Skip to content
  • About
  • Contact
  • Contribute
  • My Book
  • Careers
  • Podcast
  • Transcripts
  • Speaking
KevinMD
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • My Book
    • Careers
    • Podcast
    • Transcripts
    • Speaking
KevinMD
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • My Book
    • Careers
    • Podcast
    • Transcripts
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Be heard on social media’s leading physician voice
  • Contact Kevin
  • Custom enhanced author page pricing
  • DMCA Policy
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • KevinMD influencer opportunities
  • Opinion and commentary by KevinMD
  • Physician burnout speakers to keynote your conference
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Privacy Policy
  • Recommended services by KevinMD
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • Upgrade to the KevinMD enhanced author page

On hospital discharges: Who needs the most reassurance?

Perri Klass, MD
Physician
November 7, 2013
Share
Tweet
Share

I will do anything not to be in a hospital bed. I checked myself out as quickly as I could each time I was admitted (three obstetrical admissions) and once, after a day-surgery procedure, got in trouble with the recovery room nurse because she found me out of bed, getting dressed, before I was supposed to be on my feet.

Still, as a doctor, I am capable of taking great comfort in the idea that a patient of mine is hospitalized, under observation, easily traced. And I know from clinical experience that there are many moments when the hospital can actually be a reassuring and helpful place for pediatric patients and their families.

Sometimes the question is whether it’s the patient or the doctor who needs reassurance about when it’s time to go home.

For instance, I recently found myself worrying over whether to send a mother and her very young baby home late one evening, knowing they would have to come back to the clinic in the morning, or whether to admit the baby overnight.

The problem was the weather; a bad storm was forecast for the area. Were we really doing this mother and her baby a favor by sending them out and telling them to come back in less than 24 hours? After all, the mom was recently postpartum.

The cause of our concern was a liver condition called hyperbilirubinemia. It occurs when the newborn liver is not fully able to break down hemoglobin in order for the end products to be excreted. The unconjugated bilirubin builds up in the baby’s blood, causing jaundice, and its level can get dangerously high.

Now it was late afternoon and we were waiting for the results of the measurement of the baby’s bilirubin level to come back. The level came back too low for phototherapy, but only by a little—it had been rising faster than anyone liked. So the right thing to do was to send the mother and the baby home and have them come back the next day to have the level rechecked.

That’s when the questions kicked in. What if the storm was as bad as some of the weather forecasters had predicted? What if the mother ended up stuck and couldn’t get back? Most important, what if the bilirubin level rose even more quickly than we expected?

We went around a few times — the resident, the nurse, me — and talked it over with the inpatient attending, reviewing the mother’s transportation options and reexamining the baby. In the end, we let them go home—though as I was leaving that evening, hurrying home to beat the storm, I saw them sitting in the lobby, waiting for their ride, and I worried all over again.

I thought about catastrophic storms and bad roads and various disasters — all easily averted if the baby were hospitalized.

In the end, the storm was a minor one. Mother and child made it in without a problem the next day and the bilirubin level was lower. The baby avoided an unnecessary (and expensive) hospital stay, with all the possible associated problems (such as exposure to the infections of other hospitalized children, not to mention hospital superbugs and the disruption of home routines and breastfeeding), and the mother avoided the stress of leaving her other children for the night.

And maybe it was just reading all those weather predictions that created the ominous feeling hovering over our discussions, a sense that sending a baby out into the world was deeply and profoundly unsafe. Because the truth, as I know from my own medical history, is that when there is nothing dangerously wrong, and you “send people out,” you are actually sending them home, which is where they want to be, after all.

Perri Klass is a professor of journalism and pediatrics, New York University. She blogs at The Doctor’s Tablet.

Prev

How can we reduce friction in the hospital?

November 7, 2013 Kevin 7
…
Next

Is the time right for e-caregiving?

November 7, 2013 Kevin 0
…

Tagged as: Hospital Medicine

< Previous Post
How can we reduce friction in the hospital?
Next Post >
Is the time right for e-caregiving?

