Moderator ventana Posted September 17, 2015 Moderator Share Posted September 17, 2015 So I do geri house calls in my own practice..... got a rare morning to go to the local breakfast place - found nice corner booth and it was empty.... behind me in walks two early 60's men, both heavy set. They proceed to sit in the booth right next to mine (in spite of the entire restaurant being open they sit almost on top of my table) but oh well so much for my quiet escape breakfast... I am in a bit of hurry, rare 9am start time give me an extra 30 min! to grab bfast.... I order my treat breakfast, short stack pancakes, and black coffee The waiter goes to their table and they order a short stack and a regular order (with sugar for syrup no syrup) They each pull out a large strip (3-5) scratch off lottery tickets, and start to talk and scratch, Neither on wins anything, but then the conversation turns interesting. They start talking about how they are both Diabetics and have seen their doc recently, one of them says his doc is trying like made to get him to eat healthy but he really really does not want to give up his hot dogs, lunch meats and breads, the other shakes his head in agreement, and then goes on his own tangent of how expensive all these meds are and all the medical establishment wants to do is get you $$. I listen to this through the entire meal, and they keep talking about DM and how the doc's keep asking them to live better, and the cost of the meds and care... I can not help but wonder where on earth we have gone so wrong - these to have easily $50 worth of scratch tickets, are eating breakfast in a restaurant, and are dressed reasonably well. They clearly have been told about diet and exercise, yet all they do is order PANCAKES and SUGAR and gripe about the cost of care.... how have we as a society gone so far down the wrong path of unhealth..... I love Primary care and helping, but it is crazy that this might well be (admittedly a small sample size :-)) the common thread in society.... gripe about money while throwing money at scratch tickets, gripe about their doc's telling them to eat better, while eating pancakes and syrup/sugar General lack of caring......... I will climb down off my soapbox now..... Thoughts....... Link to comment Share on other sites More sharing options...
greenmood Posted September 17, 2015 Share Posted September 17, 2015 There will always be those people, I think. Little ownership of their own health. So many people are overweight and diabetic that the general population is starting to see these things as normal parts of aging. A few people might know someone who lost a foot or leg to diabetes, but most people are too far removed from the most obvious and serious results of that process. I try to remember that for every one of those guys, there is someone who honestly can't afford the drugs and is trying desperately to get control of a chronic disease. I want to focus my energy towards those people when I find them. Link to comment Share on other sites More sharing options...
Will352ns Posted September 17, 2015 Share Posted September 17, 2015 I have always maintained that if diabetes, obesity, and HTN hurt...we these conditions wouldn't be as prominent as they are. I worry about the next generation ready to start aging, I call them the "sit down generation." Basically the "gamers". At least the old timers you saw generally had an active childhood and early adulthood. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted September 17, 2015 Share Posted September 17, 2015 The foundational problem with our health care financing/delivery system is the disconnect between what a person receives in care and what they pay for that care. That is the foundational problem, and politicians strive to make the foundation worse every year by promising to give away more stuff to more people.These guys, and the vast majority of our patients (and US as well!!), expect their "insurance contributions" (whether through years of paying into fed taxes, or actually paying premiums) to give them not only "free" health care, but also "perfect" health care. Link to comment Share on other sites More sharing options...
wilso2ar Posted September 17, 2015 Share Posted September 17, 2015 We as a society expect modern medicine to make up for our poor lifestyle choices. This is not to you specifically Ventana, but all the others reading this especially the young ones or the people that are getting burned out. Some times the patients listen. They lose weight. They quit smoking. (In my line of work) they get up and contribute to society despite being on disability. I am currently at a conference where the first keynote session is "the future of pain management and the role of self care and integrative collaboration". I like to hold hope for the masses and after we have hit rock bottom, here is no where to go but up. Link to comment Share on other sites More sharing options...
