ⓘ Against medical advice, sometimes known as discharge against medical advice, is a term used in health care institutions when a patient leaves a hospital against ..

                                     

ⓘ Against medical advice

Against medical advice, sometimes known as discharge against medical advice, is a term used in health care institutions when a patient leaves a hospital against the advice of their doctor. While leaving before a medically specified endpoint may not promote the patients health above their other values, there is widespread ethical and legal consensus that competent patients are entitled to decline recommended treatment.

The available data suggests that in general, patients discharged AMA have an increased risk of hospital readmission, and potentially death. This data however, describes groups of patients discharged AMA, and therefore should not necessarily be applied to an individual patient wishing to leave AMA, and who may have different clinical circumstances and risks.

Although common hospital practice for an AMA discharge involves the patient being asked to sign a form stating that they are aware that they are leaving the facility AMA, the hospital is generally not legally required to use it. Rather, the legal and ethical requirement is that the authorized health care professional has an informed consent discussion with the patient regarding their choice to leave the hospital before it has been recommended. This discussion which includes disclosure of the risks, benefits, and alternatives to hospitalization, as well as the patients understanding, should be documented in the patients chart. Many physicians incorrectly believe that insurance denies payment for the hospitalization of patients leaving AMA, leaving such patients financially responsible. This "pervasive medical urban legend" may lead to ethical problems, as it "scare patients with misleading information" about their exposure to costs, leading to a "breakdown in the patient–doctor relationship" and an infringement of patient autonomy.

Some authors have begun to question the wisdom of the practice of designating a discharge as AMA, as it doesnt follow professional standards, lacks evidence of its utility to improve patient care, and may harm patients by reducing their likelihood of following up. Finally, there is widespread ethical consensus that even when patients decline recommended treatment, health care professionals still have a duty to care for and support patients.

The limited research in this area has led to a stagnation in effective interventions designed to alleviate AMA discharges. Multiple retrospective studies examining AMA discharges over the last 4 decades have attempted to identify risk factors in order to develop interventions to reduce the likelihood of AMA discharges in the future. The majority of studies have identified patient risk factors for AMA discharges that included low socioeconomic status, history of drug or alcohol abuse, and male gender. No studies have yet attempted to identify physician factors that increase the risk of an AMA discharge. More research is needed to understand this practice and intervene effectively.

                                     

1. Statistics

In the United States, the total number of stays discharged AMA increased 41 percent between 1997 and 2011. For adults ages 45-64 years, the percentage of AMA discharges increased from 27 percent in 1997 to 41 percent in 2011. By payer, the share of AMA discharges increased from 25 percent to 29 percent for Medicare and decreased from 21 percent to 16 percent for private insurance.

                                     
  • Against Medical Advice A True Story is a New York Times Bestselling non - fiction book by James Patterson and Hal Friedman, detailing the illness and medical
  • medical advice involves giving a diagnosis and or prescribing a treatment for medical condition. Medical advice can be distinguished from medical information
  • lightly. This is typically termed the RMA - AMA refusal of medical assistance against medical advice to differentiate it from a standard RMA which may be
  • common against male than female doctors odds ratio of 2.45 Medical error Medical malpractice in the United States Quackery Proving a Medical Malpractice
  • formation of the Academy occurred against a backdrop of increasing fragmentation and specialisation within the medical profession. The Academy merged with
  • Action against Medical Accidents AvMA is the UK charity for patient safety and justice. It provides free independent advice and support to people affected
  • Professional indemnity against claims for clinical negligence Support and representation at GMC fitness to practise hearings Medico - legal advice Help at inquests
  • Medical diagnosis abbreviated Dx or DS is the process of determining which disease or condition explains a person s symptoms and signs. It is most often
  • involuntary commitment, the person is free to leave the hospital against medical advice though a period of notice, or the requirement that the leaving
  • The Center for Medical Progress CMP is an anti - abortion organization founded by David Daleiden in 2013. The CMP is best known for producing undercover