Blog | Monday, August 13, 2012

I have an admission for you: I don't know what to do with this patient


I will be the first to admit that emergency departments are overloaded and their docs work very hard. But sometimes as a hospitalist getting slammed with his tenth admission in the last hour it seems like the ED has a handful of diagnoses, nay excuses, for getting the patient into the hospital rather than back on the street:

Chez Pane - If the patient has pain, pressure, or nonspecific discomfort below the ears and above the navel it is cardiac in nature. Regardless of duration this requires admission and serial sets of enzymes. This is actually French for "bring home the bread," as without these admissions the medical system would go bankrupt.

New Moan Ya - A serious infection requiring intravenous antibiotics that is evidenced by an abnormality detected on a chest X-ray by the ED physician regardless of the absence of fever, cough, sputum, or leukocytosis. The abnormality, called an infiltrate, cannot be detected by anyone else.

CHF-U - Any patient with an elevated BNP has decompensated heart failure, regardless of signs, symptoms or benign radiography. These patients get a magical drug called Lasix, which makes them urinate a lot so they are often also diagnosed with You Tee Eye.

Old - The patient is older than 65, takes medications, has a completely negative work-up, and wants to go home. However they are old, and despite having taken care of themselves their entire lives and having no medical complaints they need to be admitted.

Sell You Light Us - If the skin is red and/or swollen it is infection and requires intravenous antibiotics, regardless of clinical history, bilateral presentation, absence of fever, or normal white blood cell count, even if they have a mouth, are not septic, and have not tried oral antibiotics.

Sink Opie - Any hint of possible loss of consciousness or vertigo regardless of age, history, risk factors, and work-up has an insanely high risk of sudden cardiac death.

Stroke'n it - Any change in sensation, motor function, sensorium or headache is a cerebral vascular accident, regardless of physiological impossibility of the neurological complaint and ready availability of an MRI.

You Tee Eye - When late for a golf date, any abnormal urine analysis despite absence of urinary symptoms, fever or leukocytosis is concrete evidence of a urinary tract infection requiring intravenous antibiotics.

I kid. I kid.

ACP Member Mike Aref, MD, PhD, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging. This post originally appeared at his blog, I'm dok.