posted July 06, 2013 10:20 PM            

Disclaimer, this is a hypothetical situation, no real individuals mentioned, just a complation…and a terrible example of American healthcare….

Doc: ( a brand new lady doc, Muslim, covered in her colorful shroud) says what is going on with this patient…it is unclear to me….

Nurse: she is a heroin and crack junkie and a prostitute who got bacterial endocarditic from dirty needles…she had a valve replacement last year and ruined her heart again.

Doc; Well we are going about this all wrong…we need to get her extubated and send her to inpatient rehab so she can get her heart fixed and be clean!

Nurse: she is not coming off the vent, she is going into ARDS. (adult respiratory distress syndrome)

Doc: no we need to do this.

Nurse: she is not funded, medicaide has refused her so far, no inpatient rehab will take her….besides that she will not check herself in!

Doc: well then we need to get her to AA (you mean NA ******* )

Doc: does she have any fresh track marks.

Nurse: look at her arms and her breasts!

Doc: in attempting to educate a way smarter nurse than the cloaked doc is points to the scars…these are old, they are scars, see these scabs, these are fresh (HUH?)

Nurse: she has been inpatient for 2 weeks….NOT fresh tracks.

Doc goes on to tell nurse about how she saved a family dynamic, in another situation...

Nurse: well this aint my first rodeo, professionally and personally and her mother is a user too…family dynamics and family support?

Doc: well lets get her extubated to start….

Doc looks at her feet and legs (no track marks here!)

Nurse sarcastically: well she is a hooker and a junkie, and she has really pretty feet, suppose she wanted to look somewhat good for her “clients.”

Nurse: (grinding teeth by now, makes an excuse and walks out, tells another nurse she is going outside for a break……)

posted July 09, 2013 05:46 AM            

PS

That was a flippant remark. On a more serious note, doctors are doctors because they took the time and made the effort to qualify. Nurses have a great of practical experience but it is not really a substitute for the doctor's knowledge.

posted July 09, 2013 09:54 AM            

quote:

---

Originally posted by luisbunuel:
You seem to know a great deal about drug addicts!

PS

That was a flippant remark. On a more serious note, doctors are doctors because they took the time and made the effort to qualify. Nurses have a great of practical experience but it is not really a substitute for the doctor's knowledge.

Your post seemed to imply that the doctor ought to listen to the nurse, and I'm not going to dwell on the reference you made to her religion and ethnicity.

---

No, acutually the doctor, a brand spanking new baby doctor had no idea what she was doing.

And guess what? Good docs do listen to nurses, we are with the patients 12 hours a day, they, perhaps 60 minutes.

In the US the amount of American trained doctors is small, and dwindling.

It is too expensive to obtain an MD in the US, so physicians from all over the world come here to live and work, and it seems to us nurses that their knowledge is quite questionable often.

The local nursing schools are putting out some pretty crappy nurses these days too.

They teach "CYA" and have no clue as to appropriate patient care.

I spent 3 days taking care of two patients, both terminal both (do not resuscite), one asking to go to hospice and stating clearly she wanted to die, the other a train wreck who make herself that way. Physicians pulled out all of the stops for both of these ladies, both on their death beds one government funded, the other not funded at all so every tax paying citizen in the US is paying for her healthcare.

And yes I do know alot about drug addicts....what kind of a statement was that?

I am an ICU RN who works in a big city. Hmmmmm, I would say that close to half of the patients that I see and care for are ill due to drugs and or alcohol.

As an RN in San Antonio, I better darn well know alot about drug addicts....sorry dumb statement of yours.

The physician in the "hypothetical" situation didnt know her head from her rear, and these are the physicians that will be caring for me in my elder years.

I'd rather be dead.

Its getting very scary out there....folks should be aware.

posted July 10, 2013 12:16 AM            

When I read what you go through, I realize how through-and-through you feel about patient-care! Those are some very lucky patients to be in your watchful eye and care!!

And if those newbie-docs want to be WISE, then they should lay their newbie-big-egos down for the short time it would take to really listen to the ones with a lifetime of work experience in the field!

I HOPE reform happens soon! We're in a 'care trough' right now. They're figuring out all the rules, and building the buildings, and have an over-supply of customers: BUT NO ONE who "cares"?

I hope you would be able to "train" the newbies. I hope you are recognized as an authority in this, hippichick! We need people like YOU!

Now...... YOU must also take good care to nurture your own self, okay? (I feel the weight of your care for them all--- even the most 'hopeless'.... ---)

posted July 10, 2013 01:06 PM            

O, and I need to edit my post to the other one...

docs spend less than SIXTY SECONDS with their patients where as we spend 12 hours with them, bonding, caring for them, bonding with family memebers, crying with them...

