Another reason I think they hate medicine/doctors/nurses....

[Heddi]

Hallo everyone!

So as you know I am a much-hated RN because by proxy of my education, training, and job I am automatically a shill for the pharmaceutical industry, that I get perks when someone is sick or dies, and I get a penny for every pill I put down someone's throat (according to the health lounge, at least). I obviously don't care one whit for my patients or their wellbeing, and that's why I work 12 hour nights (currently days) with 2 pee breaks on a good day and a lunch that is inhaled in less than 5 minutes. That's why I spend at least 60% of my time going over medications in relation to their disease or illness and make sure that I shouldn't call the doctor to reccomend something different. That's why I do vital signs on the most stable of patients every 4 hours and do a complete head-to-toe assessment every 4 hours to notice any differences in strength, neurological status, or heart and lung function. That's why I constantly check intake and output to ensure that a patient isn't dehydrated or overhydrated. That's why on admit, discharge, and every moment in between, I'm doing extensive teaching on diagnosis, treatment, co-mobidities, and outcomes as well as diet, exercise, smoking cessation and other lifestyle modification behaviours that can increase lifespan and decrease disease, disease process, illness, and recurrence.

Because I just.don't.fucking.care :eyes:

Anyway--there have been many suggestions by myself and others as to why "they" hate "us" and medicine and doctors and conventional treatment. Why do they distrust us because of the ill actions of a few---and it is a few. I work with ~150 or so doctors and residents, around 300 nurses, and a boatload of pharmacists, physical therapists, nutritionists, social service workers, wound care nurses, diabetic educators.....and we're all loathed and distrusted by "them".

But I think I have another piece to add to the puzzle:

They want a cure, and medicine can rarely "cure" anything.

Ex:

Last week I had a patient who was admitted for COPD exascerbation, CHF exascerbation, and emphysema.

COPD, for those of you who don't know, is a chronic lung condition called Chronic Obstructive Pulmonary Disease, like emphysema. Emphysema is actually part of COPD (along with chronic bronchitis and a few other chronic lung conditions). Generally it occurs in smokers and former smokers, but also in people who have had exposure to inhaled chemicals in the workplace, or through smoke inhalation, etc.

CHF is Congestive Heart Failure. It, too, is generally a chronic condition brought on by a number of things--decreased lung compliance (COPD, emphysema) and increased workload on the heart (fluid overload, high salt diet, medication non-compliance).

When the patient came in, they were unable to maintain oxygen saturization of more than 60% on room air---for reg people we want greater than 92%...if they're CO2 retainers with COPD, we want 88-90% generally. 60% is horrible no matter what.

CHF had also caused this patient to not breathe effectively because of the inability of the heart to pump blood to the lungs for oxygenation. The lack of good pumping power in the heart lead to fluid backup in the lungs, so the little lung compliance and function that was there was decreased by fluid in the lung space.

We got the patient settled in and got them started on a Furosemide (lasix) drip---lasix is a diuretic and pulls water out of the body via urination. That provided immediate relief and within 10 minutes of getting an 80ml Lasix bolus the patient had put out nearly 3000 cc's (3/4 of a liter) of urine. ANd it kept flowing all night.

We got the patient on albuterol nebulizers, a bipap for breathing, and steriods to decrease inflammation.

Within 4 hours of being admitted, the patient's lungs sounded much better than when they came in, there wasn't crackles (fluid) in the lungs up to the clavicle, and the patient wasn't hypoxic (low on oxygen in the blood).

We continued this course for a few days, each day seeing more and more progress in the patient's condition. By day 2, they were off of the bi-pap and able to breathe independently. By day 3 they were off of the lasix drip and able to control fluid retention via oral medications.

By day 4, it was time for discharge with a whole slew of medications and follow-up treatments to keep this situation from re-occuring. Alot of teaching was necessary for this patient. As the days had gone by and I had cared for this person, I stressed the importance of a low-salt diet to keep water retention at a low. I stressed the importance of smoking cessation to prevent further pulmonary distress. We spoke about healthy lifestyle and exercise, and how even losing 10 lbs would have a great effect on the ability of the heart to pump adequately, and the more weight that was lost, the easier it would be for the heart to get the bloood where it needed to go in a timely manner, without pooling in one area or another.

