Five minutes pass, followed by ten more minutes. A 30-minute office procedure to place an ear tube has ballooned into close to an hour without the doctor emerging. I walk around, reassuring patients that the doctor would be entering their room shortly. Another five minutes pass before the doctor walks out of the procedure room. As I prepared to give a summary of the next patient, he calmly asks me to call the hospital emergency room so that he could admit the patient.
I stare at him blankly for a heartbeat as everyone stops what he or she is doing. Another heartbeat passes before the office staff members spring into practiced protocols. The front desk calls the special hospital line, the medical assistants begin to reschedule other patients, and I start gathering intake documents such as insurance, medication allergies, and pertinent past medical history. Three minutes later, the ambulance whisks the patient off to the neighboring hospital.
Image Source: Peter Macdiarmid
“Admitting a patient” refers to the practice of having a patient hospitalized for extended monitoring or treatment. Life-threatening conditions–such as a heart attack, acute kidney failure or sepsis–all factor into the decision to admit a patient or transfer them to another hospital for admission. For non-life threatening cases, studies show that the odds of getting admitted vary widely, especially when controlling patients’ other health conditions, age, gender, and insurance status. Ultimately, the doctors have the final discretion to decide when to admit, a decision dependent on factors such as perceived immediate danger to health, public safety risk, and others. Current research looks to developing standardized protocols, thus minimizing unnecessary emergency room visits.
As an alternative to the admit/not admit dilemma, doctors may also place patients on outpatient “observation” status if it is not clear whether they will need hospitalization for a medical condition. Outpatient observation allows doctors to monitor a patient’s condition in order to determine whether it is necessary to admit him or her. Wait-and-see protocols, in which the doctor informs the patient to observe for certain deteriorating symptoms, also provide a substitute to hospital admission.
The following day, the doctor informed me that the patient was doing fine and was discharged in the morning. Following the procedure, the patient felt extremely disoriented and was unable to stand. Coupled with the past health history of transient ischemic attacks (mini-strokes), the doctor erred on the side of caution and wanted to make sure that the patient was not having a full-fledged stroke. Suffice to say, the decision to admit or not admit a patient inhabits a gray area. The guiding principle, however, should be one familiar to all doctors: “First, do no harm“.
Feature Image Source: Justin Chin