Ever seen a doc do that?

I did once....in 13 years...once.

posted July 10, 2013 01:53 PM            

quote:

---

Originally posted by mirage29:
I know your tellin' the truth, girl!! That's right!

When I read what you go through, I realize how through-and-through you feel about patient-care! Those are some very lucky patients to be in your watchful eye and care!!

And if those newbie-docs want to be WISE, then they should lay their newbie-big-egos down for the short time it would take to really listen to the ones with a lifetime of work experience in the field!

I HOPE reform happens soon! We're in a 'care trough' right now. They're figuring out all the rules, and building the buildings, and have an over-supply of customers: BUT NO ONE who "cares"?

I hope you would be able to "train" the newbies. I hope you are recognized as an authority in this, hippichick! We need people like YOU!

Now...... YOU must also take good care to nurture your own self, okay? (I feel the weight of your care for them all--- even the most 'hopeless'.... ---)

---

Double Like

------------------
Passion, Lust, Desire. Check out my journal

posted July 10, 2013 07:35 PM            

------------------
Passion, Lust, Desire. Check out my journal

posted July 12, 2013 09:52 PM            

quote:

---

Originally posted by shura:
Hippichick it was a genuine question. No snark intended. We had several pleasant and profitable exchanges years ago and I have no reason to believe we couldn't again.

Sometimes nastiness is in the eye of the beholder, Ami

---

Her religion...because her comments were totally off the wall and innapropriate, lead me to believe that something in her personal religion was at play...

We see it all of the time...

My recommendation which all of the other docs on the case and all of the other nurses agreed to was to let her go...

Well guess what.

That is what happened last week. The Family under expert guidance of a good doc and good nurses told the mom like it is:

She shot her heart with heroin and crack, she was a prostitute, and she refused to make lifestyle changes when advised by the heart surgeon, who made the ultimate decision to not operate on her again...

This silly--ass woman newbie...really? I had to pinch myself durning the whole converstaion to make sure I was really hearing this.

Perhaps in the Muslim religion this is part of healthcare, either way, the woman killed her self and she could not save herself, neither could we.

Her stupid statements floored me.

Hypothetically, speaking...

)~(
Docs always make decisions not for the patient and the families but for their conscience, their fear, their pocketbooks...etc

Nurses dont, we get paid a certain pay and we are huge patient and family advocates,

Docs on the other hand have to see unfunded individuals, alot of them in this big city, they have law suits tuggin at their tail shirts all of the time..

O, and there is the almighty EGO.....

bleh.....

American Healthcare....

posted July 12, 2013 10:30 PM            

I dont know what they are teaching these folks these days, but it is not true healthcare, it is about, from what I have seen, making a buck, covering their rears, being compliant with a largely govenment mandated healt care system...and little about healing...

Most hospitals now are not hiring experienced nurses cause they cant afford them.

My director asked me to give her as much notice as I can, when I leave, cause she cant replace me, she has to hire a "GN" graduate nurse, a nurse who has not taken state boards yet,, but has to soon...give them some training for a couple months and they're off!

Not, good...very not good.

I got into an argument with a new doc, from the same practice as the lady doc, not too long ago about giving a patient a particular med.

The patient's heart rate was through the roof, so he kept giving her a "beta blocker" which is sometimes successful at getting the rate down, but only after a period of time on the med.

I refused to give it cause her blood pressure would not support the med.

Now beta blockers are not used specifically for blood pressure, more to get the heart rate down, but I say again, it takes time to the proper load of the med in the body.

So,, this silly young doc tells me GIVE HER THE BETA BLOCKER, it has nothing to do with the bloodpressure only heart rate.

I kept my mouth shut, but I wanted to say, refer to your DRG (docs drug bible) please...sides that I have been a heart nurse longer than you a doc and probably even before you started medical school, muchless college....and bottem line, this is MY license and I refuse to comprimise my livlihood and a patient's life by your lace of knowledge...and what I really wanted to tell him is that I have been on beta blockers...they sure to have an effect on blood pressure!

So, this idiot, fought and fought with me, even with a cardiologist on the case.

I finally got hold of the cardilolgist and got parameters for not to give the med...saving my license and the patient's life...

Yes, as you say docs are trained one way, nurses another, but any darn one of us seasoned nurses could pass MCAT (the test to get into medical school) and make far better physicians than they are farming out today.

Why dont we...cause a seasoned nurse who plays her/his cards right makes more money than a new doc anyway!

