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,
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
out of money for crack
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....
Labels: ER, excuses, patients