I, like most ED folk, have mixed feelings about homeless who come to the ED just for food and a bed.
It is an incredible drain on the system to call 911 just to get a meal. It ties up EMS and the hospital so that truly sick people can't get help, and it is a terrible abuse of the system. It also makes more work for me having to figure out which complaints are bullsh*t and which are real.
However, it's hard for me to refuse a hungry person food. Many of these people are mentally ill, are unable to get work, and have a very hard life on the streets. I usually end up feeding them, and telling them not to call 911 for food. They ignore me, of course. My only condolence is that if they don't come to our ER, they'll go somewhere else.
My most memorable malingering patient was a nasty old guy with a RUL lung mass, who had been admitted many times to the hospital for a workup but always signed out AMA as soon as he'd had enough to eat and was tired of refusing blood draws. He was really sick, usually drunk, and because he was sick we were EMTALA required to work him up every time he came to the ER.
He called 911 one morning after having AMAed from our ER only hours before with a new BS complaint. He started bellowing for food in the middle of the ER. I was about to feed him when my senior told me not to. I was conflicted, but in the end I went with my senior - CC was belly pain, which I knew was BS, but that's a good reason not to feed any patient. He kept demanding food and I kept telling him no. He signed out AMA, and as far as I know didn't come back for awhile. He probably died on the street, or found another ER that was more receptive to his crap.
Did I do the right thing? I don't know. There's no good answer. This is one of the things I really hate about EM.
That being said, I went into EM partly because we give medical care to anyone, regardless of ability to pay. I am happy and proud to give care to deserving, sick patients who can't afford it. This is just the other side of the coin.