I reufse to ever comprimise my patient's life, and I document my arse off to cover my hiney...

and have saved folks lives and my license in the meantime..

posted July 12, 2013 10:52 PM            

We see it all of the time...

Trust yourself! I trust you. xox

------------------
Passion, Lust, Desire. Check out my journal

posted July 13, 2013 04:14 AM            

I've already had MISTAKES made by doctors, and now they are bold enough to tell me that I'm "another doctor's screwup".... They refused to treat me.

'A little learning is a dangerous thing'...literally!! Ineptness. I've been frightened for a really long time.

... ptsd: When I was 4 years and 2 mos old, (Aug ~18/19, 1959)(I have a copy of the record), I WOKE UP during a T&A... several times. I felt pain. I hemorrhaged and was going into shock. They had to do it again. Almost lost me. I 'watched' the doctor, floating beside him. I am still freakin' terrified.... It's been over 50 years.

Have you ever recorded yourself saying this? I've had a couple friends who were nurses. This has been going on for decades!

WE NEED REFORM!!

(humor.clip) FIX IT!... (SNL) [0:41] http://www.youtube.com/watch?v=yo3uxqwTxk0

posted July 13, 2013 08:07 AM            

------------------
Passion, Lust, Desire. Check out my journal

posted July 13, 2013 10:30 PM            

But as a starter, Texas is a right to work state, that is, Unions are not allowed to come in...

Unions drive up the cost of living, and to me that seems that more quality healty care providers will work in a union state cause it is more expensive.

Texas, espeically where I live, is so close to the boarder, cost of living is cheap, so "cheap" workers are drawn here...

posted July 13, 2013 10:33 PM            

I promise!!!

posted July 14, 2013 03:54 AM            

There's too much 'friction' causing you to use too much energy in all this broil... you'll burn up. Seems like driving with the parking brakes on!

Hoping that you'll get a sudden inspiration, and be able to pick up your head and suddenly see a plain solution that melds all this! I wish that this will bring such rest to you, enrich your depleted resources, get you some credit and award for your life's work, and promote you to something much better and productive for your life! May your road become easier, and your life-essences breathe free and fresh again!

Ami Anne... yes, thank you for being interest and asking! Cool... I'll tell you the short of my being 'awake' under anesthesia later... BUT I've gotta make myself go to bed right now... wow, how time flies....

Looking forward to hearing all your ideas hippichick...... you ROCK!!!

posted July 14, 2013 08:49 AM            

------------------
Passion, Lust, Desire. Check out my journal

posted July 14, 2013 09:11 AM            

It is well known to us medical professionals that due to medicare/medicaid and non funded patients the cost of healthcare is going up and up. So hospitals, in particular, must cut corners somewhere, and the easiest place to cut corners is in staff.

Most hospitals are hiring brand new nurses now cause they are cheap.

And most hospitals are using these "hospitalists" groups, docs who do not see patients outside of the hospital, but only in the hospital and it is pretty clear to me that by hiring a group, they get a group rate, if you will, to contract these hospitalists.

I think one can still request their own physician to care for them in the hospital, but most docs wont anymore and defer to the hospitalists.

Now these hospitalists are not experienced physicians. What I have observed in the group my hospital contracts with is that a newbie doc will first be a night shift doc, be avail in person and over the phone for night shift...then after a period of time the newbie doc is then moved to day shift.

There is one hospitalist group in San Antonio that is not contracted with my current hospital that is actually good, I miss these docs! But these were experienced physicians who chose to go the hospitalist route.

You will never be really safe in a hospital situation with an inexperienced hospitalist as your admitting physician.

Now, the quality of physician care lies in the specialists. Rarely do I see a surgeon, renal doc, cardilolgist, etc that doesn't know their head from their rear, but that is because they have had extensive training, have been a "fellow" working with an experienced doc in their chosen speciality.

A regular MD degree requires a BS in something...biology, something science related, then another 4 years of medical school, then voila, you have your MD!

The fellows who choose a speciality work another 2 years with an experienced doc, so their total package is 10 years of schooling.

There is this awesome fellow at work, he is a general surgeon and his fellowship is over.

He knows his stuff!!!

He consulted on a patient of mine yesterday, for no real reason, the "hospitalist" used a possible gallbladder issue to get him to consult and what he said to me was....

"I am so tired of these f$@!ing hospitalists calling me to come and diagnose their patients when they cant cause they have no clue...."

He is born and bread San Antonnian, he sees the issues here and secured a new job in North Carolina.

