Admission Right, Discharge Privilege?

“…Whether ’tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles, and by opposing end them? To die: to sleep; no more; and by a sleep to say we end.”
-(Bill Shaky)

The following is a paraphrased extract of a great segment on “White Coat’s Call Room” about the age old battle of ED vs. speciality teams in the biggest point of contention in our interactions. The full story can be read here, and is well worth a look.

“I have found that some doctors who haven’t even examined the patients like to make snap judgements over the phone and risk my license by telling me to sign my name to discharge orders when I think patients do need to be admitted…
…If I call a doc and think a patient needs to be admitted and the admitting doc or consultant doesn’t think so, I respect that physician’s opinion. Then I ask the doc to come to the emergency department, examine the patient, and write the discharge orders themselves…
…After a while, the docs begin to trust my opinion. Either that or they learn that they are either going to have to admit the patient or come in to discharge the patient and that they won’t win an argument with me…
…Odd thing is that of all the docs who actually…show up in the ED, I can only remember one time in the past 10 years when a doc has come to the emergency department and discharged someone I thought needed to be admitted…
…If you disagree with a decision to admit a patient, first realize that each doc has different practice patterns and you are not the yardstick by which the practice of medicine is measured…
…If you want to have a discussion about whether a patient needs to be admitted, I’m all for it. But the conversation is going to be in person. And you can write the discharge order when we’re done….”

My own take on this: Remember, YOU are the patient’s advocate, and what’s more, you have actually seen them, talked to them and laid hands on them. Your gestalt should not be derailled by the opinion of someone who hasn’t done those things and as yet has little or no sense of responsibility for your patient (they do in fact share an extent of responsibility medicolegally once consulted, but most often, they don’t actually CARE yet). If they do not trust your assessment, all the more reason they should come and see the patient. I bet that 99% of the time, they won’t send them home either, and if they do, that is their privilege AND THEIR RESPONSIBILITY.

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About dreapadoir

Emergency Physician, author of http://underneathEM.com Emergency Medicine blog, photographer at http://www.dreapadoir.com
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