Baloney. Admission is a medical procedure that has risks as well as benefits. Patients should be assessed before any procedure to determine if the risks exceed the benefits. If they don’t, then you don’t do the procedure. The risks if psychiatric hospitalization in a patient who is factitious are numerous including positive reinforcement of dyfunctional behavior, injury of or by other patients. opportunity for further manipulation for drugs of abuse, reinforcement and reward of avoidance of responsibility. In short, when it isn’t needed, it may well make the patient worse. The problem is that most admissions in my community don’t include a qualified assessment. The ER docs (understandably) just write “SI” and the psychiatrists often don’t see the patient until three days after admission.

I treat patients in my office with “SI” every day of their lives, without admitting them to the hospital. I have sent hundreds of patients home from ER’s following wrist slashings, overdoses, and threats of the same without losing one. Even if I did lose one, it doesn’t mean that the risk wasn’t worth it for avoiding the deleterius consequences of inpatient treatment.

Doctors are paid to think and exercise judgements, not engage in kneejerk protocol application.