Medical technology is advanced and scientific but medical practice is really subjective and primitive. You may be surprised to know that a significant proportion of medical decisions are made with a high degree of uncertainty and ambiguity.
The decision to admit you to the hospital when you visit an emergency department is one of the most subjective medical decisions an ER doctor has to make everyday. There are situations when you would be admitted to the hospital no matter which ER doctor happens to see you, and there are situations when you would not be admitted to the hospital in any case. But, many situations fall in between the two extremes.
In those cases, you would be surprised to know what factors may influence the decision to admit you to the hospital. Here are some interesting observations I have made during the seven years of my medical career:
1. The comfort level of the ER doctor:
This is the most common reason given by ER doctors when there is ambiguity about the need for admission: “I don’t have any concrete medical reasons to justify the admission but I just don’t feel comfortable sending the patient home.”
On the surface, it may sound outrageous and trivial but sometimes the gut feelings of an experienced ER doctor turns out to be right. You may have normal vital signs and normal lab values but something about your story may make the ER doctor suspect he might be missing something important.
At other times, your situation may have reminded the ER doctor about a similar patient that had a bad outcome. In some instances, it could be just bad timing. The ER doctor may have seen you at the end of his shift and he may not have enough time to run all the tests to be sure. Instead of handing over unfinished work to his colleague coming in for a new shift, he may decide to put you in the hospital to finish the diagnostic evaluation more thoroughly.
2. You live alone:
When the ER doctor finds out that you live by yourself, he will lower the threshold to admit you to the hospital. Even when you could just go home and take medicines, the ER doctor gets worried that things might get worse and you could be in danger when there is no one to watch you. It is especially true if your medical condition or the medicine you need may make you drowsy or confused.
3. You keep coming back for the same problem:
The medical issue you have may not be severe enough to require hospitalization. However, if this is the third time you have been to ER in a week, the ER doctor might decide to admit you to the hospital just to prevent another ER visit.
4. You don’t have medical insurance:
At times, the ER doctor decides to admit you if he believes that you will not get the treatment you need if you go home. You may need to see a specialist or you may need to take an expensive medication. If you go home, you will not be able to afford those treatments. If the ER doctor believes that your health may deteriorate rapidly without those treatments, he will decide to admit you to the hospital. If you had insurance, you could get those treatments at the doctor’s office without a need for hospitalization.
5. Extremely cautious ER doctor:
Some ER doctors are more cautious than others but some take it to the extreme. They may have had a bad experience in the past; they just do not want to take any risk. If you happen to be seen by that doctor, you will be admitted to the hospital despite having a low risk of complication.
What can you do about it?
When an ER doctor tells you that you need to be admitted to the hospital, just ask him about the reason for admission. You can say, “Can you tell me how you made the decision to admit me to the hospital?” or “What is the main reason for putting me in the hospital?” If the reason does not seem compelling enough, you can discuss it with the ER doctor. For example, if he wants to admit you just because you live alone, you can arrange for a friend or a relative to stay with you to avoid unnecessary hospitalization.
Have you ever been admitted to the hospital when you didn’t feel like you needed it?