@ProPublica From the article: “financial incentives may drive for-profit hospitals to turn away more complicated patients… hospitals can save on staffing and other costs if they admit healthier patients and avoid patients with the most severe psychiatric needs — a tactic she called “cream-skimming.”
Although I had not seen it called “cream-skimming” before, this is a practice that is acknowledged even by some physicians and therapists. It’s a practice not only motivated by financial considerations, but also by a desire to see patients get well and the difficulty of trying to help patients who may never get well. Some physicians, knowing they are dealing with an illness, have admirable patience and longterm commitment; others do not. A therapist one of my children saw accidentally included my wife in an email she sent to her business managers explaining that she thought our challenging child was not a good candidate for continuing services. There is an inside joke among providers that if a potential client calls to seek treatment for a personality disorder, the right answer is that the practice is not taking any new patients.
It is also a problem that patients experiencing a psychiatric healthcare crisis are often unable to effectively communicate or advocate for themselves, perhaps because their thinking is very disorganized from delusions or they are overwhelmed by a generalized psychic burden such as in the case of major depression. If they don’t have a family member to advocate for them they may be at the mercy of doctors who know little about them and are practicing in an area of medicine that may be more difficult than any other—the human brain is the most complex known object in the universe. And, even if a patient has a family advocate, there are HIPAA (Health Insurance Portability and Accountability Act) legal concerns that can be obstacles to communicating. This is especially true if there is a suspicion that family members are the underlying cause of the problem and they may not have the patient’s best interests in mind.
