[www.keralites.net] Can we take him home?

 

`Can we take him home?' ALTAF PATEL Billing may boggle your mind, but a good time to leave that hospital bed is when the doctor says it is... Among the painful experiences in hospitals is a patient's discharge, which is es pecially agonising for their relatives. Billing takes hours, a frustrating experi ence that tests their patience. Patients often bring their bills to me to confirm if they are correct, and over the years, I have told many that I could not understand the bill of my own hospitalisation, admitting sheepishly that I was left as confused as they are. The most common complaint I hear is that the bill has gone beyond the estimated value the doctor mentioned. I am not surprised at this, because it is impossible for the doctor to give you an accurate estimate, except of his own fees. Initial tests lead to further exams as well as invasive tests, and drugs cost an arm and a leg when the situation is complicated. Much of this is out of the doctor's control. Till date I have not found a surefire system to predict the expenses. I always tell hospital administration that they should apprise the doctors of approximate bill amounts for various categories of medical ailments and surgeries. The problem is more complicated when multiple doctors are attending to a patient. For the patient, the first few days are critical, as much of the testing and decision-making is done in this time.I have been told by certain hospital administrations that if a patient occupies a bed even in the lowest class of rooms beyond this initial stage, the hospital is likely to lose money due to the strain on its resources. I am not sure if this is true, but it well may be. One must also understand the background of the patient's disease. If they have cancer or some chronic aliment which is likely to land them in hospital again, then they should be discharged the moment therapy is optimised, and spared the burden of further hospitalisation expenses. A terminal patient lying on ventilator or various life-support systems, which literally holds them back from the Good Lord, is a distressing situation for the doctor as well as the patient's kin.The question often posed is, "Doctor, can I take them home if there is no hope?" And I don't think this question has an answer. In one in a million cases, such a critical patient survives after several days of hospitalisation, albeit expensive. There is great rejoicing among the physician's staff and relatives alike. This, however, happens rarely. Another problem a hospital management will speak of is a discharge slated too early, especially in surgical cases. Surgeons are notorious for bringing patients with gallstones -and blood sugar of, say, 500 mg -to hospital, and then wait to operate upon them ASAP. This often drives the physician bananas as they try to bring the patient back from the brink of a diabetic coma. After expending great effort, as the patient's sugar begins to settle with the insulin, the physician arrives at the hospital on day four or five, only to find the patient's bags packed because the surgeon has approved their discharge. At this point, the patient is often on multiple doses of insulin and the physician needs to convert this into two or so doses. During the conversion, the sugars may run awry but the surgeon, having finished their job, packs off the patient. Hospitals have a limited number of beds. If the beds are empty, the administration does not mind the lingering patient. And while this may work well for a surgical patient, in a medical situation if the patient is good for discharge tomorrow they are usually good for discharge today. So the real answer to when a patient should be discharged is, when the doctor feels they are ready for it.

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Posted by: Cool Kis <cooolkis@gmail.com>

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