At what point are adults responsible for themselves?

[C.Ann]

You just earned a lot of respect from me and I'm sure many others.

I'll second that!

 

[mhsjax]

Was the gentleman provided with any information or assistance with smoking cessation? He has a nicotine addiction. It's not an easy addiction to break. And if money is so tight that I had to choose between a $4 prescription or a pack of cigarettes, it seems like that would be a pretty scarey place to be.

We have demonized smoking in this country to such a bizarre extent. I find it really odd since smoking was very commonplace when I was a kid. I'm not a smoker but I can still feel sympathy for those who are smokers.

YOu know what, I can judge, I was a smoker for 15 years. I decided that I had smoked long enough and I had kids therefore I would quit, I knew it was bad for me and I didn't even have any health problems, so I don't buy that it is an addiction, it is hard excuse. Sure it is hard, what in life isn't, he needs to quit, buy his meds and quit expecting the hospital to give it to him for free. End of story, back and white, cut and dry.

 

[Liberty Belle]

YOu know what, I can judge, I was a smoker for 15 years. I decided that I had smoked long enough and I had kids therefore I would quit, I knew it was bad for me and I didn't even have any health problems, so I don't buy that it is an addiction, it is hard excuse. Sure it is hard, what in life isn't, he needs to quit, buy his meds and quit expecting the hospital to give it to him for free. End of story, back and white, cut and dry.

And you think everyone is able to handle the addiction of tobacco exactly like you did?

 

[mhsjax]

Excuse me? Way to paint with a broad brush.

But really it is true, just look at all the crazy lawsuits. Sure not all of us are like that but way too many are.

 

[MrsPete]

I will probably get blasted for this one but here goes anyway. Not to comment on this one situation but on these situations in general. It really boils down to a finacial decision for we as a people. What is human life worth, and how much money are we as a society willing to spend to preserve life?

Before you answer how much we as a society should be willing to spend to preserve life, remember that the man himself placed a value of less than $4 on his own life.

Why should strangers place a higher value on his life than he himself places on it?

And you think everyone is able to handle the addiction of tobacco exactly like you did?

I've never smoked, so I don't pretend to know anything about addiction to tobacco, but I do know that (with the possible exception of the elderly, who might've been smokers before all the facts were in) everyone had ample warning that it would be very, very bad for their health before they started. They all had the option to avoid the problem.

 

[C.Ann]

Before you answer how much we as a society should be willing to spend to preserve life, remember that the man himself placed a value of less than $4 on his own life.

Why should strangers place a higher value on his life than he himself places on it? I've never smoked, so I don't pretend to know anything about addiction to tobacco, but I do know that (with the possible exception of the elderly, who might've been smokers before all the facts were in) everyone had ample warning that it would be very, very bad for their health before they started. They all had the option to avoid the problem.

As have people who weigh 600 lbs. and spend their money on fast food/junk food - knowing that every bite is bringing them closer to death - and as a result is now the mostly costly drain on the entire healthcare system..

So do we appoint ourselves judge and jury and decide who gets treated and who doesn't? Who should be treated with compassion and who should be treated like a second-class citizen?

I sure don't want that responsibility..

 

[Liberty Belle]

And you think everyone is able to handle the addiction of tobacco exactly like you did?

My apologies. That was rude. I could have said it in a nicer way. I'm a little tense tonight.

 

[Pea-n-Me]

The subject of medical non-compliance has been bouncing around in medical circles for decades. There are no easy or clear cut answers to the problem.

Here's a sampling of some articles if anyone's interested in reading more.

http://pages.prodigy.net/bobstein/legalnurse/noncompliance.htm

http://www.researchmatters.net/publications/NonCompliance.pdf

http://www.medscape.com/viewarticle/706837

http://www.scribd.com/doc/8429573/N...tant-Implications-for-Health-Care-Reform-1994

http://archinte.ama-assn.org/cgi/content/full/160/14/2101

 

[tammymacb]

Mother Theresa has left the building...

 

[Pea-n-Me]

Before you answer how much we as a society should be willing to spend to preserve life, remember that the man himself placed a value of less than $4 on his own life.

From one of the links I just posted:

Cost sharing is likely to represent a greater disincentive to fill a prescription for economically disadvantaged persons. Imposition of a small copay ($0.50) on South Carolina Medicaid patients (isn't that where the OP is from?) reduced prescription filling rates for important medications, such as cardiovascular and psychotherapeutic drugs (Reeder and Nelson, 1985). But in New Hampshire, a $1.00 copay caused only minimal reduction in prescription filling by Medicaid patients (Soumerai et al, 1987). These studies suggest that cost may be a significant deterrent to filling prescriptions by our poorest patients.

