Both Sides Now

Occasionally, the emergency department and admitting teams disagree on whether a patient needs to come into the hospital. Although for many, the decision is clear-cut, for some it's not easy to know when to pull the trigger. Emergency doctors err on the conservative side and want to admit patients; their role is to stabilize a patient for further care. Admitting teams know the natural history of diseases and identify borderline patients as not-needing inpatient hospitalization. On the medicine side, I've taken many patients where I wasn't convinced of the necessity for inpatient hospitalization. And with the exception of a few diseases (such as PORT score for pneumonia), there aren't always objective criteria of who needs to stay and who can go with close followup.

Now I get to see the other side. There are patients who are borderline admissions and yet I am asked to call medicine and find them a floor bed. Occasionally it is because a diagnosis is not certain. Other times, the justification is legal (if they want to discharge this patient from the emergency department, they need to come put their name in the chart). And it can be incredibly frustrating when I know that the admitting teams think our requests are unnecessary. But hospital politics are here to stay, and I try not to get in the way too much.