Staying Against Medical Advice: Top 15 Reasons!

Much has been said about patients who leave against medical advice, but little has been described  about patients who stay against medical advice.  When a hospital setting is no longer appropriate for a patient, a physician will recommend discharge to the next appropriate level of care.  For most well adjusted patients, the hospital is the last place in the world they want to be, but for a select subset of customers,  the hospital is the only place they would like to be.

Staying Against Medical Advice is your right!
The average adult probably finds it hard to believe some patients actually want to stay in the hospital longer than necessary, but it's true.

Staying longer than necessary does come with risk, including hospital acquired infections, medication errors and other unspecified iatrogenic badness.  But, try explaining that to the clientele refusing to leave and many doctors risk getting a 4 instead of a 5 on their patient satisfaction experience scorecard.

Remember, an unsatisfied patient is a hazard to a hospital's health.  With Medicare paying hospitals these days partly based on the patient experience, hospitals and their healthcare providers must walk an often impossible line between doing what's good for the patient and what's good for the patient experience.

In fact, Medicare believes so strongly in a patient's right to refuse discharge and stay against medical advice, they have a form that allows the patient to stay against medical advice and have their discharge decision appealed by some unknown entity with an unknown degree deep within the Medicare Fort.

 photo 7dac7e09-65e5-4a26-aff4-e5b0f3752f80_zpsuqaxkt07.png

So why do some patients want to stay against medical advice and risk all the complications of continued hospital care?  Here is a Top 15 List of real quotes from patients who were allowed to stay against medical advice by hospitals fearful of not getting 5/5 on their patient satisfaction scores.

  1. "You have the best Dilaudid of any hospital I've ever been to."
  2. "My daughter ain't going anywhere  until you have her pseudoseizures under control."
  3. "My ride is out of town until Tuesday of next week."
  4. "Someone stole my Oxycotton script and I'm not leaving until you write me another one."
  5. "My husband got admitted to the hospital yesterday and I want to stay here until he goes home too.  Can he stay in my room too?"
  6. "I'm lonely at home and my kids never call."
  7. "The chicken cordon bleu here is amazing."
  8. "I have a call button.  Why would I want to go home?"
  9. "I've been having abdominal pain for 20 years and I'm not leaving until you figure it out."
  10. "My team is playing tonight and I don't have cable at home."
  11. "I'm not going to rehab until I'm strong enough for rehab."
  12. "I'm a squatter.  Get over it."
  13. "My kids don't get back from vacation until next week."
  14. "My water got shut off and I have no way to take a bath."
  15. "You all make me feel so good."
Prepare yourself. Patient is staying against medical advice!

 Prepare Yourself.  Patient is Staying Against Medical Advice!


UPDATE:  Patient #9 is still in the hospital after 423 days.



Universal Ortho H&P Rescues Surgeons From Pain and Suffering.

Rosemont, IL -  David Teuscher, President of the American Academy of Orthopaedic Surgeons (AAOS), confirmed yesterday a universal H&P that just needs to be signed by the surgeon is the best selling product offered by the society.

"The H&P is by far the best selling product our society has ever had!" said Dr. Teuscher.  "As an ortho doc myself, I have personally struggled through H&Ps my entire professional life.  I wish I had these twenty years ago."

Ortho is thrilled with their new universal H&P template!
With Hospitalists increasingly refusing to do 'Need pre-op H&P' consults, ortho doctors have increasingly found themselves in the uncomfortable position of having to complete an  H&P, especially ones on patients with no actual medical problems.

Dr.  Stitch Ansaw,  a prominent orthopaedic surgeon who admits he doesn't know what H&P actually stands for,  says the AAOA template has already saved at least one of his patients from needless suffering.

"I hadn't done an H&P for at least 10 years.  Last week a Hospitalist said they couldn't get to my stat 5 a.m. pre-op H&P consult for least 30 minutes because of  three code blues they were running simultaneously at three different hospitals.  That's just ridiculous.  Here my 48 year old patient with no medical problems and stable ring-finger OA is suffering needlessly and they're too busy to help me do paperwork for surgery.  Because of the AAOA template, I  was able to get this H&P thing done without delay and my lady is now on the road to recovery."

