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Archive for January, 2011


Just a quick post.

Between the rashes and blood pressure med refills today, I think I saved a life.

One of the nurses grabbed me and said “I need you right now”, and took me into one of the exam rooms. The patient was sitting on the end of the exam table, crying, literally wringing her hands and then pulling her hair. It turns out she was so depressed after losing two family members to illness and having severe financial problems, she no longer wanted to live. She had a plan.

Her husband had brought her in because she was so distraught. He thought upping her antidepressant would do the trick. I could see in her eyes and body language that upping the med was not going to do the trick. She hadn’t told him about the plan.

After talking with her for a while, I convinced her to go into the hospital to be stabilized. She gave me a big hug and a little smile as they were taking her to the ambulance with the crisis worker. I hope she will be okay, but at least she won’t die today, hopefully she will be able to come out of it and be able to cope with her troubles. I’ll pray for her.

It was a good day.

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I consider myself a caring and nice person, after all I went into nursing for the usual reason, “to help people”. Many years were spent helping people, starting as a volunteer EMT with my local rural fire department, then on to diploma school to become a registered nurse. I chose the three- year diploma program over the four-year BSN, not to save time, but because I liked the hands-on curriculum. (I have worked with BSN-prepared RN’s who had never actually inserted a Foley catheter while in school). Ten years later I got my BSN, and now another ten years later, my Master’s. (Does this show a trend? Will I be working on my DNP when I am in my sixty’s?).

Most of my career was in home health, psych and hospice. It was tough but rewarding to help people with their chronic issues, wounds and all the stuff that goes with home health. It was even tougher and more rewarding to have the privilege of helping the dying and their families. And the psych patients could be difficult. It was so sad, their problems aren’t fixable, all we could do is try to control symptoms and help them and their families cope.

So, as I said, I consider myself a nice, understanding and compassionate person. So what do I mean about being of two minds, and why did I try to prove my niceness?

Well, I am finding that I don’t like some of what I am seeing in the Health Department clinic. This facility is there to help the “underserved”, those without insurance or money. And those on Medicaid. It is beginning to seem like it ought to be called Medifraud.

My experience of the place, which is of course limited to the last 4 weeks, shows that a large percentage of the people coming in are stealing resources from our community. That is a harsh thing to say, and I am sure I am going to get a s**t-storm of backlash, but I can only say what I see. Here are examples:

  • The family that arrives for their free appointment in a late-model BMW sedan
  • The young and able-bodied man who arrives in a uniform from a large company, wanting a  referral to a volunteer dentist for a bad tooth. He informed us that his wife got him and his whole family on Medicaid (“I don’t know how she managed it!”), and he wants to get as much out of it before his new health insurance from work starts in a few weeks. The tooth has been long neglected and is not an emergency. He would have a copay on his new insurance, you see.
  • The young woman who has beautifully manicured and pedicured nails, lots of gold jewelry and designer clothes who wants a prescription for loratadine (a cheap over the counter antihistamine) so that Medicaid will pay for it. She won’t buy it herself.
  • The woman who comes in for a follow-up after an emergency room visit last week for bronchitis. ER visit paid by Medicaid, of course. On getting her history, we discover she has asthma, uses her rescue inhaler four times a day, smokes a pack a day, and never “got around to” sending in the paper which the nurses here had helped her fill out to get her prescribed steroid inhaler for free from the pharmaceutical company’s assistance program. The cost of a stamp and the effort of putting the envelope in the mail was too much. The bronchitis was caused by her not controlling the asthma by taking all of her medications, and the smoking (at $5 a pack, $150 a month…).
  • I was cursed at for not refilling an antibiotic for bronchitis by another patient coming in for follow-up after an emergency room visit for bronchitis. His lungs were clear, he had a slight residual cough and we were about to write a script for an anti-tussive, when he became angry, beligerant and threatening to me and the rest of the staff. He knew he still had bronchitis and no stupid bitch was going to tell him he was fine and did not need more antibiotics…
  • A young person who was prescribed iron for anemia, came in for follow-up, was found to still be anemic, went through a battery of expensive tests, only to find out she never bothered to take the iron. She came in for the follow-up visit because she ran out of birth control pills and wanted her free supply.
  • The teen who was brought in by mom for a refill of her acne medicine prescribed by another doctor. The kid had mild-moderate acne, and the script was for benzoyl peroxide pads. The pharmacist had informed me the pads were rarely used anymore and cost well over a hundred dollars! She suggested simple OTC benzoyl peroxide wash instead, it costs a few dollars. Mom refused, “Medicaid pays for the pads”.

The attitude of entitlement and thoughtlessness about money (other people’s money, MY tax money) in a large portion of the people coming in the clinic is appalling to me. The reckless disregard for their own health, ignoring treatment plans and then expecting society to pay for the inevitable consequences is just unbelievable. The country is drowning in government debt and these people, who don’t take resposibility for themselves in any meaningful way that I can see, seem to think that they are owed everything.

