In the course of a typical week, we frequently encounter patients who are intoxicated, belligerent, or cantankerous. Sometimes they are all three. The bottom line with these folks is that they really don’t want to be with us. After a brief encounter, the sentiment is usually mutual.

We may ask these patients why they have chosen to visit us if, in the end, they don’t desire our company. This is a conversation best left inside our heads. A wise person said that it is best never to argue with a fool because onlookers may not be able to tell the difference.

Some may bristle at the notion of labeling a patient undesirable. This is an easy thought to have looking down from the ivory tower and less so at ground level. I believe that it is healthy to acknowledge our human nature. If you line up a hundred people (including the person’s mom) and ask them all if they want to spend time with a drunken, malodorous, and hostile oaf, they will all vote NO with both hands. Once we recognize our distaste for these individuals, setting this bias aside becomes easier.

Our ability to do this mighty feat is what separates professionals from pedestrians. We recognize that we must look beyond our immediate desire for physical and emotional distance from those who lack good judgment. Instead of crossing the street and turning our gaze afar, we must run to the social fire and fling open the doors.

I’m not convinced that it is God who looks after drunks and fools. These days it seems that this job has become the purview of the emergency physician. Drunkenness now precludes incarceration, and the police gladly deposit these citizens at our doorstep. No other physician, especially a psychiatrist, is interested in seeing these folks in their impaired state.

Objectionable behavior in a private office leads to a fast train to the ED.

We are the remedy for many apparently unsolvable problems because we are willing and we are adept. We open our arms as well as our minds to many who find only locked doors and disinterest elsewhere.

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