“When can I go home?”


Most patients want to get out of the hospital as soon as possible.  No one wants to sleep in a loud hospital room with constant interruptions for rounding, vital sign checks, blood work, etc.  Hospitals are a place for people when they’re sick, and if you aren’t sick you shouldn’t be in a hospital.

I have noticed a funny thing…often the less ill a patient is, the less they ask about discharge, and the more sick a patient is, the more they focus on going home.  A scenario that repeats itself day and day again is as follows (Warning: hyperbole ahead):

Me: “So Mr. Jones, I see here in your chart that you have a history of heart trouble, diabetes, and emphysema.  What brought you in today?”  

Mr. Jones: “Well I can’t breathe, and I’m passing black tarry stools, and my pacemaker fired three times today during dialysis, and I’m having severe belly pain.  Did I mention I can’t breathe?”

Me: “Yes, I can see you’re got a lot going on.  Tell me, when did you start having black tarry stools and severe abdominal pain?”

Mr. Jones: “Oh that started a few days ago.  When can I go home?”

I guess there is a natural tendency to focus on the light at the end of the tunnel when you are really sick.  Maybe fixating on the goal of discharge takes away some of the anxiety of the hospitalization.  The thing is, I simply have no idea when a patient with multiple active problems will be able to go home.

No one can really tell when an individual patient will be able to safely leave the hospital after a major illness.  I can tell you what the average length of stay is for a certain disease based on past experience, but this number often has little bearing on the individual patient.  Everyone is different.  The average time in the hospital for an isolated bleeding ulcer requiring blood transfusions and endoscopy may be 2-3 days, however if there are other problems that come up along the way the length of stay may be two weeks.  Predicting how long someone has to stay is really just an educated guessing game.

Truth be told, I would rather someone who is sick ask me the impossible question of “when am I going home” than the opposite extreme…

Me: “OK Mrs. Smith, it looks like everything checks out: Your EKG, labs, cardiac enzymes, stress test, and chest X-ray are all normal.  The mild vague pain that started two months ago and has since disappeared after antacids is probably just heartburn.  I can have you follow up with me in the office next week for any further testing needed.”

Mrs. Smith: “Oh no, I’m not in any rush to leave until I have everything checked out! I want an endoscopy tomorrow.  I’m overdue for my mammogram, and I think I just got a letter telling me to schedule my colonoscopy too.  My knee has been bothering me for months…do you know any good orthopedists? My daughter is out of town and can’t pick me up from the hospital until at least next Thursday anyway…”

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