I did see a few people who wanted to pay their own way. One patient needed surgery for a treatable cancer and only wanted us to help her find a hospital which would give her payment terms. She had already struck a bargain with the surgeon. I made a call and got her a hospital who would help her with that. She didn’t want “charity”, only the chance to do what was needed and what was right.

So, there you have it. I have changed from a nice caring person into an angry one. I really don’t think my original idea of helping those “poor, underserved people who have no access to healthcare” is my career choice anymore. I would much rather help those who are willing to take responsibility, and realize that everything costs money and someone has to pay. Those who don’t expect someone else to pay their way for them. People with self respect, not self esteem.

Sorry if I sound not-nice, but I am not expecting anything out of anyone that I don’t do myself, and I was not born rich. I started poor and I am still not wealthy by any means. I absolutely know what it means to be poor in money. But I have self respect, and I don’t steal from others.

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I have now spent four days clinical time at the health department. I like my new preceptor, she is patient and receptive to questions. I tend to ask a lot of questions…

I have seen a lot of patients and am finding that they seem to belong to three groups in general.

1. Those who have no insurance or are on Medicaid, and find that the health department primary care clinic is a reasonable option for basic health care needs. The amount billed is based on financial need on a scale ranging from full pay to free care. It is a pleasure to help them meet their health care needs, I know what it is like not to have insurance, so I can relate. These people are happy to get the care and tend to follow the treatment plan set up for them.

2. The walking train wrecks. These are people who wait until the latest possible moment to seek health care for a problem they have, or they wait until they have several problems, and try to pile them all into one visit. For example it might go something like this: I have had a runny nose and cough for three weeks and now it hurts to breathe, and I have this really big pimple on my butt that just keeps getting bigger, and I ran out of blood pressure medications 2 weeks ago and my back hurts really bad.

3. The yes, buts. These are people who come in very regularly claiming to feel lousy (and they most probably do feel lousy) and want you to fix them up, or maybe really not. This is what I mean…

Okay Mrs. Smith, I see you are here for your diabetes and blood pressure check. Did you bring your sugar readings log?

“I would’ve, but I forgot. They have been much better, in the low 100’s.

Mrs. Smith, that can’t be quite right, your A1c reading is 11.3  which is higher than last time. This reading indicates that your average blood sugar is in the high 200’s, not the 100’s.

Yes, but that was because of the holidays, it really has been lower most of the time.

I really need you to bring in your log next time, okay. Have you been following your diet?

Yes, but it is too hard to follow and I really like to eat, so I don’t always.

Are you walking 30 minutes at least three or four times a week? Remember how important it is to exercise?

Yes, but  a lot of days I forget, or it is too hot out.

You know it is very important to take your blood pressure medication every day as prescribed, are you taking your meds? Your blood pressure is quite high today.

Yes, but I don’t like the water pill. It makes me go to the bathroom too much, and I didn’t get my refills yet, so I ran out yesterday. Do you have any free samples? I just forget to take them sometimes.

Did you get the medication box we discussed that you can fill each week so you can remember to take your meds?

Yes, but I forget to fill it up. Oh, and my feet are swelling up really bad, can you do something about that? I am feeling so tired lately, and I gained 6 pounds last week. Is there a pill I can take to lose weight?

 

I swear, some people just like to complain, and if I hear “yes, but”  one more time, I may scream. Well, maybe not, but I’ll roll my eyes when they aren’t looking.


 

 

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So, the class opened today. I posted my self introduction, greeted old friends who posted their intro’s, set up a notebook with assignment due dates, syllabus, grading criteria, etc. I made a tentative schedule and got my preceptors’ okay before I posted it  to my instructor. The detritus from the previous term has been cleared from my desk. My books are all neatly lined up, pads of paper and a new batch of the fine point pens I like are laid out. The rolling suitcase I need to take my reference books with me to clinicals is ready. Since this clinical site will want me to wear the lab coat, I sewed the school patch onto the arm (somewhat straight) and clipped my nametag on the breast pocket. The stethoscope is in the big side pocket. Clinical time log papers are prepared and printed out for the first eight weeks.

I also got diverted in my study closet by drawing supplies, quilting stuff and other crafty goodies.

And the shelf on which I had loaded all my stuff (reports, notebooks, etc) from the previous term, collapsed spilling everything onto the floor. I managed to fix the shelf, but unfortunately it also held my stack of quilting magazines and craft books: embroidery, scrapbooking, sewing, etc. This delayed me quite a bit as well.    🙂

My neighbor stopped by with a batch of cookies, bless her 80 year old heart.

Now, I sit in my newly tidied study and look forward to this term. I am hoping that the patients in this one will sit still for exams and actually provide answers to my questions that are informative and accurate. Is that too much to expect? …Probably.

I’m pooped, it is time for a cup of tea and cookies.

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