 

[Pea-n-Me]

Mother Theresa has left the building...

 

[NikitaZee]

As have people who weigh 600 lbs. and spend their money on fast food/junk food - knowing that every bite is bringing them closer to death - and as a result is now the mostly costly drain on the entire healthcare system..

So do we appoint ourselves judge and jury and decide who gets treated and who doesn't? Who should be treated with compassion and who should be treated like a second-class citizen?

I sure don't want that responsibility..

I agree. Not one of us is perfect, so I'd rather chase away a judgemental thought with a more compassionate one, and hope that others out there will do the same for me if I need it.

 

[bumbershoot]

I've never smoked cigarettes. I hate them. I have a hard time being friends with smokers, mainly because I simply cannot physically be around them for very long, because of the cigarette smell that lingers. There are few who are MORE anti-smoking than I am.

I grew up with smoking parents and stepparents. My mom quit first, then my second stepdad (don't know what happened with the first, he disappeared post-divorce-from-my-mom when I was 17, and then my mom remarried). Then dad quit after a heart attack. Stepmom, the NICU nurse, still smokes and seems to think no one knows. (nancy, we KNOW) One time driving home from Yellowstone with dad, stepmom, brother and half brother, stepmom flicked an ash out the window, and it came right in MY window and hit me. nasty.

So I really dislike it.


And yet...I know it's a powerful addiction. Those who have been addicted to both have said that heroin is easier to kick than tobacco. It's a strong strong thing. And yes, I do wonder why on earth people ever start, especially those born after the 60s and 70s and especialy starting with the 80s. But once you've started, you almost surely are addicted.

And I'm uncomfortable forcing someone to make themselves feel the way it seems to feel to quit smoking, just to get happy health care workers. I feel that health care workers should meet people where they are, and offer kind advice, but not FORCE something.

I was once a chiropractor, and I had a practice member with MS. She had chosen on her own to not treat it in a mainstream way. She had an extremely FAST and devastating case, and nothing was helping, and the mainstream drugs just made her feel worse. So she was exploring the alternative options, such as hippotherapy (she felt that that did the most for her, but it was SO expensive and she had to drop it), bee sting therapy (again, the expense was horrid though she noticed positive changes), and then she found me. She experienced positive results from my work (I wasn't "treating" her MS, I was simply helping her body get rid of vertebral subluxations) and loved coming to me...but she had almost no money. So I met her where she was. I wanted her to get the care, so I decided to let her pay me what she could. And I insisted that her husband be under care as well (he wanted to, but they definitely couldn't pay double, or even my family rate) at no extra cost.

And...they both smoked. They were highly addicted to cigarettes, and I had to clean my adjusting tables after they left because when I didn't, my other practice members complained.

They had almost NO money. They drove an hour to see me so gas was a factor. And yet they bought the cigarettes. They were addicted.

When I decided to leave Virginia, I *gave* my practice to a colleague of mine. I'd been practicing out of my home, so there was nothing physical other than the files, and I didn't know how to price that. I gave it to her. And the first thing she did was to judge the HECK out of those two practice members, and caused them to stop coming in. She was rude about it, and she just coudln't see that they needed and wanted the care, and that forcing them to go through withdrawals just wasn't the way. She lost my practice members b/c of it.

I hate that. And I hate that you wouldn't treat this man with care because you felt that the pack of cigarettes was more important than anything else. Yes you see it the other way; that the pack of cigarettes was, to him, more important than his health. Well, wait, in a way, you both see it the same way. Those cigarettes were more important to you than anything, by the end of his time at the ER with you.

It's just sad. Maybe he noticed, and the next time he has chest pain, he won't come in for fear of being treated like that. That seems more likely than him having an "aha" moment while being left to get his own way home, when your hospital obviously has funds to send people home...

I am an RN also and have worked in a busy ER. I found myself becoming "jaded" to some recurring patient types and knew it was time to move my career on to another area of nursing. I have done that and am now more content and the patients are receiving the care they need.

You may need to look at moving on also.

I can't help but agree.

 

[HannaBelle]

OP is 100% correct here. Mr. X chose his cigs over his meds...he CHOSE...him, not me, not the OP, not the over burdened tax payers.

I am not a nurse and but have more than enough experience as a patient to say that y'all not are bunch of Mother Teresa's so stop being condesending to the OP.

 

[Luvchefmic]

Your post was the most compassionate one I have read in a LONG time..while you clearly have an aversion to smoke/tobacco you did not let that stop the compassion you felt for your previous patients and this person in the ER

You also made a valid point about how he may feel

 

[Pea-n-Me]

I am not a nurse and but have more than enough experience as a patient to say that y'all not are bunch of Mother Teresa's so stop being condesending to the OP.

