Takeaway
Clinicians must go beyond medical diagnoses and address social determinants of health, such as housing instability. Finding the best hospital discharge solution may require creativity and team collaboration.
Lifelong Learning in Clinical Excellence | August 29, 2024 | 1 min read
By Luyuan Li, MD, PhD, University of Miami & Amy Yu, MD, MS, Johns Hopkins Medicine
Mr. T was one of the patients I encountered as an observer at a Johns Hopkins hospital. His medical history included significant anxiety, alcohol use disorder, and cirrhosis. He’d been admitted for abdominal pain and rectal bleeding. Despite stabilizing for discharge after a week, Mr. T didn’t want to leave due to ongoing non-specific discomfort and an unstable housing situation.
Dr. P and I entered Mr. T’s room. “How are you feeling today?” Dr. P asked.
“Miserable,” he replied. “I have a hollow feeling in my skull and weakness in my fingers.”
“I’m so sorry,” the doctor responded gently. “However, based on your test results, there isn’t a reason for further hospitalization. We’re here to help you find the next steps.”
“I can’t leave the hospital” Mr. T said.
Dr. P sat down by his bedside and held his hand. “Is it the housing issue? If so, we’ll do our best to help you.”
The social worker followed up and learned his previous residence was no longer available and he had nowhere to go. She contacted the Baltimore Rescue Mission that confirmed a bed was available.
When this was related to Mr. T, he responded with distress. “I’m not going to a shelter.”
The social worker validated his feelings and explained it was the safest option given his situation. She then worked tirelessly to find an alternative and finally connected with Mr. T’s cousin, who agreed to take him in.
Here’s what I learned:
1. Work to understand each patient’s situation outside of the hospital or clinic to give the best care possible.
2. Respect patient preferences and work within their comfort zone to find acceptable solutions.
3. Collaborate with social workers, care managers, and other professionals to address non-medical issues and provide comprehensive solutions.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.