Rocks

In perhaps a not-entirely-appropriate manner, we sometimes refer to patients who will be in the hospital forever as "rocks." Every service has a couple of people who for various reasons, simply have no discharge plan. For example, I am taking care of a very pleasant woman whose medical problems have resolved but due to her long hospitalization, she is too weak to walk. My plan for her every day is to work with physical therapy. Unfortunately, she is homeless and has no money. For those with insurance, a reasonable plan would be a skilled nursing facility where she can get therapy and regain her strength. But because she has no insurance, she stays in an acute hospital bed, a level of care that is way higher than what she actually needs. Furthermore, because she is homeless, she has an incentive not to learn to walk because we would then send her to a homeless shelter or medical respite.

We see this all the time; the uninsured and underinsured cost the health care system way more because of that. In a time when there are not enough doctors, not enough hospital beds, not enough nurses, we need to triage patients to the places that are most suitable for them. I hope that requiring universal health coverage may ameliorate this situation, but the truth is that it may not; people may still be underinsured if skilled nursing facilities cherry-pick the patients with the best insurance. This situation reminds me that medicine is entirely a social affair and doctors must be advocates for social justice.