“We’re Doctors, Not Jailers”: How Can Hospitals Balance Patients Leaving against Medical Advice with Patient-Centered Care?

July 12, 2017 | Risk Management News

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​The rising trend of older patients leaving against medical advice (AMA) was the subject of a July 7, 2017, article in the New York Times. Reasons an older patient may leave include feeling better, fear of a procedure, and worry they will be unable to pay—or they "might simply want to go home and feed the cat," the article said. The article describes an 82-year-old man with Alzheimer disease and a history of cardiac problems who had nearly fainted while walking down the street. Later, in a hospital emergency department (ED), he was sitting up and talking, and all his vital signs were normal. His daughter, a geriatrician, assumed he must have been dehydrated, and she asked for him to be discharged, telling the ED physician that she would stay with her father overnight to ensure his safety. The ED physician refused to discharge him, insisting he be kept overnight for monitoring. The patient, known to be prone to sleeplessness and delirium when in hospitals, peeled off his heart monitors and became agitated during the night. The next afternoon, a cardiologist still had not seen him, and the hospital still would not discharge him. Eventually they released him AMA.

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