How do doctors 'make you' go in hospital w/low cnt

Team ITP,
Many here refer to doctors 'making' them go into the hospital with low counts, even when symptoms are not present. In the US I don't understand how that works. To my understanding doctors cannot force a person who is of sound mind to check in to a hospital. Either the patient is agreeing to be hospitalized, as their own choice, or there is some sort of weird forced lock up going on.

What's the deal? Is the doctor pretending the patient has no choice, or is the patient pretending they have no choice, or what?
Erica

Forced lockup, sorry, that gave me a much needed chuckle.

I think (since I'm part of Team ITP) that some patients do not realize that they have a choice, or are too scared to go AMA.

I'll bet we will be seeing a lot fewer of those lockups with the new insurance regime.

Most of the time people have never heard of platelets before their diagnosis and when the doctor says the normal range and than tells them their actual number. Than the doctor proceeds to say what can happen if they start to bleed. (worst case scenerio) Than they usually use the if you go without treatment you can die statement as well. At that point it is very easy to get someone into a hospital even if they have no money and have to pay for treatment. They are petrified and believe the only way to live is do as their doctor says.


It is known as putting the fear into a patient.

When I had platelet count that came back at 14 my new hemo called and insisted I go to emergency straight away. I informed the secretary that called that I had 3 more nights to do at work and my symptoms were not bad enough to treat. Than I added that if my symptoms got worse I would seek medical attention. (that way I wasn't refusing treatment).

Now you have to remember I've had ITP since I was 29 and this year I will turn 47! So I have learned a bit. Doctors told me when I was first diagnosed I would die (not could die) but would die if my counts ever got to zero. Well been there done that a few times and not dead yet.

I went to a clinic, got my blood drawn, the next day I got a call from the clinic saying that my platelets were at 6 and I needed to go to the ER immediately. When I was in the ER, my platelets were at 2, and the PA's there told me that I could hemorrhage and die without treatment.

Now that I have a hematologist, I don't see him forcing hospitalization on me, but before, I did not have one, or even a PCP (hence going to a clinic).

It usually happen with the people get diagnosed first time with ITP. When person get to know that minimum normal platelet count is 150k and he/she has the count in single digit, it is quite oblivious to get panic. I believe doctors add to this panic by telling that how critical the situation is and what could it lead to like excessive bleeding and brain hemorrhage. In this situation patient has no choice rather than listening to whatever doctors says. But as people learn gradually more about it they start understanding when to get hospitalized and when not.
If I talk about mine, same thing happen with us, my wife spend 10 days in hospital when she has the platelet count between 10 to 20k with no bleeding symptoms. But now we are following up with hematology department of a national hospital and they have guided us what needs to be done in any particular situation and moreover to this PDSA is the best resource of the knowledge on ITP.
Many thanks to Team ITP.

Been away for a while; what is this Team ITP? Can I join?

I've never been to the hospital for ITP. My first hematologist sent me on my way with a count of 11 and suggested I stay away from knives. He could have been a bit less glib....

Erica just made up Team ITP. I guess everyone here is a member....no special credentials needed except having had ITP or knowing someone who does. Erica? Your rules.

Well that puts me out I am not so good at following rules!



Unless there is a kick your hematologist till he speaks clearly rule! hehehe

Of course everyone here is part of Team ITP.
Erica

They can't force you but when you have a platelet count of 6 and you know you bleed when your count is under 20 it can be highly recommended to be admitted for treatment.

First let me say, I was diagnosed in 1978 so I have had years of experience dealing with ITP:

The last time I was admitted into the hospital for low platelets, I vowed to never do that again unless I was actually bleeding. In fact, I did refuse in two other occassions after that. And I was fine; I just did the IVIG treatments as an outpatient (6-8 hours a day for 3 days), took prednisone, and I was fine. I just didn't do anything like ride my horse or anything dangerous. The reason I don't like to be hospitalized is because by the time the doctor told me to go the the hospital through the time it took me to: get admitted, get settled in my room, have multiple history & physicals, order the IVIG which takes hours to mix-up, then start administering the IVIG, it was over 12 hours!!! The didn't even offer me Prednisone until I had been in the hospital bed for almost 6 hours. Really? One little pill? I told them no, I had already taken one in the car on the way to the hospital. It was just silly slow there. The doctor was like, "hurry to the hospital!" but when I got there, they pretty much forgot about me for hours on end. If I had gone to the outpatient center, I would have been done with treatment and home before they even started it at the hospital.

It was just sad.

So, I just refuse. Interesting fact: my previous hemotologist told me that even if I had a brain hemmorhage and was laying in the hospital bed, I would still die. There wouldn't be enough time to move me into the OR to do anything about it. At least he was honest, LOL!

Hopefully other people have had better/quicker experience with their hospital admissions for ITP. My count was 2,000 at the time, by the way, with not a single bruise on me. Just a tiny red dot on my chin.

I can share my experience in Hong Kong.

In short, the risk of internal bleeding with low platelets count is our doctors' main concern.

That's why I got low platelet count <50, even the symptoms are not present, the doctor must force me to stay at hospital and take IVIG for 5-6 days.

It's really affect my job when I need to be hospitalized.

The first time I ever had treatment for my ITP (Diagnosed at 17, first treatment 32) I had a count of 3 and they phoned me at night and told me to get to A&E ASAP.

When I got there they took my blood, stuck me in a room for a for hours, was then seen by 2 doctors who gave me prednisone and I was then left until 3pm the next day.

To say I played Hell was an understatement.

When I finally saw the haematologist I was already in the process of discharging myself and she was tried the to scare me to stay stating that I was at very high risk of brain haemorrhage etc..

She did her best to scare me to stay but at the time I was so angry that they had left me for so long without any kind of explanation of what was happening I left.

I went back a couple of days later to start a 5 day IVIG treatment and I had a heart to heart with my haematologist and explained that so long as they tell me what is going on and not to presume that I know everything then we will get along just fine which we now do

My haematologist does not use a count to determine if you need to be admitted but more what your symptoms are.

This time even thou my count was 5, I am not bleeding, no mouth ulcers, not suffering from any other symptoms and whilst I do have bruising, most are on my arms and legs due to me having 2 young children who like playing with daddy.

My preference as in my haematologist is always to stay out of hospital if it can be helped.

swrhodes wrote: my previous hemotologist told me that even if I had a brain hemmorhage and was laying in the hospital bed, I would still die. There wouldn't be enough time to move me into the OR to do anything about it.

There have been two or three patients here who have survived a brain bleed and were not at the hospital at the time. One member has had three of them and survived them all. The last one he had occurred while he was at work. He was in rehab for a while and let me stress that he is one who does not respond to any treatment, so just lives a fairly normal life with low counts.

This just occurred to me and I never really gave it much thought, but I have seen more strokes here over the years due to blood clots than I have seen due to hemorrhage.

Sandi, how is Steve doing, do you hear from him?
Erica

No, unfortunately I have not heard from him in a while. I miss having him around!