Admittophiliacs
Some people really want to be admitted to the hospital. Here are some of their more common presentations:
1) They have a flare-up of their fibromyalgia, their chronic low back pain, or their migraines, and they "just can't take it anymore." Unfortunately, in the absence of intractable vomiting or acute neurologic deficit there really isn't a good reason to admit these patients. Nowadays, patients only get admitted if there is a reasonable chance that some harm will come to them if they are sent home. "My pain is worse than usual" just doesn't qualify, and there is nothing that I can do about that. If these patients have a personal physician who compassionately agrees to admit them, I'm happy to call their doctor to arrange it. If they expect the "no doc" physician on call for the hospital (or even the partner who is covering for their personal physician) to do the same, then they are likely going to be disappointed.
2) Their gastroparesis is acting up again. They have been admitted a dozen times this year for the same problem, and they usually only last a few days at home in between admissions. There is apparently no medical regimen that will keep these patients from vomiting and allow them to function outside of the hospital, so these unfortunate patients only go home for the occasional holiday. If you think you can actually discharge them from the ER, you are mistaken. You can't fix them - they will be back in a few hours or the next day at the latest.
3) It's cold, or hot, or rainy and the smelly unkempt homeless types with chronic pancreatitis want a clean bed, a TV, 3 meals a day, and a wait staff. Oh, and another pain shot,please bitch.
4) She's old and lonely and feeling weak. There are no specific complaints, but she "can't go home like this." Helloooo, megaworkup.
5) He fell off a ladder and broke his _________. Unfortunately, a broken ________ is not an indication to admit an otherwise healthy adult to the hospital, even if his mother gives me a hard time over the cellphone. Sorry.
6) She's been throwing up for 3 days and feels really bad. But through the miracles of good fortune and modern medicine, all her lab tests look good and she's not throwing up anymore. Bye.
7) He's got the flu and feels really awful. Unfortunately, he's going to feel really awful for several more days whether he's in the hospital or not. Here's a work excuse.
8) He's been up for 3 days, and now he'sout of money for crack "suicidal." Again.
9) He's still drunk from his last bender, but he's afraid he's "going to go through withdrawals." This time he's serious about quitting. Again.
Let's hear your favorites....
1) They have a flare-up of their fibromyalgia, their chronic low back pain, or their migraines, and they "just can't take it anymore." Unfortunately, in the absence of intractable vomiting or acute neurologic deficit there really isn't a good reason to admit these patients. Nowadays, patients only get admitted if there is a reasonable chance that some harm will come to them if they are sent home. "My pain is worse than usual" just doesn't qualify, and there is nothing that I can do about that. If these patients have a personal physician who compassionately agrees to admit them, I'm happy to call their doctor to arrange it. If they expect the "no doc" physician on call for the hospital (or even the partner who is covering for their personal physician) to do the same, then they are likely going to be disappointed.
2) Their gastroparesis is acting up again. They have been admitted a dozen times this year for the same problem, and they usually only last a few days at home in between admissions. There is apparently no medical regimen that will keep these patients from vomiting and allow them to function outside of the hospital, so these unfortunate patients only go home for the occasional holiday. If you think you can actually discharge them from the ER, you are mistaken. You can't fix them - they will be back in a few hours or the next day at the latest.
3) It's cold, or hot, or rainy and the smelly unkempt homeless types with chronic pancreatitis want a clean bed, a TV, 3 meals a day, and a wait staff. Oh, and another pain shot,
4) She's old and lonely and feeling weak. There are no specific complaints, but she "can't go home like this." Helloooo, megaworkup.
5) He fell off a ladder and broke his _________. Unfortunately, a broken ________ is not an indication to admit an otherwise healthy adult to the hospital, even if his mother gives me a hard time over the cellphone. Sorry.
6) She's been throwing up for 3 days and feels really bad. But through the miracles of good fortune and modern medicine, all her lab tests look good and she's not throwing up anymore. Bye.
7) He's got the flu and feels really awful. Unfortunately, he's going to feel really awful for several more days whether he's in the hospital or not. Here's a work excuse.
8) He's been up for 3 days, and now he's
9) He's still drunk from his last bender, but he's afraid he's "going to go through withdrawals." This time he's serious about quitting. Again.
Let's hear your favorites....
posted by scalpel at 11:03 AM
42 Comments:
One doc just admitted someone with "nausea with coughing." Reason for admission: Coughs up phlegm and that makes her feel nauseous. No vomiting, but just can't go home and stand the thought of coughing and feeling nauseous any longer. I overtly argued with the doctor over that one. 6 hours in the ER waiting for a bed, eating, drinking water just fine.