ADVERTISEMENT

Related Posts

  • Don’t judge when trainees use dating apps in the hospital

    Austin Perlmutter, MD
  • When physician pay packages become hospital kickbacks

    Jordan Rau
  • A physician’s addiction to social media

    Amanda Xi, MD
  • 5 challenges of working in a county hospital

    Pranav Sharma, MD
  • Hospital administrators thinking about no-cost treatment which really helps patients

    John Corsino, DPT
  • What do hospital discounts really mean?

    Robert S. Berry, MD

More in Physician

  • The attention economy is starving public health

    Paul Dranichnikov, MD, PhD
  • Physician burnout is not the whole diagnosis

    Gus W. Krucke, MD
  • Physician advocacy can close the gap between appointments

    Samantha Jackson Dilts, MD
  • Medical hierarchy is silencing young doctors who want to write

    Dr. Buga Charles George Kenyi
  • Why military patients carry pain a chart can’t explain

    Ann Lebeck, MD
  • Leaving medicine is a translation problem, not a loss

    Shveta Gupta, MD, MBA
  • Most Popular

  • Past Week

    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • The double standard at the heart of chronic pain treatment

      Joshua Saylor | Conditions and Diseases
    • Your sinus infection may not be an infection

      Franklyn R. Gergits, DO, MBA | Conditions and Diseases
    • Why scientific medicine alone is not making us healthier

      Narinder Singh Parhar, MD | Physician
    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Primary care crisis requires new training and skills

      Justin Oldfield, MD | Physician
    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • Polycystic ovary syndrome is more than ovarian

      Oluyemisi Famuyiwa, MD | Conditions and Diseases
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • Physician retirement is a myth for the ripening doctor

      Farid Sabet-Sharghi, MD | Physician
    • Primary care access is the real problem, not the system

      Payam Zamani, MD | Physician
  • Recent Posts

    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
    • Fear of cancer recurrence is a human response, not a flaw

      Jae L. Ross, PsyD | Conditions and Diseases
    • The attention economy is starving public health

      Paul Dranichnikov, MD, PhD | Physician
    • Mental health ghost networks are badly hurting patients

      Steve Cohen, JD | Conditions and Diseases
    • 3 changes physicians on social media need from institutions

      Trisha Majumdar | Social Media in Medicine
    • Why your overhead percentage is the wrong benchmark

      GetPracticeHelp | Physician Finance

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • The double standard at the heart of chronic pain treatment

      Joshua Saylor | Conditions and Diseases
    • Your sinus infection may not be an infection

      Franklyn R. Gergits, DO, MBA | Conditions and Diseases
    • Why scientific medicine alone is not making us healthier

      Narinder Singh Parhar, MD | Physician
    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Primary care crisis requires new training and skills

      Justin Oldfield, MD | Physician
    • The MCAT requirement persists as a norm, not as a tool

      Aniruth Ananthanarayanan | Medical Education
    • Polycystic ovary syndrome is more than ovarian

      Oluyemisi Famuyiwa, MD | Conditions and Diseases
    • DEA fear is reshaping how doctors prescribe

      Ronald L. Lindsay, MD | Physician
    • Physician retirement is a myth for the ripening doctor

      Farid Sabet-Sharghi, MD | Physician
    • Primary care access is the real problem, not the system

      Payam Zamani, MD | Physician
  • Recent Posts

    • 20 years inside a Medicare Advantage insurer, and who actually pays [PODCAST]

      The Podcast by KevinMD | Podcast
    • Fear of cancer recurrence is a human response, not a flaw

      Jae L. Ross, PsyD | Conditions and Diseases
    • The attention economy is starving public health

      Paul Dranichnikov, MD, PhD | Physician
    • Mental health ghost networks are badly hurting patients

      Steve Cohen, JD | Conditions and Diseases
    • 3 changes physicians on social media need from institutions

      Trisha Majumdar | Social Media in Medicine
    • Why your overhead percentage is the wrong benchmark

      GetPracticeHelp | Physician Finance

MedPage Today Professional

An Everyday Health Property Medpage Today

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...