A Happy Hospitalist: I Wonder If I Should Recommend A Divorce

A Happy Hospitalist: I Wonder If I Should Recommend A Divorce.

Perhaps this is one Happy quote I do totally agree with:

He said I was treating her like baby and told me not to come back.

Which is fine. Except that attitude is a major part of the problem. Perhaps adults who act like babies, adults fully incapable of making grown up decisions (like showing some initiative in their own disease management); Maybe they should be treated like children.

I don’t know what to do for someone who chooses not to help themselves. Free will is a powerful thing. But it works both ways. All I can do is make sure we do everything within our power to remove the barriers to patient’s care. And hope they make the right decisions for themselves and their family.

It’s funny we were just talking about patient responsibility this week at work and how that should play into the reforms slated to take place in health care.  I’m of the nature that says, “You can do whatever you want.  BUT.  You must be willing to take responsibility for your actions.”  And that is the problem with so many of our gomers.  They refuse to take care of themselves and end up back in our halls time and time again.

Take for example the twin renal patients who by all accounts have used up their money from the MNB (I didn’t know that was possible to do, so that assumption may be wrong).  They spend months at a time in-house, then get discharged.  And when they get sick again, because they live 200+ miles away, they get Lifeflighted back to our hospital – because that is where their docs practice and they refuse to live closer.

Or the young (under 50) gentleman who is already in ESRD due to uncontrolled diabetes.  Last A1C was something like 14.  As he’s sitting with a CBG (actually serum glucose beacuse the meter just read “HIGH”) of 520mg/dl, says, “So can I have 2 bowls of Cheerios to go with the sandwich I have in my bag?”  And these are just a few of our frequent flyers.

So many are just the same.  They decide that they don’t want to take their meds, or won’t go to the pharmacy to pick them up, or decide that 3 times a week dialysis cramps their busy social schedule too much and only go twice, think that movie theater popcorn and Wendy’s is an essential part of a low-salt diet or think nothing of just stopping their Lasix one day out of the blue.  They come in all saying, “I don’t know what happened!  I was doing everything I should!”  And we spend hours trying in vain to (re)educate them, hoping that they will not bounce back once we turn them loose.

Part of me says, “Fuck ’em.  They’re not willing to take an active role in their health care, they shouldn’t get any more than the barest of minimums.”  Research has shown that the management of chronic diseases is the one that saps the most money out of our health care and while the specter of paying for outcomes instead of fee-for-service may be a valuable tool to prod docs (and nurses!) into more productive engagements with their patients, this too is a two-way street.  All the teaching, even if done in the most agreed upon, for sure to work approach, most interdisciplinary method possible will never work if the recipient of said information is not willing to put it to work and practice the concepts we teach.  Maybe those that refuse to do this should be excluded, be given a certain amount of chances, document the refusals, then at a certain point, begin to withhold all but the most basic of care.

The other part says that maybe if we keep doing what we’re doing, it will sooner or later sink in and the habits will start to change.  Plant a seed and all that crap.  The problem there is we cannot continue the status quo.  Something will break and it isn’t going to be the patients.

And as for our ideas about reforming health care, we all conceded one point:  the paradigm of health care must change but that entails a societal shift in values.  More prevention, less end-of-life heroics with the understanding that death is a part of life and the reduction (some argue by any means) of non-compliance with medical therapy.  It sounds harsh, but we are reaping what we’ve sown.  The American Entitlement attitude has led us to this point and it will only be by changing that attitude will we be able to fix the probelm we’re in.  And if that means treating adults like children when they are acting that way, so be it.



  1. Everybody is a victim. I had an ESRD patient my age who drove me nuts, when I got to admit her for the second time one year on a major holiday, which I had to work on another unit.

    She just never wanted to take her amiodarone, “because”. I just wanted to tell her, “Please have your arrhythmia at home alone, so your idiot husband doesn’t save anything else for us to amputate.” (she also was a repeat amputee).

    We’re not a hotel, for when you don’t pay your utilities, we’re a hospital. If you don’t want to comply, be non-compliant on your own.


  2. I agree with this post wholeheartedly. I am a strong advocate of being a proactive patient, however what does a patient do when their own Drs are obstructive and wont be honest about their medical state, care etc because of a medical mishap from another Dr two years earlier. No the patient cant change Dr because they are all partners in the same town. This leaves a frustrated patient who is now hypervigilent and non trusting of their Dr.


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