Here is one for pediatrics:
"He should be admitted! He is ONLY FIVE YEARS OLD after all!" Diagnosis: anything
1) 74yo F w progressive bulbar palsy fell and bruised her hip (all images negative), need admission for "pain control" (required a whopping 1mg dilauded in 24hr).
Oh yeah, her husband "can't handle her any more at home" -- just before a holiday weekend, so we get to babysit while he gets a holiday
2) 81yo M w progressive SOB ("for unknown length of time" - oh, O2 sat of 98%) - 320 lbs, bedbound. We diagnosed him w COPD 10 days ago, but now can't get rid of him because he lives in a true sh!thole of a house - 3 floors literally falling down around him, no working plumbing, dead rats (!), packrat (minimal pathways through mounds or rotting "stuff") - he's refusing a nursing facility ("because mom and dad died in one") ---> my staff's comment, "we just can't let him go back to that house".... (forget the fact that he's a competent adult who's *chosing* to go there).... AUAUAUAUGH
3) 77yo M w 1 episode of "forgetfulness" yesterday morning - all lytes, VS, and imaging dead normal
1) 74yo F w progressive bulbar palsy fell and bruised her hip (all images negative), need admission for "pain control" (required a whopping 1mg dilauded in 24hr).
Oh yeah, her husband "can't handle her any more at home" -- just before a holiday weekend, so we get to babysit while he gets a holiday
2) 81yo M w progressive SOB ("for unknown length of time" - oh, O2 sat of 98%) - 320 lbs, bedbound. We diagnosed him w COPD 10 days ago, but now can't get rid of him because he lives in a true sh!thole of a house - 3 floors literally falling down around him, no working plumbing, dead rats (!), packrat (minimal pathways through mounds or rotting "stuff") - he's refusing a nursing facility ("because mom and dad died in one") ---> my staff's comment, "we just can't let him go back to that house".... (forget the fact that he's a competent adult who's *chosing* to go there).... AUAUAUAUGH
3) 77yo M w 1 episode of "forgetfulness" yesterday morning - all lytes, VS, and imaging dead normal
How about- "My blood sugar is out of control. It's way too hard to shop and get the food I like and control my diabetes. My (illusive) diabetic neuropathy is so bad right now and only percocet will help. Also I need gravol. My throat is feeling a bit itchy and I know that benadryl helps. By the way, a girl's elbows could get chapped on these sheets... would you fetch me some moisturizer kiddo?"
OR- My f'n back is killing me. I sold my fentanyl patches and now I hurt so bad. You gotta admitt me and take care of this pain."
SAD TRUTH- both were admitted.
Three posts in one day?
Who are you and what have you done with Scalpel?
We have a couple of docs like this. The flip side is that we have a couple of docs like the following:
Me: She's 76, has diabetes, high cholesterol, strong family history, known cardiac disease, she smokes, and she has had an hour of waxing and waning crushing chest pain.
PCP: Are her enzymes positive?
Me: No
PCP: Does her EKG show any changes?
Me: No
PCP: So why the hell are you admitting her? Send her home. Her cath from 1998 showed no change from previous.
Me: You want her on tele or the unit, then?
I wouldn't put gastroparetics in that group scalpel (ie. most in that group are pains in the a$$). As you well know a couple days without any oral intake and these people are pretty dehydrated. Even G-J tubes don't seem to help the bad ones. Maybe the gastric pacing will live up to the hype. It is really too bad that the JD lawsuits/FDA got rid of cisapride. It really did seem to be the most effective medication for severe gastroparesis. It should have been a med of last resort instead of essentially banned (yes you can apparantly still get it direct from the manufacterer, but try finding a GI doc who will prescribe it).
God, why do people WANT to be admitted? I didn't want to be there any of the four times (3 childbirths, 1 emergency surgery) I had to be.
Hell, I checked out AMA after my first daughter was born because they didn't tell me in advance I was supposed to have someone pick me up from the hospital (this was when my husband was deployed). I really don't get staying any longer than absolutely necessary.