winterallsummer Posted September 17, 2015 Share Posted September 17, 2015 Diabetics eating pancakes and sugar. Endocarditis patients and skin poppers with bad abscesses continuing IVDA. Ischemic CHF, CAD and CKD patients having ice tea, New York strip, fries and cake every day, and never forgetting their handful of candy out the door but always forgetting their handful of pills. Lung CA and end stage COPD patients with AFib smoking a pack and a half a day. Schizophrenic patients using hallucinogens. The list goes on and on. Keeping us in business. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted September 17, 2015 Share Posted September 17, 2015 Self responsibility is serious lacking in all aspects of American lifestyle - don't everyone attack me. We sue manufacturers when we use a product in a completely inappropriate way and get hurt. It is always someone else's fault - my parents were alcoholics, my parents weren't around enough, etc etc etc We HAVE to own our guns but don't want to take responsibility when someone uses them for murder. It strikes me as odd that when the Affordable Care Act MADE people get insurance - Lots of folks screamed "no govt interference" and "they can't force me to do anything". However, when these folks without insurance bust an appy or get hit by a bus and need over $100K in medical care they suddenly scream - "I don't have insurance, how am I supposed to pay for this?" and then take the DSHS handout or declare bankruptcy or - these days - build a go fund me site for being irresponsible. So, I remain confused. WHAT ARE folks responsible for? I get frustrated with my patients who have resources but choose not to use them wisely (yeah, my opinion of wisely) - one patient has $2000 in tattoos in one year but can't pay for Advair copay as a brand drug. Perhaps our society has a skewed perception of "life, liberty and the pursuit of happiness" as meaning do whatever you want and don't deal with the consequences. I give my patients homework - a list of their responsibilities and we discuss the consequences of allowing blood sugar to be too high, blood pressure to go untreated, etc. It is the best I can do right now. It doesn't make situations like breakfast at the diner any easier, though - so, the battle continues. AKA Reality Check - my login got messed up and I had to re-register under another email. Trying to get it fixed. My 2 cents Link to comment Share on other sites More sharing options...
NLRP3 Posted September 18, 2015 Share Posted September 18, 2015 I agree^. I would also add that I don't think that people realize how big of a deal it is when these conditions go unchecked. I don't think people understand how much CHF, Diabetes, CKD (or all three) can ruin your life. Someone said earlier that if these conditions hurt than they would not be as prevalent, and I totally agree. The corollary to this is that, I think, if people realized how much pain was in store for them, that would be sufficient motivation to change their behavior. I used to be afraid of normal irrational things, but now the things that really motivate me and scare me are the thoughts of CHF and diabetes. Just my $0.02. There are many dimensions to this problem, but take it for what it is worth. Link to comment Share on other sites More sharing options...
CAAdmission Posted September 18, 2015 Share Posted September 18, 2015 Self responsibility is serious lacking in all aspects of American lifestyle - don't everyone attack me. This is the crux of the problem, and what has effectively killed America. We are too far gone. There is no hope without a major national crisis. We started as a country of rugged individualists that carved a nation out of the wilderness. We have degenerated into a lazy nation that lacks drive and responsibility. A greater percentage of the nation is dependent upon government handouts now than any other time in our history. Unfortunately, I have come to believe that the government likes it this way. If they give you your food, they can pretty much tell you what to do. Link to comment Share on other sites More sharing options...