Contrarily, Hospitalists were thrilled to learn of the society's plan to help surgeons complete required pre-operative work.   Dr. Burke Kealey, President of the Society of Hospital Medicine, commended AAOS officials for their proactive approach to helping their members not look so helpless in the eyes of everyone around them.

"I'm actually quite surprised orthopaedic surgeons need help completing an H&P.  Most of them completed four years of medical school and at least five years of residency training, which is two years more than even the brightest internist.   You'd think they would have picked up a few H&P pointers from the medicine guys in those nine years," said Dr. Kealey.

Dr. Kealey admits he has little compassion for his poor ortho colleagues.  "I watched an ortho colleague the other day struggle for two hours trying to complete the universal H&P form while mumbling 'H&Ps are for little people' the whole time.  All he had to do was sign the form and be done."

For a scant $1,799 annual fee, ortho doctors  have been promised unlimited access to this copy write protected level 3 ortho H&P.  "Our members will never have to worry about doing an H&P ever again," said Dr. Teuscher from his 4 million dollar condo in Maui, paid for by AAOS H&P proceeds.

"I think we can probably charge 10X that amount and still not lose any sales."


 photo 841485ee-c933-4fe6-919c-845cba9419bf_zpsivssfdot.png



First Time Mother Shows Up In ER With Complaints of Bilateral Symmetrical Breast Swelling.

Jackson, MS  - In what ER doctors are calling one of the strangest cases of Failure To Parent ever, 20 year-old first time mother Tanya Jameson called 911 demanding to be transported  back to Jackson Memorial Hospital by ambulance with complaints of severe, progressive, bilateral breast swelling three days after delivering a bouncy 10 pound 2 ounce baby boy.

New mother admitted to hospital with iatrogenic pregnancy side effects
Paramedics arrived at the scene to find Tanya's mother in a panic consoling her daughter writhing in pain.  "You've got to take my daughter to the ER.  Those damn doctors let her out too soon. Something is terribly wrong!" said her anxiety ridden mother Teagen, who's been bottle feeding the newborn with free hospital provided formula for the last three days.

When paramedics called in report, Emergency physicians were prepared for a critically ill septic young female with bilateral mastitis, a breast infection that can cause serious illness when left untreated. But when physical exam failed to show anything more than normal milk filled breasts, doctors realized the patient was unaware of the need to empty her breasts of milk.

Doctors called in the hospital's lactation specialist for a stat ER consult.

"Yeah.  I remember this girl last week.We tried to explain the whole breast feeding thing to her in the hospital, but she just wouldn't stop texting.  I heard she was even texting her baby's daddy right through delivery," said Jane Swanson, a lactation specialist who says this is pretty normal these days.

When doctors tried to talk to the mother about how to help her daughter navigate life as a new mother, they discovered she had gone outside to smoke a carton of cigarettes with the turkey sandwich she requested in triage.

After six hours of trying to get Tanya comfortable with morphine, Ativan, Zofran, Bendryl, Phenergan and Demerol, ER doctors called the Hospitalist to admit at shift change when she FINALLY become unresponsive to texting and the ER doctor was ready to go home.




Hospital Eliminates Paid Bathroom Breaks; Installs Computers In Restrooms For Mandatory Nurse Charting.

Gainesville, FL --  Barner Hospital officials have confirmed all staff restrooms were outfitted with  computers last week to help improve nurse charting efficiency and cut down on unproductive work hours that threaten the bonus structure of top administrative officials.

"After great thought and input from ourselves,  we concluded the ten year plan just didn't have wiggle room in the budget for paid restroom breaks," said Dan Stenwick, Chief Financial Officer at Barner.

Mandatory bathroom charting in the new normal for some nurses!
"Over the last few years, we've had to make some difficult sacrifices on behalf of our team members to maintain our rapidly rising salaries here in administration.  After already eliminating 401-K matches and changing to a $10,000 per year high deductible healthcare plan, we felt getting rid of paid bathroom breaks was the most logical next step."

Starting today, all nurses will be GPS tracked at every moment in the hospital and sophisticated computer algorithms will be able to flag nurses - in real time - who fail to perform any charting while taking refuge in the restroom.

