As part of the med school admissions process, applicants must write a personal statement in which they confess their undying love for humanity and their willingness to join the medical field for the sole desire to help others. Applicants come up with pretty unique ways of demonstrating their humility with everything from the mundane such as serving lunch to the homeless to extremes such as trips abroad to teach Third Worlders about sanitation and vaccines. When I applied, I had to prove that medicine was my life’s calling. I don’t know why medical schools purposefully force pre-meds to pretend that through divine will they chose medicine as if they were entering the convent and becoming a monk for the rest of their lives.
Part of this humility involves the willingness to treat all people regardless of race, religion, or ability to pay. Although a noble cause, medical schools try to coerce students into this feel-good attitude about treating a variety of patients including criminals, the insane, the criminally insane, and even the stinky. At my own urban hospital, we play host to numerous homeless persons who drop by for everything from getting a drug fix by mentioning vague 10/10 abdominal pain, to those hungry few who couldn’t convince the residents outside to donate a dollar to get a meal—so they show up at the emergency department demanding turkey samiches.
The emergency department serves at a gateway into the rest of the hospital. Its doctors serve as the primary care physicians for a variety of non-tax payers who think that healthcare is free anyway. Our hospital sees drug seekers, samiche seekers, and even skirt chasers. I’ve had quite a few Casanovas call out to nurses, “Hey baby doll, bring me some water and come on over here.” While these pseudo patients with no medical issues are taken through triage, a good physician can stop them there. Unfortunately, a few attendings still believe the personal statement story they wrote many years earlier.
I’ve seen sickle cell patients claim 10/10 diffuse body pain and demand round-the-clock dilaudid, only to fall asleep during the interview because they already had so much morphine on board. For this particular patient, I had to use a sternal rub to wake him up—at which point he slurred his words to say that he was still in 10/10 pain and required more powerful narcotics. I wanted to send him home and tried to plead my case for my attending. My boss said that we could not judge the patient’s level of pain and wrote for a patient-controlled dilaudid pump that would deliver enough drugs every 10 minutes that would send an average man into a coma. This patient was an average man. Nurses found him unresponsive and had to call a code to resuscitate him. When the patient regained consciousness, he stated that he was still experiencing 10/10 pain and requested cinnamon-coated apples for lunch.
Similarly, my current attending wants all patients to remain in-house for complaints that could be handled as an outpatient. I have one gentleman who has been waiting for the results of his biopsy during the past week. Keep in mind that we aren’t actually doing anything for him other than waiting for the test result to come back. When I asked the physician in charge why we’re holding onto the patient for so long, she replied that he may not return to clinic given that he’s homeless. We throw around phrases such as “lost to follow up” to describe patients who miss outpatient appointments. Some of these people are homeless; all of them are uninsured. So instead of losing $400 with the biopsy and clinic visit, the hospital is now losing $10,000 a week just to have the patient sleep in one of our mechanical beds.
The worst patients are the homeless individuals who show up with multiple friends and family members. For the homeless, getting admitted to the hospital is like winning the lottery. They get free meals, a warm bed, and a nurse offers a sponge bath every morning. One patient had six friends show up and demand beds of their own—because in their kindness, they wanted to take care of their buddy.
Instead of charging tax payers the extra expense of hospitalization, let’s send the bill to the attending who hides behind the label of loss to follow up. If nothing more, let’s have med schools cut their nonsense about helping others and admit only students who clearly have a business sense and a wariness to discharge patients when the hospital fails to provide added benefit over outpatient care. Now that’s a personal statement worth reading.