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Hospitalization Vs. Discharge: When Is One The Preferred Option?

I received a call recently from an emergency room (ER) physician about a patient who presented there with rectal bleeding. Does this sound blogworthy? Hardly. We gastro physicians get this call routinely. Here’s the twist. The emergency room physician presented the case and recommended that the patient be discharged home. He was calling me to verify that our office would provide this patient with an office appointment in the near term, which we would. We had an actual dialogue.

This was a refreshing experience since the typical emergency room conversation of a rectal bleeder ends differently. Here’s what usually occurs. We are contacted and are notified that the patient has been admitted to the hospital and our in-patient consultative services are being requested. In other words, we are not called to discuss whether hospitalization is necessary, but are simply being informed that a decision has already been made.

There is a tension between emergency room physicians and the rest of us over what constitutes a reasonable threshold to hospitalize a patient. I have found that many ER docs pull the hospitalization trigger a little faster than I do. What’s my explanation for this? Here are some possibilities. Read more »

*This blog post was originally published at MD Whistleblower*

When Is It Safe For A Patient To Leave The Hospital?

When I initiate  final hospital discharge planning, I am making a clinical judgment that the patient is safe to leave the monitored confines of the hospital system. Hospital discharge planning begins on the day of admission.

Good hospitalists are always thinking in their minds how to get the patient safely discharged in the quickest, safest and most efficient way possible.

Sometimes the patient wishes to leave against the medical advice of the physician.  Sometimes they refuse to leave at the advice of the physician.  And sometimes the physician and patient agree it’s time for the next level of care. Read more »

*This blog post was originally published at The Happy Hospitalist*

When Should A Doctor Break Up With His/Her Patient?

They say that breaking up is hard to do
Now I know, I know that it’s true
Don’t say that this is the end
Instead of breaking up I wish that we were making up again

There are times that relationships need to end.  Usually something happens to undermine trust; it’s hard to build trust, but it’s very easy to destroy it.

I had a discussion today with the other physicians in my practice as to when patients should be “discharged” from our practice.  I have always found it somewhat ironic that we use the term “discharge” when we are basically telling patients we don’t want them to be our patients anymore.  Doctors deal with discharges of various sorts – most of which are not pleasant.  Here is a dictionary definition of discharge: the emission of pus, mucus, or other liquid from an orifice or from diseased tissue. True, there are other definitions of discharge that don’t cary that connotation (we discharge patients from the hospital), but if I see an appointment on my schedule with the word discharge as part of the reason for visit, I am not excited.  I am praying for a no-show. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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