this post was submitted on 01 Feb 2026
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Way too many people are not educated well enough to be parents, I know I just argued with people who say there should be less kids, but like, my parents did best they knew and I turned out pretty fucked up, 3 psychiatry docs quite confidently gave me contradictory diagnoses, that feels like an achievement
We recently got an in-house overnight hospitalist at my tiny inner city hospital. She was on our psych unit doing medical assessments for new admissions and asked, "How can all of these people have schizoaffective? Is that just what they put when they don't know?" I almost choked on my coffee.
Honestly, it's also just what people get diagnosed with when their primary problem is actually just homelessness. Homelessness is a "risk factor," not a diagnosis you can bill Medicaid for. Sure, they might have some combination of psychosis, mood instability, poor social skills, inability to care for their bodies, and maybe substance use sprinkled in. But the street just produces that. Exposure, starvation, assaults by humans and animals, untreated wounds—all of it combines into a swirling pile of physical and emotional risk factors.
Eventually, if someone manages not to actually go crazy, they’ll often fake or exaggerate symptoms to get admitted to the relative safety of the psych ward. Then they stamp schizoaffective on the chart, prescribe a mood stabilizer and a second-generation antipsychotic, let them stay a week, and discharge them back to the street to start the cycle over.
as an aside...
...if they’re an absolute menace while they’re there (say, physically capable of bathing and toileting but shitting their pants and yelling at a 20-year-old nursing assistant that it’s her job to clean them) they might get labeled antisocial or malingering and get discharged and refused admission. But those are rare cases. Most homeless people seeking three hots and a cot are prickly at worst (which like, yeah). Usually, we’re both just resigned to it while I'm admitting them. After I finish the annoying parts, I’ll steal them a blanket from the warmer on medical.Seriously, if we just put people in houses, the mental health system would be halfway fixed. Many would still need occupational rehab or intensive skills training to avoid putting forks in microwaves or flooding residential bathrooms. But that would still be a million times cheaper than forcing me to do intensive, invasive acute psychiatry bullshit on people who barely qualify as a threat to themselves or others, simply because they end up on the same unit for lack of anywhere better to send them.
What is a hospitalist?
It's the doctor whose entire specialty is the general environment of the inpatient hospital, they also might be called an "internist" as in "internal medicine." The outpatient equivalent is a primary care, general practice, or family physician, since they both handle all body systems at once. The hospitalist is usually the attending / resident for an admitted patient for something basic like pneumonia or early stage heart or kidney disease (or some complicated combination of multiple that's not well handled by any one specialist). Once those are advanced in one particular organ or system they get taken by a cardiologist or nephrologist etc but for most patients the hospitalist is the doctor in charge. In psychiatry the psychiatrist is the attending / primary team, but the hospitalist is consulted to do a brief medical assessment to handle any underlying medical conditions like diabetes so that the psychiatrist doesn't fuck up their insulin or heart medicine.
Interesting! Thank you for educating me.
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