sas5814 Posted September 18, 2015 Share Posted September 18, 2015 So I do geri house calls in my own practice..... got a rare morning to go to the local breakfast place - found nice corner booth and it was empty.... behind me in walks two early 60's men, both heavy set. They proceed to sit in the booth right next to mine (in spite of the entire restaurant being open they sit almost on top of my table) but oh well so much for my quiet escape breakfast... I am in a bit of hurry, rare 9am start time give me an extra 30 min! to grab bfast.... I order my treat breakfast, short stack pancakes, and black coffee The waiter goes to their table and they order a short stack and a regular order (with sugar for syrup no syrup) They each pull out a large strip (3-5) scratch off lottery tickets, and start to talk and scratch, Neither on wins anything, but then the conversation turns interesting. They start talking about how they are both Diabetics and have seen their doc recently, one of them says his doc is trying like made to get him to eat healthy but he really really does not want to give up his hot dogs, lunch meats and breads, the other shakes his head in agreement, and then goes on his own tangent of how expensive all these meds are and all the medical establishment wants to do is get you $$. I listen to this through the entire meal, and they keep talking about DM and how the doc's keep asking them to live better, and the cost of the meds and care... I can not help but wonder where on earth we have gone so wrong - these to have easily $50 worth of scratch tickets, are eating breakfast in a restaurant, and are dressed reasonably well. They clearly have been told about diet and exercise, yet all they do is order PANCAKES and SUGAR and gripe about the cost of care.... how have we as a society gone so far down the wrong path of unhealth..... I love Primary care and helping, but it is crazy that this might well be (admittedly a small sample size :-)) the common thread in society.... gripe about money while throwing money at scratch tickets, gripe about their doc's telling them to eat better, while eating pancakes and syrup/sugar General lack of caring......... I will climb down off my soapbox now..... Thoughts....... This is what I deal with daily. I take care of lots and lots of poor people who eat bad food daily and smoke and probably 90% are overweight or morbidly obese.. It is a Sysiphean (sp) task to get folks to make any lifestyle changes despite the cost saving and health changes it would create. If it was a low percentage of my patients it probably wouldn't frustrate me so much but it is nearly 100% of them. Its the complaining that I'm not "fixing" them or "doing anything" for them that makes me go to my office and thump my head on the desk over and over. I used to say "I ca n't care about your health more than you do" and then I realized that wasn't true anymore. Link to comment Share on other sites More sharing options...
sk732 Posted September 18, 2015 Share Posted September 18, 2015 My old SP used to say that "Modern biochemistry allows people to maintain the crappy lifestyles that they've happily grown accustomed to". I guess one of the problems is that people just want us to fire pills down their necks so they don't have to do the hard work, you know like going for a walk, drinking some water instead of pop, etc. Unfortunately, like dude noted above, these folks do pay our mortgages. Best we can do is guide them and hope they listen. SK Link to comment Share on other sites More sharing options...
BruceBanner Posted September 18, 2015 Share Posted September 18, 2015 I agree with the sentiments above. Part of it is selection bias---healthy people don't generally need care. The bigger issue though is the pervasive lack of personal responsibility. My philosophy as a provider is that my #1 objective is to treat injury and disease appropriately, or find someone who can. I'm not a lifestyle coach, I'm not a therapist. Here's what I think is wrong with you, here's what you can do, should not do, and what I recommend. The rest is up to them. Lifestyle issues are difficult because there is no fear of imminent death or morbidity. When that does happen, it's too late. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted September 18, 2015 Share Posted September 18, 2015 Lifestyle issues are difficult because there is no fear of imminent death or morbidity. When that does happen, it's too late. Who are you kidding here. 75% of people who die on TV are successfully resuscitated and walk out of the hospital without any neurological deficits! Link to comment Share on other sites More sharing options...
Sam I Am Posted September 18, 2015 Share Posted September 18, 2015 Diabetics eating pancakes and sugar. Endocarditis patients and skin poppers with bad abscesses continuing IVDA. Ischemic CHF, CAD and CKD patients having ice tea, New York strip, fries and cake every day, and never forgetting their handful of candy out the door but always forgetting their handful of pills. Lung CA and end stage COPD patients with AFib smoking a pack and a half a day. Schizophrenic patients using hallucinogens. The list goes on and on. Keeping us in business. And I'm totally okay with people "living it up" because it keeps me in business - I work nursing homes where they reflect on their life and say "Damn it - wish I hadn't started smoking, etc." Link to comment Share on other sites More sharing options...