What an interesting comment.

 

[chloelovesdisney]

I work in a downtown ER and I see it all. Unfortunately, this stuff happens all the time. However, this guy really rubbed me the wrong way.

I took care of Mr X. He came in via EMS and his complaint was chest pain. His risk factors were high blood pressure, high cholesterol, diabetes AND he smoked a pack a day even though he'd had cardiac stents and a coronary bipass already. His insurance is Medicare and Medicaid.

Upon going over Mr Xs medications with him, he proceeded to tell me that he hadn't taken any of his home medications for a few days.. When I asked him why, he replied that he wouldn't get his "check" until the first of the month. ( Just BTW, Mr X is younger than my Dad who still works full time ) He said he couldn't afford his medications. I then asked Mr X "Don't you have Medicaid/Medicare? He got angry and said I do, but the medicine still costs money you know.. Yeah, like $4.00 for a 30 day supply. ( And yes, I do know how expensive meds can cost, but his meds were ALL available in cheap generics that would cost less than $10.00 per day.) But, he can't afford them. But he CAN afford a pack of cigarettes a day.

I told the doctor about the med situation. He made me hold Mr X until the caseworker could fill all of his medications for free.

Now, my question is. At what point does this adult male make the decision that I'd rather buy cigarettes than medication and we say, OK. Good luck? Why are we as taxpayers responsible to make sure he gets BOTH? I see it over and over and over again. And, like my opinion or not, if you CHOSE not to buy your meds and buy cigarettes instead, that is your problem. It really chaffed me to give him those free meds because he could afford them. He just wanted his smokes more.

Well, Mr X got his free meds and then told me he wanted me to call a cab and send him home on the hospitals buck too. Instead, I took him to the waiting room and sat him in a chair near the phone. I told him he could call anyone he wanted and I'm sure somebody would give him a ride but he wasn't getting a cab.

I'm sure I'll see him again within the month.

It is a regular practice for some to come into the ER and get their medications for free through the social worker and also ride to and from the ER for free thanks to the taxpayers. Most people outside of the healthcare system really have no idea how the system is taken advantage of. Multiply the cost of that free cab ride home by a million because that happens in every ER in every city every day, many times over.

Most everyone has a monthly budget. It is our responsiblity to prioritize and pay for the necessities before luxuries. He chose to spend his money on cigarettes and not his medications. If I choose to spend my money for the month on a Chanel bag and can't pay for groceries, I can go to a food bank and get free food. That doesn't make it right.

 

[emdav]

I think you will get different reads on this situation:

1) from people who aren't nurses and

2) from nurses

Oh wait, you'll get a third:

3) nurses who see it the way you see it

But before I offer you my opinion, I'm just going to say I don't know a nurse or other health care professional on this planet who hasn't also been frustrated at situations like this at times, including myself.

And personally I subscribe to the "teach me to fish I eat for a lifetime" philosophy (as opposed to "give me a fish I eat for a day") as well.

From a strictly NURSING perspective, you failed to see this man holistically and help him in the way he needed to be helped at that moment in time. You acted extremely judgementally and I was embarrassed as a fellow nurse reading your post. I am not surprised others here saw you as burnt out as truthfully, that's the way you sound to me also (and not necessarily not understandably, as I've worked in an inner city ER also and tertiary hospitals for over a quarter of a century so I know well what you deal with every day).

For one thing, many people like this have some form of mental illness - diagnosed or not; known to us or not. But more importantly, he's human and prone to all the mistakes and bad choices that all of us humans make - including you and me. Hospital policies and other regulations are usually based on research that's shown one thing or another. In this case, as a pp alluded to, it may just be that in the long run, providing patients with free pills and cab vouchers may just save health care dollars in other ways - it may very well simply balance out. Ideal? No. Obviously, smoking cessation would be great as well. But even with it, he may still find other things to spend his money on rather than his pills if he doesn't place a high value on them. So the problem of his not buying his pills is really one that's a lot more complex than it appears on the surface.

Now, I'd like to know what, exactly, you did do for this man, other than treat him angrily and send him on his way without a ride home? Here's your chance to redeem yourself - because I know down deep, you have it in there somewhere. Please tell me you treated him respectfully and compassionately in some way, and attempted to educate him in the best way you could given his individual and unique life circumstances...

Thanks for posting this.

 

[Cooky]

.

 

[luvestodizz]

I agree with the OP. If you can buy cigarettes you can buy your medication. To go further,there should be a requirement that Medicaid recipients be tobacco free. Why should the taxpayer have to be burdened with medical costs that can be prevented by not smoking? Personal responsibility needs to be addressed.