Anonymous Doctor

I understand the comments on the previous post. I should have been clearer, maybe, so that it would be more obvious that the problem is the system, not the ethics of the doctors. Even if the patient cap wasn't an issue, we would still save the discharges until the end of the day. Because discharges take time, and every minute we spend on a discharge is a minute we can't spend on patients who have active problems we need to deal with. The priority is the sick patients who need our help, not the patients waiting to go home. To stop in the middle of the day, when there are still things on our list, to discharge someone is a poor use of our time. There are only so many things we can do at once.

Similarly, every minute we spend processing an admit is a minute we can't spend running our list and dealing with what we have to deal with. If I'm called at 2:00 to process a new admit, it means everything on the patients I already have on my list gets pushed. We're simply never sitting around doing nothing. It's not a matter of avoiding work. We are always doing something. We are always busy. We are always left with less time than we need. And any of us would rather prioritize the patients we're already dealing with and trying to treat over the new admissions that are waiting to be processed. Because we already know the patients on our team, and they need us. The new admits can be processed by anybody.

The night team ought to process the new admits. They don't come in with a list of things to do for the current patients. They come in with a blank list. We work the whole day trying to get as much done as we can to get out at a reasonable hour and get a little bit of sleep before coming back in to do it all over again. If we have nothing to do, sure, give me a new admit. But otherwise we are busy. And if we have to spend the whole day processing new people, the old people will crash and burn. I need to protect my people. My patients, and my interns. So I will do everything I can to avoid new admits if I can push them off, because I don't want to deal with all of my patients dying on the floor because I was distracted.

There ain't enough people. That's the problem. We have an unlimited amount of work. No one's being lazy. We're just trying to manage our day and not get overwhelmed and sacrifice care. This is vastly different from the ethical problem of buying your way into medical school. Or I'm just delusional.

Oh, and I probably overstated how much control we have anyway. Even if we process the discharge, they're usually there for hours waiting for social work or pharmacy or nursing or someone to come pick them up (that's always a fun one). They're just as busy as we are, and they're just as likely to have sixteen other things to do that take priority over a discharge. So it's not like we're really in control.

But I won't pretend I'm backtracking from the post. None of us want new admits if we can push them off to the next shift. Not the doctors, not the nurses, no one. We have too much to do already with the patients we have, and we don't want to be at work 24 hours a day. And we shouldn't be.