"It's important for our nurses to know that this new policy is not optional and failure to chart while you fart is grounds for immediate dismissal.  To help set the stage for our new era in efficiency, we have renamed all our staff restrooms to chartrooms," said Dan.

To enforce the new policy, Barner Hospital hired six new Charting Enforcers to hand out pink slips  under the bathroom stalls - 24 hours a day- when nurses are caught not charting with their pants down.

Surprisingly, the policy was receiving mixed reviews by nursing staff.  Some of the old-time nurses were outraged while most of the new graduates just figured it was for the good of the team, because they just didn't know any better.

The seasoned nurses have reason to be concerned.  Some studies have suggested multitasking increases the risk of errors for all tasks and one nurse, who wished to remain anonymous, confirmed that finding.

"This new policy is crap.  I give it a year or two before they figure out how ridiculous it is, like everything else new they try around here," said the experienced nurse.  "While going #2 this morning,   I accidentally charted I gave 2 Dilaudids instead of 1.  Talk about a near miss error!"

Barner quality officials say they have anticipated a rise in multitasking errors and have implemented forms to track #1 and #2 type errors in the chartroom with the hopes of fine-tuning a training program to minimize chartroom errors in the future.





UpToDate® Forced To Admit Google Used as Their Main Source of Information.

Waltham, MA -  On the heals of an imminent 60 Minutes documentary exposing the inner workings of UpToDate®, the popular subscription-only, physician-authored clinical decision support resource,  officials were forced to admit  most of their authors use Google as their goto resource.

In a prepared statement to reporters, Wolters Kluwer Health, which owns UpToDate, confirmed  that Google is hands down the most popular resource used by their 6,000 physician authors to regurgitate medical information into neatly repackaged articles for the $500 per year professional service.

It turns out Google and UpToDate are pretty much the same thing.
"I don't even know why this is news.  Everyone knows doctors have been using Google for years to get their trusted medical information like the rest of us, said CEO Nancy McKinstry.

"As little as 20 years ago, our physicians would have had to go to a library and ask a librarian to find peer reviewed articles, but nobody has time for that anymore.   The use of Google is just a natural extension of the internet revolution."

UpToDate says they actually encourage their authors to use lay people resources to fine tine their articles for the current patient-satisfaction-centered model of care.  "We know patients are using Google to find their trusted information.  It just makes sense for our authors to use Google too so our users don't find themselves in the uncomfortable situation of questioning the accuracy of Google with their patients," said Nancy.

In fact, just last week UpToDate stopped hosting all images on their servers and instead link directly to Google images to help physicians see hundreds, sometimes thousands of examples for any given condition.

"Our goal is to have Google and UpToDate coexist in a perfect symbiotic relationship where doctors feel good about using our service instead of Google and patients feel comfortable their physicians aren't dumber than Google," said Nancy.

Dr. Franklin Bennington, a surgeon at Johns Hopkins University School of Medicine and prolific UpToDate author of more than 500 articles says he has no problem using Google to keep physicians abreast on best practices.

"In my article on performing lap appys, I linked to a 2007 YouTube video with over 2 million views I found by typing lap appy videos into the Google search engine.  And I even included recommendations on post-operative care from an online forum by a guy who calls himself Knot-A-Surgeon."

The revelations have left many physicians angry at paying $500 a year for information they can get free from Google.  But those emotions quickly subsided after realizing they can earn hundreds of hours of continuing medical education credits everyday just by looking things up.  "I used UpToDate the other day to try and find some information on routine hypertension management and earned 60 hours  of qualifying CME in just 30 minutes," said Dr Elaine
Fenwick, a Kentucky Hospitalist who's state license totally coincidentally requires 60 CME to be renewed next week.

Recent research confirms the lack of patient mortality difference between physicians preferentially using Google over UpToDate as their research choice.  However, one subset of patients did suggest physicians with prolific Wikipedia experience may actually have a slight survival benefit.

"The data is intriguing and we may have to gently nudge our authors to lean more heavily on Wikipedia than we have in the past," said Nancy, who also notes a 78% increase in patients printing Wikipedia articles to show their doctors.

The close relationship between Google and UpToDate has some financial speculators suggesting Google my purchase UpToDate and change its name to GoogleCME®.