Magazine article Drug Topics

Hospital Admission or Discharge Up to Doctor, Not Budget

Magazine article Drug Topics

Hospital Admission or Discharge Up to Doctor, Not Budget

Article excerpt

The decision to admit or discharge a patient with a serious illness such as community-acquired pneumonia belongs only to the doctornot the insurance company or the managed care organization. This patient-oriented principle may make life easier for doctors, patients, and pharmacists, but not for some hospital bureaucrats and tightfisted insurance companies, said an expert on economic and legal issues in medical care today.

"Patient advocacy is at the core of being a doctor," said Thomas E. Wallace, M.D., J.D., pulmonary and critical care division, University of Tennessee, Memphis. "Patients trust that you'll give them the best individualized care they need. They come to you because you are a physician, not a cost-containment specialist." At the same time, he noted, it's not a contradiction to be aware of scarce economic resources and use them wisely. Wallace was speaking at a symposium, "Advances in the Practical Management of Patients with Respiratory Tract Infections," sponsored by Tufts University School of Medicine, Boston. Funded by an educational grant from RhonePoulenc Rorer, the symposium was held at this year's meeting of the American Thoracic Society/American Lung Association in San Francisco.

To safeguard the patient, the doctor should consider the following, said Wallace, who triages admissions to his Memphis hospital's intensive care unit:

1. What resources does the patient need in order to be treated appropriately for community-acquired pneumonia? Antibiotics? Swan-Ganz catheter [to determine fluid balance]? IV fluids? Oxygen? Do comorbid conditions need additional resources?

2. Where are the resources located? If oral antibiotics are what's needed, why not just send the patient home with a prescription? He warned, however, that "if there's inadequate care at home, or if the patient lives far from the hospital, it could be unwise, even dangerous and far more costly in the end. …

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