Guest Paula Posted September 19, 2015 Share Posted September 19, 2015 My old SP used to say that "Modern biochemistry allows people to maintain the crappy lifestyles that they've happily grown accustomed to". I guess one of the problems is that people just want us to fire pills down their necks so they don't have to do the hard work, you know like going for a walk, drinking some water instead of pop, etc. Unfortunately, like dude noted above, these folks do pay our mortgages. Best we can do is guide them and hope they listen. SK Totally random comment here........I'm so glad to read that someone else uses the word pop. It's so midwestern and minnesotan which is my primary language. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 19, 2015 Moderator Share Posted September 19, 2015 Totally random comment here........I'm so glad to read that someone else uses the word pop. It's so midwestern and minnesotan which is my primary language. is that like soda.....:) Link to comment Share on other sites More sharing options...
Reality Check 2 Posted September 19, 2015 Share Posted September 19, 2015 is that like soda.....:) I am from Texas - everything is a Coke there. Pepsi - NO. Dr Pepper - YES. Otherwise, what kind of Coke do you want? If it is fried, it has gravy on it. Or, it just has gravy anyway and bread is used to sop it up at the end. Diabetic, CAD heaven.......... Don't even start with the Mexican food..... Link to comment Share on other sites More sharing options...
whoRyou Posted September 19, 2015 Share Posted September 19, 2015 I am from Texas - everything is a Coke there. ... Don't even start with the Mexican food..... Me too and I sure do like my chips and salsa Good thing I work out and have a good metabolism LOL Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 20, 2015 Author Moderator Share Posted September 20, 2015 soda or pop????? Link to comment Share on other sites More sharing options...
wilso2ar Posted September 20, 2015 Share Posted September 20, 2015 It's pop, not soda. I am south of my comfort zone right now and ordered an iced tea at a southern style fast food joint (bojangles) It was the sweetest and one of the most disgusting things I have every drank. tasted like sugar water. Link to comment Share on other sites More sharing options...
sk732 Posted September 20, 2015 Share Posted September 20, 2015 Where I'm from (north of 49th) soda is fizzy water...pop is fizzy water with whatever flavours and real or fake sugar. SK Link to comment Share on other sites More sharing options...
Guest Paula Posted September 20, 2015 Share Posted September 20, 2015 It all comes from the term soda pop. We used to say....let's get a crush.....orange crush, grape crush, strawberry crush. Same thing as soda pop. Or as Minnesotans say......let's go get a pop. Now that I've lived in WI for 20 years I have been converted to saying soda, but I just can't get my mind around bubbler. (Water Fountain) If our patients continue to drink the soda pop we will all stay in business. I recommend plain old water to my patients. I have a few patients who love Mountain Dew. Does that stuff have cocaine in it? One guy drank 3 - 4 6 packs of 16 oz bottle a DAY! He had the worst case of acid reflux and an H. Pylori infection. Plus he had financial troubles, and smoked 1-2 ppd. So you know where my conversation took a rabbit trail down. How to be richer and healthier by developing a healthy lifestyle. We calculated out that he could save $700 per month by quitting the pop and cigs. He could pay his mortgage on time!!!! He never came back for follow up. Link to comment Share on other sites More sharing options...
CAAdmission Posted September 24, 2015 Share Posted September 24, 2015 It been my experience that people who say "pop" usually look like this: Link to comment Share on other sites More sharing options...
sk732 Posted September 24, 2015 Share Posted September 24, 2015 Can they spell it though? Link to comment Share on other sites More sharing options...
whoRyou Posted September 25, 2015 Share Posted September 25, 2015 It been my experience that people who say "pop" usually look like this: I have heard first hand stories like Ventana's, and it seems people think they are inevitable towards death. I personally don't get it. I eat healthy for the most part, but every now then ... But for people to ignore their own health seems asinine Link to comment Share on other sites More sharing options...
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