(will miss him, he is sweet, knowledgable and very easy on the eyes.... )

Now, nurses:

Again are not prepared correctly. In my day in nursing school, I graduated nearly 14 years ago, we were taught "critical thinking."

Nurses are taught today CYA, and I have asked them....yes, they are teaching nurses the legal aspects of nursing more than patient care!

And it is quite obvious when they do their clinicals in the unit...they ALL are unprepared, dont know what the heck is going on, and these are about to graduate nurses!

Critical care is one of their last classes and none of them have a clue.

There is one instructor, however, she is a well degreed RN, rounds for a doctor on the weekends and her students know their stuff, but most dont.

This is what happened to me yesterday:

I get this patient from the floor, admitted "stat" to the ICU. A very sick 43 yo lady, with lots of health problems anyway. End stage renal disease, liver failing, diabetes to mention a few.

So she comes in to the hospital cause she notices her skin is turning more yellow (called jaundice a symptom of liver failure) she is throwing up, and her white blood count was very elevated and she had a mad fever.

They drew blood cultures and it grew strep b, which is indicative of the flesh eating bacteria strain.

Nobody did anything.

Day 2 white cell count goes up even more...nothing, higher fevers...nothing, no antibiotics, nothing.

Finally I get her yesterday fixing to "code" as some doc finally thought..."hmmmm perhaps she should be on an antibiotic."

Nursing failure of the floor nurses: this woman had mad fevers the since admission. 104 was the highest and in 2 days she was given Tylenol at a doseage that would not bring an ant's fever down, only once!

The floor nurse that called me report said her last blood pressuer was 88/something, I forget, which is indicative of sepsis. Her last temp 102.2

So she rolls in from the floor with FOUR blankets on, one from home a FLEECE heavy blanket...fever anybody?

By now her temp had climbed to 103...suprized this woman didnt go into seizures as she has a history of them.

My god!

So I strip off her blankets and clothes, she still had her street clothes on, put ice packs on her, gave her a cool bath, gave her tylenol, which by now she was so out of it she could barely swallow, slammed the antibiotics in her, but her on a med to support her blood pressure and guess what...left her quite stable last night.

So, why is it an ICU nurse had to "fix" the patient....

Why didnt the floor nurses question the docs on using no antibiotics and her raging fevers?

Cause they are new and unexperienced and have not been schooled correctly.

Thats fine, their license, but this is costing folks their lives.

It is largely a bigger issue in Texas, I think...I am quite sure there are issues other places, but in Texas, again a right to work state, and will never be unionized for nurses. The cost of living is very inexpensive here so like I already said, things are cheap here...especially the hires.

Off my soap box for now.....

Gotta get some work done on mi casa!!!

posted July 15, 2013 03:35 AM            

The issue of American health care is alarming. You're right. They are lowering standards of education, and putting kids in position of responsibility they are not trained or perhaps not inwardly gifted or motivated at all to be in this line of work. BUT!!!!, they get "paid"! Not corrected. They get a paycheck.

Quality of care..... they get their money regardless of how they treat the object (patient,client) of this care. I think the people who own and run these failing institutions need to have their income pinched.,,, (their own paycheck gets docked when a client complains... hehe)

The health care began to slide when America went to HMO's. The physicians gave away their power to money brokers. It's about the health of their own bank accounts. Patients are a means to get wealth. There's no "Honor" in them --- Look at what they're doing in your state! (And it's not the only one.)

In reform, I think the persons who own Hospital should take on the responsibility like a SACRED and awesome HOLY process-place.... The POWERFUL reverence and mystery of the Healing of a Human Body and Minds, should be forefront. They need an Ideal that has "money" be subservient to the miracle on earth of repairing these suits of flesh we're born into.

People's very personal body are being handled like COLD MEAT and not human living sensing organism. Doctors don't practice an art anymore... They are equipment managers. The computer-system and robots have taken over the 'human' job of healing flesh organisms, void of soul.

Psychiatry has definitely gotten so weak that it isn't the same deep relating. More about electrodes and chemicals... not one human soul healing the human heart....

posted July 15, 2013 03:41 AM            

Dorothea Lynde Dix
(clip) National History Day - Dorothea Dix & The Asylum Movement [8:46] http://www.youtube.com/watch?v=2aOGuKzd0fw

posted July 15, 2013 04:01 AM            

(clip) Monday Mornings (2012)(Trailer) [2:06] http://www.youtube.com/watch?v=qLRHe-JkByA

Monday Mornings

Premise

posted July 15, 2013 09:52 AM            

------------------
Passion, Lust, Desire. Check out my journal