Illness drives us to illogical decisions, and that’s one of my pet peeves in medicine. As doctors, we think that we know what’s best for our patients and frown when they disagree with us. We are even trained in medical school and residency to put ourselves into their shoes to help guide our decisions. Yet with such extensive preparation and almost a year of clinical practice behind me, I still am unable to rationalize some of the decisions my patients make.

Last evening I was paged by nursing that one of the asthmatic patients demanded to be discharged from the hospital, at 10:45pm. She was taking multiple anxiolytic agents, along with sedatives. She complained that her wheezing had not improved since admission, and that she “needed” to leave. Earlier in the evening outside of visiting hours, she had a visitor who demanded to meet her in the hospital lobby. When security denied their rendezvous, she threw a fit.  I gave her a standard discussion about leaving against medical advice, and that I did not believe it would be ideal if she left in the middle of the night while she was ill.

Over the next hour, she demanded to speak to me over 5 times. I presented the AMA form that relieves the hospital of any wrongdoing if she left and told her that she could even die with untreated asthma. Around 2am, the nurse notified me that the patient had left the hospital.

I guess she was probably withdrawing from some illicit substance, like a third of my patients predictibly do (I am working at an inner city “Outside Hospital”).  Afterward, I felt disturbingly relieved that my patient had left–I wouldn’t have to write a progress note on her in the morning.

medicine medicine, rant