Hey Doc, I know you are a hospitalist and part of your job is to reduce unnecessary hospitalisations, consults, etc, but I have to say I beg to differ with your plan on this patient. This poor guy is 58 but is really sick. He has metastatic prostate CA with spinal mets, looks like a malnourished concentration camp survivor, has a fever of 102, grossly dirty urine, a WBC count of 19,000, a systolic BP of 89 and a heart rate of 110, and a Hgb of 7.8. I really think he is septic and needs to be admitted for fluids, antibiotics and possibly blood transfusion just to start.
I know you claim to have found all this information in his previous admissions showing that he has “chronic tumour fever”, “chronic leukopaenia”,”chronic anaemia”, and “chronically dirty urine”. I was waiting for you to say “chronic sepsis” but you didn’t. Anyway, you say you managed to convince his PMD at the nursing home that he can go back there and get his fluids and antibiotics. Well, you may have convinced him but not me. If you want to discharge him, you’ll have to do that yourself since I’d really worry about getting sued if this guy boxes.
Guess what happened? The guy got sent back and returned a day and a half later. BP in the 70′s, Hgb 5.5, fever 101, WBC 22K, and now with a creatinine of 3.5. Sometimes you have to actually look at the patient and not all that other stuff.