Hospital Junkie? Who Are They and What Do They Want?

There is a certain population that thrives on hospitalization. It's pathological. A normal person hates being confined  in the the hospital. But the hospital junkie is different. Between the uncomfortable beds, the constant blips and beeps, the IVs, the telemetry, the constant conversation of nurses telling stories and the controlled diet that often tastes like wax paper, any normal human being would be itching to leave the hospital as soon as possible.

You would think.

But not the hospital junkie. In my five years as a hospitalist, I have learned there is a very large and defined group of people who thrive on being admitted. I call them the hospital junkies. They are a unique  group. They are the folks who come with their suitcase. They are the folks who know the nurse names by heart. They  request to be admitted to certain wings. They are the folks who take no personal responsibility to practice a lifestyle that keeps them out of the hospital. They  thrive on the personal attention they receive by doctors and nurses who wait on them hand and foot. They are frequently smokers who come in with emphysema attacks. They are frequently morbidly obese with uncontrolled blood sugars who come in with infections or asthma or heart failure. They are the young antisocial or borderline personalities who drink, do drugs and don't take their insulin for a week, in spite of their type I diabetes. They are the chronic pain patients who shop around and ask for IV dilaudid or demerol by name.

It's not just their illness that makes them hospital junkies. Some diseases are always going to be touch and go and very difficult to manage in spite of a controlled environment. I'm talking about the person who chooses not to manage their disease but instead finds comfort in the confines of the hospital to let someone else manage it for them. These are your hospital junkies. 

You can be a smoker and I will gladly take care of you. You can be fat and I will gladly take care of you. But if you smoke with the expressed intent of being admitted for an emphysema attack, you are a hospital junkie. If you chose not to manage your diabetes and fail to care for yourself with the expressed desire to get admitted, you are a hospital junkie.  If you come in searching for drugs, you are a hospital junkie.

I know them when I see them. I know because they have 25 admissions in a two year span. They rack up hundreds of thousands of dollars a year from the Medicare and Medicaid National Banks.  I'll even see many uninsured folks act this way. They don't care when they come into the hospital and get billed $10,000, $20,000, $30,000 for a stay they know they can't pay, and they know they instigated. And they fight you tooth and nail when you try and discharge them. That's a hospital junkie. 

In the mind of the hospital junkie, we are there to serve them. They are demanding. They are manipulating. They learn what to say and what to do to try and extend their stay. They actually incur risk by becoming pin cushions for unnecessary xrays, lab draws and invasive testing. I've had patients have their gallbladder taken out because of malingering drug seeking behavior. I've had patients transferred hundreds of miles to my hospital to evaluate  unexplained pain. The explanation is clear. They are drug addicts. And they use the hospital as their drug dealer.

These hospital junkies will do every thing in their power to stay admitted. They will fake seizures. They will vomit on command. They will complain of severe abdominal pain or really bad headaches. They will pretend to be too weak to walk. I've had twenty year olds claiming to be so weak, they needed a walker to move. Twenty going on eighty. That's your hospital junkie.

It's real. And I see it every single day. They are the patients that are irrational by all  means. They are the patients that throw tantrums if they don't get their way.  They threaten to assault you.  They  threaten to  sue you if you don't do what they say. These are your hospital junkies. And they ruin it for everyone else.

I believe it's an addiction. I think it should be treated like any other addiction. They need to go cold turkey. They need to be banned from all hospitals. They need to be exempt from EMTALA regulations. They need to be refused entry to the free room and board and waitresses that they consider our nurses to be. They are junkies and they need an intervention. What they need is the system to stop enabling them. They need to be  forced  to take responsibility for their lives.

I have taken a hard line approach to these patients  over the years. I will not allow my hospital to be their licensed drug dealer;  To be their room and board because they don't like their kids or they need a break from their family. I will not let my hospital become their full service hotel, complete with their very own butler. I will not cave to their pathological hospital junkie status. With science on my side, they can throw all the tantrums in the world. They are free to leave any time they like.

I'm here to take care of patients who want to get better; Patients want to use the hospital as a step back into society. I'm not here to take care of patients that use the hospital as their home. When I discharged a Hospital Junkie the other day, he told me

"I'll see you again real soon, I'm sure".

Of course this patient showed up in the ED less than 36 hours later. The family couldn't handle him anymore. I said no. I'm not admitting someone because their family can't handle them. I am not their babysitter. The more we enable the hospital junkies to get their way, the longer we allow them to destroy our morale and bankrupt the system. At some point somebody has got to stand up for rational thought and responsibility, and I am walking that walk. I consider it my own intervention, every time I say no to a hospital junkie. Eventually they will either listen or give up. Either way, everyone wins.