Leaving AMA
I have had three patients leave AMA (against medical advice) this week. Though it significantly lightened my patient load, I still have been a little irked by it. If I have patients that insist on leaving, I at least try to give them prescriptions for medicines they will need before they go, but all three of these patients left abruptly at night. By the time I had heard about it, they were gone.
One was a lady with COPD and pneumonia who left because I wouldn't let her go outside and smoke. Two were alcoholics being treated for various alcohol-related disorders who left to resume drinking. Maybe I should start ordering beer and cigarettes for my patients so they will stay for treatment. But wait, those are the things that got them there in the first place. Imagine what ER's around the country would be like if there was no smoking and no drinking. Most would have to shut down for lack of business.
Or, as I heard from an ER attending, we could do what one large hospital in Chicago did. They added a one dollar charge at the entrance gate for their ER's parking garage. This small change led to car after car pulling up to the gate and then backing out and driving away. Their patient volume literally fell by 50%. It's scary the abuse of ER's in this country. People go to the ER to get out of going to jail, to get med refills, to have a place to sleep, to get some food...almost everything but to get medical care for a real medical emergency. I guess we still have those too, but it's still a problem. Whew, I guess I had to get that off my chest.
One was a lady with COPD and pneumonia who left because I wouldn't let her go outside and smoke. Two were alcoholics being treated for various alcohol-related disorders who left to resume drinking. Maybe I should start ordering beer and cigarettes for my patients so they will stay for treatment. But wait, those are the things that got them there in the first place. Imagine what ER's around the country would be like if there was no smoking and no drinking. Most would have to shut down for lack of business.
Or, as I heard from an ER attending, we could do what one large hospital in Chicago did. They added a one dollar charge at the entrance gate for their ER's parking garage. This small change led to car after car pulling up to the gate and then backing out and driving away. Their patient volume literally fell by 50%. It's scary the abuse of ER's in this country. People go to the ER to get out of going to jail, to get med refills, to have a place to sleep, to get some food...almost everything but to get medical care for a real medical emergency. I guess we still have those too, but it's still a problem. Whew, I guess I had to get that off my chest.
posted by Victor | 11:36 PM
1 Comments:
regretably impractically, that probably just expands the meaning of 'do no harm'. And it expands your sphere of care for people as well.
Now, are resources that could better be spent on those sincerely needing care getting wasted on the others? That's a problem.
And concerning the hospital in Chicago, I wonder if that practice has detracted a number of persons from seeking the medical care that they really need. Many people (certainly not a majority) might have a tendency to ignorantly disregard the urgency of their need for emergency care. Probably not the majority though.
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