“My doctor told me to come get admitted”
Posted by Amy on March 13, 2007
Almost every shift I work, I get a patient who was “sent by my primary care doctor to get admitted”. These are often extremely frustrating situations, for both me and the patient, if poorly executed by the PCP. There is definitely a right and a wrong way to refer a patient to the ED.
Some PCP’s do it right. Maybe they saw the patient in their office earlier in the day and thought the patient needed more tests/xrays/labs and possible admission so they call ahead to the ED to give us a heads-up. Or, maybe the patient called the PCP and couldn’t be seen, but clearly had a life-threatening emergency (chest pain, shortness of breath, left arm hanging off) and so was told to go directly to the ED.
Then there’s the wrong way to do it. The PCP is too busy to deal with the patient in person, so they tell them to go to the ER. Okay, I’m fine with that. What I’m not fine with is when the same PCP, after having never layed eyes on the patient, tells him “to go to the ER to get admitted”. Why would they do this? They haven’t seen the patient. They have no idea if the patient is sick enough to get admitted. And, they invariably don’t admit their own patients (they let the hospitalist admit for them).
For example, last week I saw a middle-aged Type II (adult onset) diabetic patient who said his PCP’s office had called him because his sugar was high on a previous blood-draw and told him to go to the ED to get admitted. He had spent the previous day in our ED, ruling out a blood clot in the leg, and was not happy to be back, but had followed his PCP’s instructions and returned. He waited for an hour or two in triage. He waited to see me. He waited as I did more blood tests to rule out serious salt or acid/base imbalances. And then I got to tell him that he didn’t, in fact, need to be admitted. Yes, his sugar was high (400’s) but everything else was just fine. I talked to his PCP on the phone and she agreed that the patient didn’t actually need to stay in the hospital. But, I’m the one who had to break the news to the patient. He got really upset (understandably) and demanded to be admitted. Great, now I’m the bad guy.
In the end, no amount of explaining or reasoning could make my patient understand. He started crying and I finally broke down and admitted him. When the hospitalist asked the reason, all I could say was “hyperglycemia and tears”.