Val Jones with a case where the ER doc is damned if he does, or doesn’t. A patient, whose father is a significant donor to the hospital, insists on being admitted. Fallout ensues:
The son of a business tycoon experienced some diarrhea. He went to his local emergency room immediately, explaining to the staff who his father was, and that he required immediate treatment.Because of his father’s influence, the man was indeed seen immediately. The physicians soon realized, however, that there was nothing emergent about this man’s complaints . . .
The man complained bitterly and said that he wanted to be admitted to the hospital. The physicians, with respect, explained that he didn’t show any signs of dehydration, that he had no fever, his diarrhea was indeed fairly mild (he had only gone to the restroom once during the hours of his ED visit ““ and that was when he was asked to produce a stool sample). The man’s pulse was in the 70’s and he had no acute abdominal tenderness.
The man left in a huff, and called his father to reign down sulfur on the ED that wouldn’t admit him.
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{ 12 comments }
Wow! patient autonomy to the extreme. This reminds me of during residency, at a large NYC teaching hospital, the top floor was a “VIP” floor, with single rooms, plush carpeting, hushed alarm bells, etc.
Patients admitted there were always relatively well, and if something did change, e.g. typical chest pain necessitating transfer to telemetry, it always raised a ruckus between joe-hedgefund and the staff.
Even back then, doctors & other clinical staff always caved to administration, and then are alone justifying that decision from a medical standpoint. Needless to say, there was lots of “chart doctoring” justifying both admission and remaining inappropriately on a poorly monitored unit.
it was, however, run by marriot. so as a resident it was always great to get breakfast there post-call from the icu!
Some aspects of reality can be so disheartening. Arrogance at its best.
I would have admitted him, then subjected him to every invasive, uncomfortable test possible… you know, just to make sure there wasn’t a more serious underlying cause
Not that you legally/ethically could, but it’s nice to dream.
the missing order on the chart:
“enemas until clear, then 5 more”
I would have just done what the patient or his son wanted. I would not have fought or be passive aggressive. There are so many battles to fight during my 12 hr shift and this one I know I will not win. I would quickly dump this one on the hospitalist or the on call Internist and let him be the one to deal with him. With difficult patients, I always ask a nurse to be in the room and be a witness to the interview and exam.
I had an aunt who was a wealthy small town matriarch. She built a wing with about 10 or so rooms and a nursing station onto the small local hospital in the 1960’s. She had the architects include her own personal room in the design. When she was feeling poorly she would check in there and be tended to until she felt better and could go home. When she did not require her room it was open to hospital to use as they wanted. I think that the hospital and the town did pretty well out of the deal.
I’m glad your Aunt never contracted VISA or C. Diff. There are sound non-financial reasons we don’t admit well patients to the hospital. It is the job of the doctor to explain these things to the patient even if they don’t want to hear it.
The same logic holds true for antibiotics for viral URIs and indiscriminate uses of benzos and narcs. Sometimes doing the right thing makes the patients mad. But you have to do the right thing, otherwise you are a coward and a poor doctor.
b
I don’t think I would fight it. I would explain to him why hospitals are not a safe place to be if you don’t need to, If he still was demanding, I would just admit, if the beds were available. If they are major donors, and there isn’t a bed crunch, they aren’t taking something away from someone else–and it is less risky than all of these unnecessary cosmetic procedures that people get.
If someone else needed the bed, I would stand my ground and let the chips fall where they may. The nice thing about a medical liscense is that you can always get another job–there is no reason to violate your personal standards.
It is exactly this type of scenario that makes me so thankful I practice medicine in Canada. Although it does happen rarely, for the most part patients realize they can’t buy their way into unnecessary treatments, investigations, or hospitalizations. Thank God for the public health care system!
I would have admitted him. Anyone naive enough to think there are not VIP’s for healthcare services as in anything else is, well, just naive. How do you think many competitive medical school and residency slots are awarded? DUH! How many of you know doctors who didn’t “make the grade” but got a competitive slot ahead of more qualified candidates? Wake up and smell the coffee. Money makes the world go round, and in these financially challenged times a hospital cannot afford to jeopardize private dollars.
How is this significantly different from “professional courtesy”? My boss (married to a dentist) was billed squat by an oral/maxillofacial surgeon even without having donated a dime to the clinic. That’s not “bullying” anybody…it’s the provider recognizing that there will be personal gain by extending a favor — in this case, to someone who did nothing to deserve it except marry right. At least the “benefactors” described in these posts already made some contributions. (Yes, they do sound like idiots.)
I know one thing that would have cured this young man’s demand for admission. The doctor should have done a rectal exam. Isn’t that mandatory in all GI cases?
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