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Patients Leaving AMA

April 19, 2012

There are a lot of legal challenges involving patients who leave the hospital against medical advice.

Considerations include whether or not a patient has decisionmaking capacity and whether the patient understands the consequences of and alternatives to leaving against medical advice.

Here is the handout outlining some of the topics I discuss in the lecture I give on AMA discharges … including what the abbreviations “F/U ASAP, R/B/A disc, VU. NCT/SDT” mean and how they can help you if you are ever sued for wrongly discharging someone AMA.

Although physicians usually have an appropriate discussion of AMA issues with patients, they aren’t as good at documenting the discussions. A good article on shortcomings in physician documentation of AMA discharges titled “Emergency department discharges against medical advice” can be found in the Journal of Emergency Medicine. Although not available online, the basic gist of the article is that in a study of charts from 52 consecutive patients discharged AMA from a moderate-sized hospital, documentation showed that

  • 36% of patients understood their diagnosis
  • 44% of patients understood the proposed treatment
  • 2% of patients understood the alternative therapy
  • 57% of patients understood the consequences of refusal
  • 62% of patients were referred to follow up physician
  • 67% of charts documented patient competence

Documentation improved significantly after physicians were made aware of the deficiencies.

Oh, and for all of those people who were in the lecture and didn’t know who Sgt. Phil Esterhaus was, here’s a link to his famous catchphrase.

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