Never knew much about their medical history because I was a greeter but --
1) woman REALLY wants her father (~90ish?) admitted for shoulder-arm pain. Keeps repeating to me how he's the "rock" of the family & that he needs to be admitted for the drs to "figure everything out." (That's always what they say, right? You have to be admitted for the docs to "figure everything out" -- disregarding OP follow-ups or even the fact that an admit doesn't always equal finding out what the hell is wrong.) Anyway, got progressively more upset because she REALLY WANTED HIM ADMITTED BECAUSE HE WAS "THE ROCK" OF THE FAMILY. I think she was dealing with the fact that he's probably gonna die soon.
2) The out-of-towners who just show up at the ER with X person who needs to be admitted for Y zebra-diagnosis. They don't have a specialist/dr with admitting privs to the hospital but keep coming back to the ER (literally day after day) until they're admitted.
3) The more general category of people who come to the ER expecting to be admitted because their dr told them to go to the ER. Or the nice lady at Walgreen's told them to come to the ER. (Or their PCP told them that he'd "call ahead" for admission but of course he doesn't and the ER docs can't really find anything to admit for.)
4) But then again /I'm/ a long-term psych patient who has had varying success with purely OP treatment. I know when I'm going to be admitted -- so I do usually show up with a backpack of clothing. Although I would never put myself in the same "category of suffering" I have noticed the same with people who suffer from serious chronic conditions like CF or sickle-cell.
My personal favorite is the patient who comes to the ER to be admitted to "figure out what's going on" with three or four chronic complaints that have not been assigned a satisfying diagnosis because the outpatient work-up is not proceeding quickly enough. In attempting to send one such individual home as none of her unrelated, chronic issues warranted admission, her argument against discharge was, "Well, what's this rash then?" as she gestured to her legs. "How long have you had that rash?" I asked. "For at LEAST six months!" she stated. "I think you need to see a dermatologist about that rash, then," I replied. "I already did! He didn't know what it was!" she exclaims indignantly. "I don't think we're going to be figuring it out in the emergency department tonight, ma'am," I state. And then she "humph!"ed at me and I discharged her.
You poor babies. Maybe you're in the wrong line of work.
anonymous says: "You poor babies. Maybe you're in the wrong line of work."
... and that is why I don't allow anonymous posting on my blog.
My personal favorite:
"I got thrown out of the homeless shelter so you have to give me a place to fu%king stay"
"... and that is why I don't allow anonymous posting on my blog."
The thrill of poking someone with a pointed stick comes from hearing their lamentations.
First patient of my day, "Lyme disease flare up." Requesting to be admitted for therapeutic Dilaudid loading.
Discharged 15 minutes after seeing her. I am not pain management.
I'm just curious about all of you blogging nurses who brag about how crappy you treat suicidal idealiation, considering suicide, and suicide attempt patients... do you really do so in real life, or is it all made for blog view? Let's hope so, and leave it at that!
Yours,
A Psychiatric Nurse 10+ years
In the ER, we generally dislike any self-inflicted problems. COPD'ers who continue to smoke and come in short of breath. Dialysis patients who habitually miss dialysis and skip meds and only come to us when they are near death. Cirrhotics and pancreatitis patients who continue to drink. Alcoholics and drug addicts who can't handle their shit. And yes, even those tormented souls with suicide gestures who are usually just seeking attention.
That doesn't mean we treat them poorly. I don't have to like someone or approve of their behavior to provide them with good medical care.
I think there is a growing trend among physicians, at least that I've observed, which suggests docs just don't like people. I'm not saying that's a bad thing. Perhaps the monotony, as in any profession, eventually wears away what the bleeding hearts would call your humanity. Although I guess with any social service, which I guess is what health care has become, you're going to have people who abuse and misuse the system. That has to be irritating as well. After a while everyone might start to look like the drug seeker or the lonely guy who just wants attention. I'm not sure how you do it.
I don't like people. I know that I could not handle it. And for me I would have a hard time dehumanizing sick people or those even pretending to be sick.
That's why I teach special ed students, aka IT professional. Special ed students, aka useless computer users, aren't really people but more like organic job security. And even though I loathe them, that doesn't make me incapable of providing excellent client relations.
Meh. Client relations? Teh heh, thought of an Eliot Spitzer joke, but I'll leave it alone.
I had a #9 who was named Dionysus.
I kid you not.
I think there is a growing trend among physicians, at least that I've observed, which suggests docs just don't like people.
A lot of stupid or misinformed people (yes, those are 2 different groups) come to the ER. Can you blame them?
Anonymous 04:15 You wrote-
"I'm just curious about all of you blogging nurses who brag about how crappy you treat suicidal idealiation, considering suicide, and suicide attempt patients... do you really do so in real life, or is it all made for blog view? Let's hope so, and leave it at that!"
