Disclaimer: I work for two separate health care systems representing a total of about 10 facilities. I am not going to identify at which facility(ies) this occurred.
We have had this patient who has spent more than 25 days during the month of July in the hospital. It was not a 25 day admission. It has been 14 separate admissions at two facilities (in the same system). The patient always checks out AMA (against medical advice) after about day 2 (sometimes on day 3 or 4; sometimes the same day as admitted). The patient does have a medical condition (COPD), but it has never gotten better or worse in the entirety of the hospital stays. The patient has had the following services at home: home nebulizer with home deliver of drugs, home oxygen, home health (for nursing care), meals on wheels (for one hot meal a day). Every single person who has been to the patient’s house has been kicked out by the patient, and told to never come back. The patient refuses to go to a nursing home. The patient wants to be in the hospital and preferable in ICU. The hospital is like a 4-star hotel with room service. When we (health care workers) try to give the patient breathing treatments or physical therapy, the patient refuses at least half of the time. ["I don't have to do that. You can't force me]. On the last admission, the patient was convinced that he had pneumonia. There was no medical evidence to justify that pneumonia was present [no increase in white blood cell count, no fever, no opacities on chest x-ray], but the patient demanded antibiotics for his pneumonia. After 36 hours of not getting antibiotics, the patient checked himself out of the hospital AMA. This time one of the hospitalists told him that [I'm paraphrasing because I wasn't present for the entire conversation] if he left the hospital AMA that he would never be admitted to this hospital again for any reason, and that if he was back on the property he would be arrested for trespassing. The patient left anyway. [He went to the ER of another hospital in the same health care system where they also refused to admit him].
THE VERY NEXT DAY the patient once again showed up in the ER. There was no medical evidence to justify an admission, but the ER physician said ‘He sounds horrible. He needs to be admitted.’ [He sounded no different than the day before when he left AMA]. The hospitalist [not the same one as the day before, but a partner] refused to even see the patient. The ER physician huffed and puffed and yelled some more, but the hospitalist stood firm. Meanwhile, the patient is in one of the ER beds demanding DEMANDING! a sandwich and coffee from the nurses. The nurses ignored him. The patient started yelling “I’m not getting good service here. I need a sandwich.” Someone eventually told him ‘If you want a sandwich, go to a restaurant. If you want service, go to a hotel’ [ It wasn't me, and I admit that was a bit harsh.] The hospitalist and the ER physician were at a stand still that wasn’t resolved until the ER physician shift ended and a new one came one [Hosptialist shifts are 24 hours; ER shifts are 10]. The new ER physician discharge the patient [without any drugs] and told the patient that he needed to leave the premises immediately. That was on Thursday. Today is Saturday. The patient hasn’t been here since Thursday.
That is why the health care system in the US sucks. This patient will probably never pay a penny of his hospital bill(s). He has throughly abused the system treating it as if it were his own personal resort. He was abusive to the staff when he didn’t get his way, and came and went at will.
We as health care providers have the ethical obligation to treat people who are truly sick. We also are in constant fear that one wrong move will be the end of our job and/or license. Each complaint must be taken seriously because what if THIS ONE is real. Each visit to the hospital incurred charges >$5000. We have to draw blood EACH time, and take an X-ray EACH time, and pay the physicians, nurses, radiology techs to take the x-ray, the radiologists to read the x-ray, the patient registration person to register the person, an ER tech to take an EKG, and respiratory therapist to administer nebulizer treatment and draw ABGs, lab technicians to analyze the blood work. Every single time this must be done, because on the one day that something is not done, and a test shows up positive, a lawsuit appears at the door. AND EVERY SINGLE PERSON WHO TOOK PART IN THE PATIENT’S CARE IS INITIALLY NAMED. This is why our health care system if fucked up because it is cover you ass medicine-not medicine for the good of the patient, or even for the good of the facility, but medicine to prevent getting sued because a law suit cost money…even one with no merit. And that is why health care in this country is so expensive.