We spoke about these things in length. THe diabetic educator spoke to the patient about how steroids---IV (like in the hospital) and PO (like at home) can cause precipitious rise in blood sugar, and that while the patient didn't have "True" diabetes (in the sense that they're caused by medication and would go away once the steroid were done), the need for glycemic control was there, and the damage that high blood sugar can cause on the microvasculature in the toes, feet, legs, hands, fingers, kidneys, and eyes.

We sent the patient home on inhalers, diuretics, heart medication, insulin, and blood pressure medication. We spent about 4 hours each day on education with an additional 3 hours on the day of discharge. Questions were asked and answered numerous times.


As the patient was preparing for discharge, they asked me "Why am I going home now? I'm not cured"

I told the patient there was no "cure" for lung disease. There was no "cure" for heart failure. These were the byproduct of poor life decisions and that management and treatment were the key at this point.

them "But You're supposed to cure me. To fix me. That's what Doctors and nurses do. You fix people'

me "I can't fix you. I can't fix a 2 pack-per day for 40 year smoking history. I can't fix 50 years of poor diet. I can't fix the fact that you didn't comply with your medications you were given a year ago. I can't fix that. I can do my best to make it better, and to give you medications that will hopefully prevent it from getting this bad in the future. But that's up to you.

"You know, we've spent alot of time talking over the last few days. And not just me and you. There've been alot of educators in here to see you because we care about your health and don't want to see people come into the hospital. HOnestly. I would love it if I were out of a job because there just weren't any sick people around. But there are. And I do my best to make you better. But I can't cure you, and I can't really fix your problems. Any doctor who says they can is one that I, personally, would stay away from because your problems aren't curable, and they're not fixable in any permanent way. They are, however, managable, and if you take your medications and follow a sensible eating and excersize plan and cut down (notice I didn't say STOP) on your smoking, there's no reason that your lung and heart problems can't be managed."

them "But you're supposed to cure me. THat's what the medicines do. They cure people. Doctors cure people. Why are you sending me home before I'm cured"

---
and around and around it went. This person could not understand that contrary to popular fiction of the time, most chronic conditions cannot be cured. I don't care what the ads say, what the magazine articles say, what the late-night infomercial say, THERE IS NO CURE for most of the things that cause people to be hospitalized.

And I think thats why we are hated. Because we don't say that WE CAN CURE CANCER. But that quack chropractor on the corner says it. And Alternative Health Magazine heavily implies that a diet high in blueberries and oxen oil will. And the ads in the back of alternative health magazine practically outright state that their Ancient Chinese Secret of 23 Secret Herbs and Spices will cure you of Cancer, HIV, Chronic Diarrhea, and Internal Hemorhoids.

But because we don't say it, and we generally don't imply it unless it's a possibility, we're hated. we're shills. we're frauds. we're out for profit.

**WE** dont' cure it because there is no PROFIT in cure, they say. HAH! I swear to god this gets me the most. If there were cures for cancer, and diabetes, and heart disease I KNOW there would be a profit because every hospital in the country could cut staff to 10%. There would be no nursing shortage. Nursing wages would drop. Doctors would be out of work. Pharmacists would be out of work. To suggest that there is no profit in cure is to completely misunderstand the sheer numbers and costs of treatment.

---
Sorry for the long ass rant. I've had many doozy patients this week and nearly all of them have had me leave the building screaming. I promise to be more concise next time

:)

Love,

hed

[TZ]

1. You've got it exactly right

When you have nutters who claim that chronic conditions like Lupus, MS, autism and others can be simply cured by yanking out DENTAL filling of course people think that if doctors aren't curing everything its cause its not monetarily in their interst to do so!
Have you noticed that woos expect all doctors to be perfect and not make any mistakes but if any woos make a bad decisiion its always well thats just a bad egg.....
I also am tired of the western medicine doesn't treat the root causes meme, just the symptoms. AAGH! What the hell is dietary advice if not trying to help with the root causes.
Sometimes I am very glad I do my work in a lab on samples and I don't have to deal with the patients directly.
Between your stories, Warpy's stories, and chicagomd's stories, I wonder how you all deal with it sometimes!!
:hi:

[Heddi]

3. Denial is very powerful

and I think that one of the roots of Wooism is denial of personal responsibility with regards to illness.

