Tuesday, May 1, 2007

UNSAFE DISCHARGE

I work in a nursing home and a patient who was admitted after a hospitalization for alcohol withdrawal is apparently being considered for discharge. However, he is not participating well in his rehab, and the physical therapists are writing that he is “unsteady” and “at high risk of falls”.

Fine. So they are looking to me to discharge him and I’m like “PT is writing that this guy isn’t steady and you want me to just sign off on his discharge?” The head of PT insists this is fine, and that “It’s up to the doctor to discharge”. Right in front of a family member. Thanks a lot for selling me out.

I can just see what will happen. He goes home, falls, hits his head, is found days later in a coma. Then I’m dragged into court with some lowlife attorney saying “Well, YOU’RE the doctor, YOU should have known it wasn’t safe to send this man home.” None of these ancillary staff people can understand this level of liability. At a “multidisciplinary meeting” (similar to having root canal, but no anesthesia) I ask “Do you have a med alert bracelet”? Get this: the patient doesn’t even have a PHONE! And I’m the only one who asked this. The social worker didn’t know.

I just hate this trend where doctors have become social workers. Even in the office, you have to consider not just the treatment, but the COST of the drug. You don’t just consider the test, but which LAB you have to send the patient so their insurance will cover the test. This is not what I was trained to do, and I don’t understand how medical doctors became responsible for so many of these issues. No wonder we don’t have time to keep up on new developments or talk with the patient.

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