I don't think it is so much bragging as it is venting. Sometimes, if you don't laugh, you cry, or lose sleep..or want to run as far away from the hospital as you can get.
Moms get together with other moms and brag or vent about their kids' latest capers. Heavens- they even blog about it. This doesn't mean that they treat their children poorly.
Why do you find it so odd that nurses need to vent about working in one of the most emotionally and physically exhausting jobs that constantly brings them into contact with the bottom feeders.
Good grief, you'd think someone in the psych field would understand this.
Let the nurses vent. It's not like we can sit at the dinner table and share this crud with family or non-medical friends.
Acute care nurse who sometimes vents on blogs ;)
Good point Scalpel. Part of being a doc is being able to look past your personal prejudices and things that make you dislike, annoy, or even hate patients to give them good and appropriate medical care.
I must honestly say I've met very few doctors I liked.
I must also honestly say that if I dealt, day in & day out, with the dolts they deal with, I'd probably not like people either. Shit, I don't much like people now.
To the anonymous psych nurse:
I thought the term was "suicidal ideation." And is there any difference between that and considering suicide?
Semantically yours,
UH
How about the sicklers? We have one on our service right now who has been here for THREE WEEKS. For the last three days she has received THREE doses daily of 0.5 cc Dilaudid IV (she is written for 0.5 Q3 PRN but is obviously so comfortable she is not asking for it anymore). And has missed her evening doses of MSContin as she has been sleeping comfortably. yet on rounds she conjures up some tears and lies in bed literally shaking and complaining of pain. and keeps her fucking nasal cannula oxygen on all damn day. SO ANNOYING!!!! Why the attending won't dump her already is beyond me.
A psychiatrist once told me he hated people. Why would anyone work in psychiatry if they hate people? That's crazy.
Thank God he wasn't my doctor.
It sounds like he should have become an "IT professional" instead.
OMG, I love it. Especially since I've actually committed one of those excuses. (I'll never tell which one...)
Actually, anybody who knows me could definitely guess which one, heh...
Honestly, as someone who is a chronic self-injurer who lands in the ER several times a year for 200+ stitches (which takes a /while/)...I have never been outright mistreated by staff.
I'm usually pretty talkative during the suturing, so. Movies, TV, my studies...etc. Occasionally, yes, it turns to /why/ I continue to hurt myself like this. There is always bitterness there, both from myself and from the person treating me.
I remember one NP who was particularly angry that I was basically throwing my life away. Even as she chided me, she did her job expertly.
I would say that you tend to expect certain treatment. I can't really complain because I can see where they're coming from. Maybe that sort of insight would lead others to quit their self-harming behavior, I'm not sure.
Psych patients: Ah, breath of fresh air. The 4 Ss: Search, safety, security, social work referral. Nothing much for me to do.
I just re-read my last post. WTF? Somebody was being a frumpy old shrewd.
I <3 doctors. And computer users. And special ed kids. And Republicans. (I know, I'm splitting hairs with the last two).
I think there is a growing trend among physicians, at least that I've observed, which suggests docs just don't like people. WTF?
::shakes his head in disdain::
Hey doc. I wrote about the
The Hospital Junkie
last month.
Yes, they do exist.
Wow, I missed that one.
We're like two chefs creating totally different dishes from the same basic ingredients.
Saddest thing is the terrible waste of important resources.
Hat's off to emergency crews. I've only been once and was glad they let me go home. Hospitals are full of sick people...with germs.
I am in alot of pain,(under rib cage and stomach. for the last week , and I noticed blood in my very hard stools,( been constipated with extremley hard bowels for the last Year, the pain was just a bother at first, now it is getting constant and I look like I am 9 months pregnant( swollen) I have been told by friends and fam, to go to the ER immediatley, I really don't want too, I hate needles, what should I do?? Stacy.....
I have minor gastroparesis and end up in the hospital maybe once a year and hate every moment of it. Domperidone really helped me, but it's only available via compounding in the US.
Dom Perignon works for me too
just want to try HTML
hello to scalpel. It is a pleasure to read your blog. Thanks for keeping it real.
How's my HTML driving?
Hello to Scalpel. Thanks for keeping it real Thanks for keeping it for all. ,Thanks for keeping it real.
Thanks to Scalpel http://www.theonion.com/content/index Read Onion to spare your sanity. Good Bye.
Needs work.
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