you must not want it bad enough.

Tacocat, ASN, RN · Jan 30, 2020

10 minutes ago, HelpfulNatureHopeful said:
If you’re not willing to make the changes you must not want it bad enough.

Here's a question for you, based on an actual case.

You're a surgeon. The patient is a 27 year old male admitted for infective endocarditis due to intravenous heroin use. He has three other admissions in the previous 24 months including a previous admission for endocarditis requiring surgical intervention.

He requires a valve replacement. This would be his second valve replacement.

Would you refuse to perform the procedure, knowing his long-term outcome without it would likely be poor? And are you comfortable looking at your patient and telling them that you will not to the surgery?

I'll be happy to tell you what happened to him but 'm interested in your take first.

HelpfulNatureHopeful · Jan 30, 2020

Ofcourse I would do the surgery. Why wouldn’t I? He needs it, I need to make a living, works out for everyone. What would be the downside to doing the surgery?

Tacocat, ASN, RN · Jan 30, 2020

1 minute ago, HelpfulNatureHopeful said:
Ofcourse I would do the surgery. Why wouldn’t I? He needs it, I need to make a living, works out for everyone. What would be the downside to doing the surgery?

Because he clearly hasn't changed his behavior if it's a readmission. He's going to keep doing drugs and getting infections.

Why the change of heart? Literally ten minutes ago you said you'd rather have patients that want to get better.

HelpfulNatureHopeful · Jan 30, 2020

Why would I decline to do a surgery that makes me a lot of money, that a patient also wants?

Think of it as being a mechanic, fixing someone’s car, who isn’t taking care of it. You’re going to fix the car because it’s your livelihood, but are you going to spend all day trying to convince them to not tear it up next time knowing they’re not listening? Physicians are already strapped for time. Another patient who would actually like help is not getting the help I could offer, because of someone wasting my time.

I’m saying I wouldn’t waste my breath trying to convince the patient over and over. I’d educate them, if they were receptive, I’d continue to educate. If not, I wouldn’t waste my time unless they came to me. Like they say you can lead a horse to water...

Tacocat, ASN, RN · Jan 30, 2020

If you want to know the outcome of the patient my little case study is based on: he received a second valve replacement. A year or two later, he required a third. He didn't get it and died 9 months later.

Tacocat, ASN, RN · Jan 30, 2020

2 minutes ago, HelpfulNatureHopeful said:
Why would I decline to do a surgery that makes me a lot of money

Until you realize that the reimbursement rates vary wildly between CMS/Medicaid and private insurance.

HelpfulNatureHopeful · Jan 30, 2020

What kind of quality of life did the patient have anyway? How long would he have lived had he gotten a 4th? A 5th?