For many people, holidays are a time of good cheer.  For others, it can be quite lonely. It's a time of year when some people come to the Emergency Room pretending to be ill.  They're not there for treatment...but companionship.

I've worked over the holidays for many of the more than 25 years I've been an ER physician.  From time to time, we see patients who visit during the holidays.  They seem well enough that you wonder what motivated them to pay us a visit.  A doctor writing in a recent issue of the journal The Lancet describes an elderly patient whose husband died more than 20 years previously.  Both of her children had grown up and lived abroad. According to the doctor, she complained of injuries.  Her doctor ordered a battery of tests that were found to be normal.  Each time her doctor was about to discharge her from hospital, she complained of new symptoms that required further investigation.  When confronted by her doctor, she admitted that she made up her complaints in order to extend her stay in hospital.  Finally, she admitted to her doctor that she was lonely. 

Click here to read an accompanying editorial in The Lancet.

It's rare to get that kind of clarity from a patient.  Most of the time, the doctors and nurses suspect the patient has what we call a "hidden agenda" but never manage to find out what it is.  It's not just seniors who come to the ER for companionship.  So do people homeless people, those with psychiatric issues and those who are disabled.

They come to the ER because we're open 24 hours a day, seven days a week.  We're obliged to take on all comers.  We've also learned from bitter experience never to look too closely for what we call a hidden agenda.  In that way, we don't assume a patient is faking or even exaggerating their symptoms because we're meeting them for the first time.  If we assume the patient isn't really sick but lonely - we might miss a life threatening illness and they'll die on our watch and their family will blame us for missing something.  Or, they might be lonely AND sick.  To ask if a patient has come to the ER because of loneliness, you really need to know the patient.  ER physicians and nurses seldom have that luxury.

All too often, it's not the patient's idea to come to the ER.  The hospital ER is often used as a last minute place to send parents and grandparents when families either can't cope with a loved one in need or who don't want to.  There are many reasons why they do it.  They might be well meaning but haven't organized extra support for their relative.  They may be in denial that their loved one can't cope at home.  Some have plans for the holidays and feel that tending to their loved one will spoil them.  In fairness, in some cases, the problem is that the person they bring to the ER is lonely or unable to look after him or herself and won't accept help or even say that they need it. 

If you think the hospital is cure for loneliness, guess again.  That's what a team of nurses at the University of Alberta led by Donna Wilson found quite recently when they interviewed nine seniors at two hospitals in Edmonton who were awaiting placement in a nursing home (click here to read more).  The seniors interviewed called the hospital a bleak environment.  They described sitting in hospital with absolutely nothing to do and no one to visit.  Few waiting seniors have regular visits from friends and relatives either because they have outlived them, or they didn't marry, or didn't have children, or their children are working, busy with family commitments, or live far away. In many cases, there aren't enough hospital volunteers to fill the gap.  I can tell you that in the ER, with the emphasis on moving patients through the system - we call it moving the meat - there's little chance you'll get TLC if you say you're lonely. 

There's how we should cope and how we do cope.   When I was a lot younger, I thought of lonely patients as a nuisance, just like many of my colleagues.  As you get older, your patients begin to remind you of your parents.  I wouldn't want my folks to be seen as a nuisance, so why should I feel that way about lonely patients.  As you get even older, you can't help but begin to wonder how you'll be treated when and if you go to the ER some holiday season.  If all else fails, I look at the lonely people who come to the ER at this time of year and feel grateful for having family and friends.

That's something for all of us - not just the people who work on my side of the gurney - should think about at this time of year.