People do not want to admit that a sedentary lifestyle, a smoking lifestyle, a heavy drinking lifestyle, a medication non-compliance lifestyle, a poor diet lifestyle will and does have detrimental effect on overall health and lifespan. They want to blame something else. Why, my lung cancer didn't come from smoking---it had to have come from some chemical in my sofa cushion!!! I have no blame in my ill health because of government conspiracies regarding indoor air pollution, or because of some poorly designed drug, or because of something else BUT NEVER BECAUSE OF POOR DECISIONS I MADE THROUGHOUT MY LIFE.

Quackery, though, removes all personal responsibility. Do you have X disease? Why, it's not because of all those bad choices you made. It's because of something that you had no control over. Can't be cured of an incurable disease? It's because THEY don't want YOU to be cured. But *I* have the secret and it will be yours for only $100,000 and no guarantee of safety or efficacy. If you use my product and aren't cured, it's because YOU were doing it wrong.

That's the only responsibility a woo has. If Wooism doesn't work for you, it's because you're not properly woo'ed. You still don't have any blame for morbid obesity, or heart or pulmonary problems, we've already established that. But you are to blame if your iron chelation goes wrong, or your ethyl alcohol enema causes alcohol poisioning. THAT's your fault. THAT is the only time you, the one undertaken by woo, is to blame.

And re: Obesity.---just as a quick (ha!) side

So often I hear that obesity IS NOT CAUSED BY OVEREATING AND THAT THE MAJORITY OF PEOPLE WHO ARE OBESE HAVE ENDOCRINE PROBLEMS.

well, partly true. Endocrine imbalances DO cause obesity, or at least weight gain.

However, I have to say that I have never, ever, ever ever treated someone who was morbidly obese that had an indocrine disorder. They have an eating disorder. Their endocrine function is perfectly fine, and we see this again and again with lab after lab test. I'm not saying that it is non-occuring, and while not morbidly obese, I am about 50lbs above *MY* ideal body weight.

But my obesity is not due to adrenal this or thyroid that. It is because I enjoy food too much and enjoy exercise too little. I consume far more than I burn and that is why I weigh 50lbs above my ideal body weight. And that is why *ALL* of the patients I have cared for are above their ideal body weight. There has not been one obese patient that I, as an RN, as a student RN for 2 years, cared for that was obese due to medication or pathophysiologic reasons.

Again, it's a denial of reality. I can't possibly be obese because I consume 20,000 calories a day, or because my only exercise consists of walking to the car, walking out of the car to Target (always looking for the closest parking space), and walking out of the car back to my house. oh no! It's because my thyroid is wonky (even though tests show a perfectly functioning thyroid), or because my adrenals aren't adrenalizing. Nope. It's a conspiracy. "THEY" want us to be fat. THEY want us to be ill they they they.

---
It is hard to deal with the root problem when the patient is in complete denial of the root of the problem. Thank God for Chantix because it really makes it so much easier for people to stop quitting. And the report of side effects is so little by patients that I have cared for who have been on chantix for months and who quit smoking after their first week. No delirum, no more bad dreams than normal, no excessive drooling or whatever other scare tactics are dredged up. Finally, a freedom from their nicotine addiction. They don't even THINK about smoking. Being around smokers isn't a trigger. They have just added a minimum of 10 years to their life and they are HAPPY about it. And I am happy for them (I am in no way compensated by Chantix or their makers or anyone who profits from Chantix by making these statements. I am not saying that Chantix is right for everyone. I am not giving medical advice)

It is hard to deal with root problems when people are unwilling to make lifestyle choices, like diet, that will directly impact their health and wellbeing. My community has a large hispanic and native american population, and culturally, their diet generally consists of food prepared with lard, fatty meats, and salt. Patients may be willing to make low fat, low salt choices for themselves, but when their cultural identity with regards to diet includes lard, salt, and fat, and that's what the rest of the family expects for food, it's hard to have people make those choices.

Diet isn't just for the patient. The entire family has to make the change in order for it to be effective. But families aren't willing to make those changes, or sacrifices, because THEY aren't sick (yet). They don't have diabetes (yet). They don't have heart disease (yet). They don't have morbid obesity (yet). So they, in effect, condemn the patient to a lifetime of ill health because they are unwilling to modify recipes and diets to include low fat, low salt, low sugar options.

