The medical field... sigh. page

[lorichka6]

So I just started nursing school. Currently I spend 1/2 day a week in clinical - so not much hospital time yet. I'm on a Med Surg unit - so a pretty wide variety of patients.

I guess I knew this going in, but so many things seem so counter-health rather than pro-health. The food served to patients is AWFUL. Everything is processed and nearly all of my patients have diabetes - their menu choices include plain white bread, subs, burgers, fries, chicken noodle soup, pretzels, chips, etc. Dessert comes with both lunch and dinner.

Pain management is such a priority (which I guess it should be...) that most patients seem to be constipated because of the narcotics they are on. Many have thrush because of some broad spectrum antibiotic that wiped out normal flora. When my patient today asked the nurse if she could take a probiotic instead of another antibiotic for her thrush the RN just ignored the comment as though she was joking. I don't know... could that have worked?

I just go along and do what I'm told and keep my mouth shut as my T2D patient asks me if she should get mac and cheese or pizza for lunch... but it does bother me. I'm not saying that medical care today is bad, just that there are so many aspects of disease prevention and health maintenance that seem to be ignored.

Anyone else out there is medical land? Are you conflicted giving care that could be improved upon? Do you do anything to change things?

[EyeOfRound]

I agree with you re: poor nutrition at the hospital. Personally, if I'm ever hospitalized, I'm having friends or family bring me stuff from home to eat. I suggest the same to patients. That said, a lot of people have atrocious eating habits at home, as well.

Re: other issues, I'm not entirely sure what you suggest be changed. Yes, narcotics can constipate you, but that's why people get put on a bowel routine when they are admitted. Inactivity doesn't do much to help with constipation, either. You can't just not give people pain meds.

Thrush is not treated with an antibiotic, it's treated with an antifungal. Regarding non-pharmaceutical remedies, I think most of us have seen enough self-treatments gone bad to insist on the proper treatment being given. I personally don't care if a patient refuses their antifungal and wants a probiotic, I just don't want them to turn around and blame ME for their thrush not resolving 2 days later and claiming I wouldn't give them the antifungal. I understand you haven't been in the field long and let me tell you, people are manipulative and are happy to throw you under the bus. I had a guy refuse to fill his Rx meds for BP/dyslipidemia because his chiropractor told him not to (don't even get me started here) and subsequently have a heart attack, then INSIST that I never gave him a prescription for them and it's all MY fault he had a heart attack. Good thing I had documented everything during our visit before.

Regarding broad spectrum antibiotics - that's usually what people get started on and then it's stepped down to a more appropriate one when the cultures/susceptibility are back. You don't want someone to get sepsis and die because they ended up growing an exotic bug and you thought Vancomycin or a 3rd gen cephalosporin was overkill.

[lorichka6]

EyeofRound - clearly you know more than I do

You are clearly correct in everything you point out. I don't know why the hospital is bothering me. I guess I equate nutrition with a foundation for health. And in the hospital that foundation isn't there. And then I just see med lists that are nearly a dozen long - often with one med given only to counteract a side effect from another med. I don't know what changes need to be (or should be or could be) made. It just seems - to me - that something is wrong.

And I will never forget that antifungals treat thrush

[Noctiluca]

Our 'health' care system does suck. In fundamental ways that have nothing to do with corporations or money.

I TOTALLY agree with you on the food! Since when should sick people eat jello, apple sauce, and apple juice just because it is 'bland'!? There are foods out there that are healthy AND bland if they need a basic diet while their gut heals or some such. It would be awfully nice if the menus at least pretended to meet the food pyramid guidelines! (We all know there is a better way than the USDA proposes but they are the general standard!)

And I agree with you on the medication lists. I work as a paramedic and I honestly believe that for a large number of my patients their real issue is the medications they are on. Some medications are very necessary either chronically or temporarily but I see an awful lot of people on an awfully long list of meds! I'd really rather see some doctors at least SUGGEST some lifestyle and/or diet changes first! It totally depends on the patient, the rapport I build with them, and what is going on but I HAVE suggested to a few patients that they might want to talk with their doctors about trying to trim down their medication list. And a few have!

I guess my advice is that you do have to keep your mouth closed and just deal for a lot of it but you can be the awesome nurse that when you have an informed patient that suggests maybe they could eat some real food you could be on their side instead of saying 'oh no!, just eat the crap we bring you. We know best'.

So stick with nursing school, learn everything you can, continue to educate yourself about common issues you see and be a pro-active member of the health care team! You WILL have to put up with BS. Try not to get burnt out and quit caring!

[Lizzielou]

I think any medical professional feels the same way about hospital's and the 'revolving door' syndrome. Admittedly it sounds like hospitals overseas (assuming you are in the US?) are serving up some crappy food, at least our hospitals in NZ kinda try with the food. The food is pretty gross, but we have lots of vege and fruit with every meal.

The bit that totally gets to me about hospitals is how the patients ended up in them. It is so truly seldom that you'll see someone in a hospital who has looked after themselves, eaten a good diet, maintained their fitness, listened to Dr's advice, non smoker, non drinker. Look around the average hospital ward and think about the real reason each person is there, its because they are overweight, its because they didn't take their medication, its because they have never exercised or whatever. Of course there are lots of reasons for this, its not as simple as blaming the patient, but at the end of the day, its just so damn frustrating.

As I've continued in my career I've come to the realisation that unless people take responsibility for their own health we can't do anything for them other than try to make them comfortable in the time they have remaining. No amount of education and treatment can help them unless they take charge.

I now work with supporting the elderly living independently and its lovely to work with a person who is determined to maintain their independence, very refreshing after caring for the sick for so many years.

[Knifegill]

I'm a vampire in a big hospital. Every time I hear "statins" I smile and just advise them to do a little research on their own.

[BratKat]

I work in a pharmacy, for God's sake! It is frustrating and disheartening at times. On the one hand, I am frustrated when doctors appear to completely ignore the root cause of a medical issue and just throw medication at the symptoms... then you have the patients that, when advised of diet/exercise changes that would benefit them, ask if they can't just take a pill instead... SOME are receptive to suggestions for things they can do for themselves, many are unwilling to exert themselves in any way. Some can't be bothered to even know the names of their meds, much less what they are for. Many literally have no idea why they are taking half of their meds. So many just won't take any responsibility for themselves.

Also, I HATE it when doctors advise their elderly patients that are getting too thin to pick up some Ensure or Carnation Instant Breakfast. I'll try to talk them out of most of the time. Tell them to eat real food that they like, not fake crap.

[Bushrat]

The medical system is working exactly as it was supposed to...

[texas.grok]

The medical system is working exactly as it was supposed to...

Unknown source for this quote but one of my favorites:

Your system is perfectly designed to yield the result you are getting

[Damiana]

Sometimes doctors don't have a choice and need to stick to a script, regardless of what they believe. Change takes time. Remember, just a few hundred years ago we still believe in bleeding people. Hell, people still do it (I went through a particularly painful course of folk medicine when I was a sick child).