Financial Times Weekend Magazine | July 15, 2011

By Kiran Gupta

Doctors should feel responsible for the well-being of a healthcare system with limited resources

Most patients cannot wait to leave the hospital. But on occasion, we doctors come across one who would just rather stay put. Sadly this often occurs when the patient has nowhere else to turn. He or she might be homeless, the family may not want to take them back – for whatever reason, the hospital provides a better living option than any alternative.

But hospitals are not hotels and once the medical reason for hospitalization has been adequately addressed, it is up to us to discharge the patient (and to make sure that he or she actually leaves). We have been known to reach into our own wallets to slip a patient a $10 bill for a cab fare.

Mr D arrived one night from across the country. He had packed all of his earthly possessions into two giant duffle bags, boarded a flight and come directly from the airport to “see a doctor.” His records revealed that, over the years, he had frequented more than 12 different hospitals in eight different states. He had previously been hospitalized at my hospital for alcohol detox and had come all the way back so that he could be discharged into the same rehab program he had attended five years ago. It is commendable that someone would fly so far to sober up but he could have done it for free in his hometown and would not have had to pack.

Initially, his mysterious pile of stuff sat in a dark corner of the room as we treated his withdrawal symptoms. Eventually, I secured him a spot on a detox program and discharged him. At 1pm I checked the computer. Mr D was still listed. I started to get a sinking feeling. Sure enough, his nurse soon paged me: “patient refusing to leave, worried about his stuff.”

I went to investigate. Mr D was seated on the edge of his bed surrounded by his things. “Where am I going to put it? I can’t take it with me, someone will steal it. Can’t you bring me a laptop? I need to look for a storage facility. Also will you get a van and drive me to store it somewhere?”

It was 2pm. I was done with all my work. I was tired. It was gorgeous outside. I wanted to leave. I thought to myself: eight years of training. I am not a mover. I am not a hotel concierge. I am a doctor. This is a hospital.

The situation was ridiculous, sad and, unfortunately, all too typical. Now my job was to convince someone at the hospital to store this poor man’s worldly possessions while he went to rehab. For a split-second, I even thought about dragging the huge bags down to the trunk of my car. But I had no idea what was in them.

Ultimately we convinced the janitorial staff to store Mr D’s possessions. As I heaved the bags into the hall I couldn’t help but feel frustrated at the way the hospital often serves as a dumping ground for bigger social problems and how, despite such frequent occurrences, we healthcare practitioners remain completely ill-equipped to deal with them.

It is hard to forcefully discharge someone from hospital. But, as a doctor, I feel responsible not only for the needs of individual patients but for the well-being of a healthcare system with limited resources. “Too much stuff” is not a reason for spending thousands of dollars on hospitalization for someone who no longer requires care. Healthcare funds are often spent unwisely – wasted in ways that are unfathomable. Extending this gentleman’s hospital stay would be such an example. I was not going to permit it.

Mr D may have gone but his stuff remains somewhere in the depths of the hospital. At some point, I plan to find out what was actually in those bags.

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