[cosmik debris]

2. I wonder if it would help

If people like that were treated the same way they treat potential liver transplant patients who continue to drink? They get hospice treatment and that's all.

If doctors and hospital administrators could just say "We can't waste our valuable time and resources on people who have chosen not to cooperate. We are referring you to hospice."

I wonder if that would have any impact?

[Heddi]

4. I am a socialist, and I believe in socalized medicine

but I have a personal ethical dilemma when it comes to repeatedly treating people who refuse to make any modification to lifestyle.

Ex:

There are patients that we call "Frequent flyers" because they're in the hospital more frequently than I am as an employee.

One lady has chronic kidney failure and must get dialysis 3 times a week if she wants to live.

But she doesn't like dialysis. I can't blame her for that. I wouldn't like it either.

SO she goes 4 or 5 days without dialysis, gets into pulmonary edema (fluid on the lungs), can't breathe, and gets admitted to the hospital where she undergoes emergent dialysis and gets breathing treatment and bipap and all these expensive things that she will never pay for (I don't really have a problem with that). And then 4 days later she goes home with explicit instructions to her and her family about the importance of being dialysed regularly, and she says "yes yes yes" and the family says "yes yes yes" and then a week later she's back in for the same thing. And a week later for the same thing. and a week later for the same thing.

I can count of AT LEAST 50 times this woman has been my patient. ANd that's not counting the times that she's been admitted when I'm off work or in another unit or working as charge nurse.

There's a gentleman who is a chronic smoker with chronic lung and heart problems. He refuses to take his medications at home and every 4 days (I swear I'm not exaggerating) he comes to the hospital with chest pain and difficulty breathing. ANd he's admitted. And he leaves AMA (against medical advice) within 24 hours.

Between October 2007 and December 2007 he was admitted to the hospital TWENTY FUCKING TIMES and each time he left as soon as he got a breathing treatment and a diuretic and dinner. Just up and out of his room. Then two days later he comes back.

And not being able to afford medication is not an issue. He is one of several chronic patients that our hospital provides ALL Medication to free of charge. No copay No nothing. He just has to come to the hospital ONCE EVERY THREE MONTHS!!! to get his prescriptions. They are ALL free of charge.

So he gets his meds but refuses to take them. Then he comes in every 4 days or so and gets admitted, leaves, gets admitted, leaves, lather, rinse, repeat.

Lately, they've been keeping him in the ER for his regular 12 hour stay rather than admitting him because they know he's going to leave.

I don't know what else can be done for these, and the dozens of other "frequent flyers" who refuse to do simple things on their part and rely on me and my staff to do it for them.

The lady on dialysis was given free transportation by teh county to get to her treatments. THey would pick her up, BUY HER LUNCH< and take her back home every day that she had dialysis. But no, she just doesn't feel like going.

---

I don't know what the answer is. The realist in me says that some limit has to be placed on those who refuse---as in the case of these two--to manage their own health when they are perfectly able to mentally and financially. Why do we continue to admit these people to very expensive, heart-and-lung monitored beds with very highly trained RN's when there are REALLY sick people who REALLY want to change their lives and get better that have to be diverted to another hospital, or who hve to sit in the ER for 16 hours while we wait for a bed to open up because fools like these are hogging the beds from those who truly need them?

But the humanist in me says that we should treat everyone regardless of how non-compliant they are, and regardless of how we are basically one step away from putting the fucking pill in their mouth every day and forcing them to swallow it. Realistically, though, there are not enough hospital beds for the people who are truly sick and truly willing to make a change. There are not enough RN's and LPN's to care for them. There is not enough expendature to pay for those who cannot pay. Because of this, something has to be done, and I fear that rationing care to those who are not "frequent flyers" due to their own non-compliance may be the way it has to go. I think it's cruel, but then again, I think it's cruel that people who need my care can't get it because people who don't really care one way or another are getting it instead.

[cosmik debris]

5. Of course you are right, it is a serious dilemma.

But I still think you should bring up the subject of hospice every time you see them.

