Sunday, October 27, 2013

This is a Hospital, NOT a Hotel

      I had no idea until I started my intern year, that people are very resistant to leaving the hospital. At least the people that reside in this borough of NYC. It makes little sense to me really, I mean, who wants to be in a hospital?  80% of my patients apparently. If I were a patient and the doctor told me that I could leave, I would jump for joy. However, it is usually a fight to get my patients to leave when we are done caring for them medically. Technically, we need to give them 24 hours notice that they are being discharged, and then they HAVE to leave, but we never do that here. The thing that disturbs me the most, is that the social workers, doctors, nurses, and everyone else taking care of the patients here just allow them to stay. As if this were a hotel. Which it kind of is to them. They are waited on hand and foot, get their meals brought to them in bed, get great pain medications, sleep aids if they need them, and individualized attention that this population of people likely do not get at home. Here is MY problem though: This is a city hospital, and the bill is paid for by you and I and all of the other taxpayers contributing to both Medicare and Medicaid. PLUS staying in the hospital makes patients sicker (they pick up infections, pneumonia, etc. from just sitting here) which leads to further problems in general. I have had patients refuse to leave because they claim they have no ride home. There are always buses and cabs (at least in my world). "How much does a cab cost?" they have asked before stating "What is the big deal if I stay another night here?" Well, I want to tell them (but I don't), a cab is about $25 dollars, and another night here is at least $1,000 of the tax payers money. So really, they mean what is another night to them. Nothing. It is all of the people collectively that use the hospital as if it were a hotel that is taking a big toll on our healthcare system. If we took all of the money that is thrown in the garbage by allowing people to stay in the hospital when they need no further medical treatment, it would allow us to channel it towards a lot of other people who need healthcare but do not get it.

P.S: I have had the son of a patient ask if we could keep his mother here for the week while his family went on vacation. Note to all: if the hospital is not a hotel, it is certainly not a kennel.

P.P.S: I have also had "social admits," for example, a man who was admitted because his wife broke her hip (and was a patient on the ortho service), even though there was nothing wrong with him. I was told that because he was dependent on his wife for his activities of daily living, there was apparently no other option.

P.P.P.S: Last week, I had a patient who was sneaking candy so her finger stick glucose values would shoot up and we would not be able to discharge her.

P.P.P.P.S:  I have been told that by the end of the year I will be so jaded by all of these social issues that I will not feel the need to comment or worry about them anymore. I guess we will see.

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