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.