Yes, this is me ranting and it is a constant frustration that is faced when dealing with an acute population.

This was the phone call that broke the silence of my office. My old friend, the ER, was calling to talk about a new admit. “I need to find a bed for…” I was reading the patient’s chart with astonishment. I struggled to find any diagnosis, besides substance use, that the patient had for multiple years with little or no effort on his part to participate in treatment. He was otherwise as stable as could be, except for supposed alcohol withdrawal. His blood alcohol was zero, and he had no active symptoms of withdrawals. No shakes, sweats, seizures, jitters, or anything. When asked, he told us, I just need to stop drinking. Ok, well, that’s a great goal. Aren’t we a little too restrictive of an environment for this? We have a locked unit with no exceptions.

I was livid, and I told the ER folks this. The patient was not even medically compromised, but yet it was essential to admit this patient. We frequently run out of beds and have to farm people to other hospitals, which is an expensive prospect. Out of system can cost us somewhere in the neighborhood of five grand a night. Seriously? While I have discussed the need for provider-level care in long term alcoholic withdrawals, every time an alcoholic stops drinking does not require medical supervision. As he was stable, we go back to no medical need.

The evidence does not support inpatient treatment (hearing a theme here?). The best course is to detox or what is called drying out and then abstaining from alcohol. In the process, you are able to begin outpatient treatment. This patient was already aligned with outpatient treatment and could very easily meet with those services…So why inpatient? There is no reason, and it is counter-productive (Is the horse dead enough?).

So, hanging my head, I finally had the admission thrown at me, and I shrugged and said, ok. During the admission of the patient, who was voluntary, he continually asked about using his own cell phone, being on a computer, contacting people at odd hours, and name dropping in the first five minutes. For Pete’s sake, I couldn’t even do the most basic physical assessment without being bombarded. Ugh, seriously dude? He even goes so far as to say that coming in may have been a bad idea since he had way too much to do. So, an overall waste.

I guess at the end of it, going to the hospital may not be the best answer for everyone. We put way too much stock in constant care. I am always here if there’s an actual need.

The hounds are restless at my feet. Maybe they can sense the agitation or perhaps who they had for supper isn’t sitting well with them.