What do you mean by "dumps" and "can't handle"? (again, honest question)
Read the
House of God and you'll know what I'm talking about.
If a patient has private insurance, within a few days of hospitalization, the insurance company will often-times pull the plug on payment. They'll argue the patient shouldn't be in the hospital because the psychiatrist is not doing much. Of course in some cases the psychiatrist isn't doing much, but in other cases the psychiatrist can't do more and the patient is not safe enough for discharge.
Just to given an example, if a patient is severely depressed, if you start a patient on an SSRI, they usually don't work for weeks, and you can't go up on dosages daily. For most SSRIs, you start on a dose you aren't supposed to increase it for about 1 week.
Okay so it's 4 days later and now the insurance company doesn't want to pay anymore because you're not changing the meds.
Yes I know...it doesn't make sense.
But several hospitals and their doctors want to dump patients that really are not yet appropriate for discharge, e.g. they may still be suicidal or homicidal, to the outpatient office, and then if the patient commits suicide, they try to pull an argument that they weren't the last person who "touched" the patient. A large part of it is because the insurance company will no longer pay, so the hospital is now losing money on that patient.
E.g. a social worker will refer the patient to the office, telling the office the patient is actually doing well, then when the patient is seen in the office they tell you they are still suicidal and they've only been in the hospital for 2 days, and the doctor only spent a total of about 30 minutes with the patient total.
So you then tell the patient to go back to the hospital, the patient refuses saying they were treated terribly there, and you call the police, the patient is brought back to the hospital, then the ER discharges the patient, now the patient is screaming at you to get them better and they're more than you can handle and they really need to be in the hospital treated with REAL care, not some schmuck just giving them an SSRI and discharging them 24 hours later.
And in case you didn't know I've had 2 suicides. One of which was a patient that fit the above, I decided from there on we wouldn't ever take a referral from that specific hospital again. And for those of you savvy psychiatrists that know there's patients that are chronically suicidal but never really actually do it that really should be discharged, no she wasn't one of them. This patient really was dangerous, and I sensed it from the beginning. Anyone who's been suicidal since the age of eight years with no history of abuse, borderline sx, no drug abuse, who denies she's suicidal to me, then after she leaves my office and in the waiting area I hear her telling her mother to stop worrying about her because after a few months she'll be over it with her future suicide, telling her she's thought about it long and hard that she really wants to kill herself and the only thing hold her back is she knows it'll sadden her parents but their sadness will only be for a few months while her depression has existed her entire life, even as a child...etc, and again no borderline sx...just pure depression.
This was one of the few times ever I had a suicidal patient where I sensed she really wanted to do it and do it soon, and believe me, I've discharged borderline patients telling me they'll kill themselves if I discharged them only to see them again and again in the psych emergency center. No this one was different. She committed suicide within 5 days of me seeing her. Personally if I was the inpatient doctor I wouldn't have discharged her unless I was confident she was better and if I wasn't I would've transferred her to long-term care.
And while she was the straw that broke the camels back, I had about a dozen patients that came from this hospital and with the exception of one, all of them told me the doctor would insult them, tell them they were losers, or even things to the affect of "your'e so much of a loser you couldn't even kill yourself." As I've said before, if one patient tells me, I don't believe it. If several tell me and these people don't know each other, I'm thinking there probably is something to it. Then on top of that a colleague of mine worked at that specific hospital for a month and then resigned telling me all the stuff my patients were telling me was true and she couldn't tolerate working with this guy that she described as a monster.
Getting back to my original point, when you're new to an area you don't know who the good sources are for referrals. I'd have my guard up and have the insurance just in case.
