https://www.theguardian.com/housing-network/2012/may/30/nhs-discharges-homeless-patients-to-street

This imagine was taken by Frank Baron for the Guardian Newspaper regarding an article about homeless patients. The description of the photograph is that of a homeless man that was admitted to the Hospital and is now being discharged back on to the streets. I choose this image because It reminded me of a similar patient, I had encountered during my clinical practice block at Khayelitsha District Hospital.

Reflection

During my first clinical practice block, I was assigned to a patient by clinicians and they had described him as ‘a patient that pretends to be in intense pain’. When I went to see him in one of the wards that he was in, I was excited and scared because of the description my clinician gave of him as a troublesome patient, however when I met him it was a different story. Having met him for the first time his personality was warm and welcoming, he spoke with a hopeful sense of humour. I went through his file and saw his diagnosis was listed as Mild traumatic brain injury and went through his relevant information and found that he had no social history written on his folder. Furthermore, when I was asking him about subjective questions, I followed up and asked about his social history. At first when I was trying to get information about his social history, he did not look interested in answering the question but when I asked if his family visits he responded and said he doesn’t have family and his homeless.

Having found out his living situation it then made sense to me why he did not want to get discharged. Furthermore, into the above referenced article it is reported that seven out of 10 homeless people who end up in hospital are discharged back onto the streets (Alice, 2012). Homeless people are often discharged without the root of their illnesses being addressed, which damages their health further and increases the costs that the hospital undertakes (Alice,2012).

Having read the above, one should see that there are ethical defaults such as inequality and lack of empathy and understanding. Had the multidisciplinary team tried to understand his situation then they would’ve known why he did not want to get discharged and they would have understood that being inside the hospital for him is better than the fight for survival that he faces outside. Inside the hospital his basic needs such as shelter, food and water are met and constant than when he is outside, and they are scarce and non-existent. Additionally, other medical roots could’ve been explored which would have led him to be kept in a shelter to ensure that he does not have to constantly come back to the hospital because someone would be caring for him.

Life on the streets is rough. Homeless people not only have high physical and mental morbidity, but also
seem to experience poor access to health services in our communities. According to a report by the UK
Department of Health, more than 70% of homeless people who are admitted to hospitals are discharged
back onto the streets, instead of shelters, sometimes prematurely and without having been treated for their
underlying health problems.

Through this experience, I learnt that it is better to find out about patient’s circumstances and to always try and understand why a patient behaves in a certain way before assuming your own conclusion which can lead you to treating them unfairly and harshly which will further not benefit the patient from treatment session but could deteriorate their progress. To avoid the above as an outcome, ethical principles needs to be upheld and practised thoroughly.

References 

Alice.,S.  (2012). Discharges to the Streets: Hospitals and Homelessness. . Louis U. Pub. L. Rev., 19, 357.Craig, T., & Timms, P. W. (1992). Out of the wards and onto the streets? Deinstitutionalization and homelessness in Britain. Journal of Mental Health, 1(3), 265-275.Buck, D. S., Brown, C. A., Mortensen, K., Riggs, J. W., & Franzini, L. (2012). Comparing homeless and domiciled patients’ utilization of the Harris County, Texas public hospital system. Journal of health care for the poor and underserved, 23(4), 1660-1670.