And that is why we will spend an entire summer fighting this. Even though I have been a bitch about my recent injury, I am staying away from the hospital. We need to stop the expectation of hospital admission. We also need to stop casually admitting people to our wards.

Right now, amid this pandemic, maybe as responsible healthcare providers, we need to cut down what we call “soft admissions.” These are admissions where there is no definitive acute reason to admit; we are just doing because the patient wants it. Or, more often than not, the family is trying to dump a situation that is not acute, but they are tired of handling.  You know this would be easier if we did something about healthcare in this country, besides voting in people who want to get rid of it.

(Back to the rant) Well, I am sorry, kids, but in case you haven’t seen, we are amid a pandemic.

We are very soon in many areas, and already in many regions, taxing our frontline medical resource.

Last night was a great example of this. A patient presented to the ER wanting to “get back on their meds.” He had been released from jail and did not like the answer he received from Outpatient Mental Health because it would take a couple of weeks.  So off to the ER and a social worker who is completely incompetent practically sold this guy up for admission to the ER attending. As a hospitalist, I was presented with a fait accompli, which I should never be presented with or have a patient shoved on my service.

Look, I get it that the guy would like to get his shit together, but as I have said prior to this, it does not require admission on a locked unit. These are the kind of things that can be and are better-done outpatient, even in good times.  Because you are having a tough time, it does not require the highest level of restriction in your care.  We meet too many providers that are afraid to tell a patient, “Hey, I know its rough, but let’s get you set up outpatient.  There is no need to come right in and be in the hospital.

Now we have a fucking pandemic.  I don’t care if you believe it or not, but very soon, our hospital will be overwhelmed, and this kind of admission puts both the patient and our inpatient population at risk. (this patient came from an institutional setting with positive COVID cases.

Look, I am sorry that you are voluntarily off your meds for ten months, and then all the sudden decide you need to be in the hospital because waiting for shit to settle down and go to outpatient is too much effort.

We cannot make soft admissions like this for a short bit (and perhaps longer). It is not safe for the service; it is not safe for acute patients on service; it is not safe for that patient. Why the actual fuck do we insist on pushing an admission on someone who is not a danger to themselves or others.

As a whole frontline providers/prescribers/folks with admitting privileges, we need to enforce this behavior, even if it makes patients make a little extra effort.

Oh well, half this country is listening to the kid who licked windows in grade school trying to sell the country on his version of medicine.

Please, the kind of person your dog and your mom hope you are.