[Heddi]

6. The limitation to hospice

is that in order to qualify for hospice, the patient has to have a life expectancy of 6 months or less. Of course, if they live past 6 months it doesn't mean they're off hospice, they just have to be re-evaluated by their MD and given 6 month life expectancy. My aunt had ovarian cancer and was on hospice for about a year and a half, but that was very unexpected and no one really expected her to live 3 weeks when they discovered the cancer had spread to the brain and bone and lymph. But she kept trucking along and I think partly because of the relief that hospice gave her--finally, adequate pain control!

But I do think that people should be given truthful realization of things. If you keep drinking you WILL die. You WILL NOT get treatment or a liver transplant, etc.

When I was a student I met a guy at dialysis and I asked him if he was a candidate for a kidney transplant and he said he would be if he ever stopped eating potatoes and onions (potatoes are bad for those with kidney disease). So I said "POtatoes are more important than a kidney?" and he said plainly "Yep, I love my fried 'taters and ongyons and I figgerd I quit smokin and drinkn and i wadn't about to give up the last thing in life i enjoyed". Can't fault him for that, and he was willing to go through a lifetime of thrice-weekly dialysis because of his choice.

There was alot of uproar about the UK not giving orthapedic replacement (hip, knee) to those who were obese. THAT I agree with. The joints of the morbidly obese are under enough strain as it is, add to that surgery (where risk of complications with anesthesia are greater in the obse), post-surgical complications (which are increased in the obese) and the following therapy (which is much harder on a new joint that has to be able to bear full weight, much less the new joint of someone who is morbidly obese).

Why do surgery on someone that is doomed to fail? TO make the patient more incapacatated? To make their lives more miserable? It's unfair to the patient, and unfair to those who will then have to spend years and years rehabilitating the patient for a procedure that should take no more than 2 months rehab at most.

[TZ]

7. OOh people like that PISS ME OFF

Especially because of this crap I have to deal with:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=105x7473806
:grr: :grr: :grr:

[Warpy]

8. That final decision is the patient's, not ours.

Our job is to do the teaching so that they know what they need to do to stay out of the hospital. However, few people are actually willing to do all the things they need to do to stay medically stable, so they become frequent flyers. Our job isn't to force them into something they don't want to do. Our job is to buy them a little more good time to spend at home with their families, living their lives.

That's the way I've always looked at it, from hopeless cancers through the HIV nightmare in the late 80s to the chronically stubborn who won't stop smoking and eating a diet based on lard and salt. They're all equivalent illnesses to me, and if I can make them comfortable and send them home alive for some more good time, I've done my job.

What we're doing with the teaching is giving them a choice between arriving at the hospital as nearly dead meat every couple of months or going as much as a year between hospitalizations. It should come as no major surprise that people want to live their lives the way they always have before and that they expect these magic pills to cure them.

All we can do is tell them the truth. If they refuse to believe it, just wave goodbye and say you'll see them in a couple of months.

[mr blur]

9. Well, coming from the other side of the bed (so to speak)

I love doctors! And nurses. I know they can't cure MS, but if a cure comes it will come from scientists and not from whackjobs and halfwits.

And I had a heart attack a couple of ears ago; I asked the Consultant, "Any idea what caused it?" and he said, "Did you smoke?" and I said, "Yes" and he said, "Well, that would probably be it!" Well, there you go - if I'd died, whose fault would it have been?

Doctors and nurses saved my life and keep me free from most of the worst symptoms of the MS. And because we have socialised medicine here it doesn't cost me a penny now that I need it. Of course, I could always take out a bank loan and have my karma cleansed but I don't think it would help much.

Of course, I no longer smoke - how stupid would I feel going to see the doctor smelling of cigarette smoke?

[Deep13]

10. They forget that medicine is not magic.

The things that work do so because they have been developed and tested. In 100 years, what medicine does now will be seen as primative and barbaric. On the other hand, it is seemingly miraculous compared to what it was 100 years ago. Even then, however, there were some impressive improvements over the previous century.

[trotsky]

11. Heddi, you nailed it once again.

I absolutely love your contributions to DU. Don't ever feel bad for going on a "long ass rant" because this was half as long yet contained 100 times the valuable and accurate information as most of the crap in the Health dungeon.

They want the quick fix. They don't want to admit that maybe sometimes their problems are the result of their bad decisions. It's always somebody (or something) else's fault. Give me a pill, doc, and let me go back to smoking and eating cheeseburgers with chili cheese fries.