It is a challenge to provide quality healthcare when patients do not adhere to their physicians’ recommendations for treatment. The patient who insists on leaving the hospital Against Medical Advice (AMA) is an extreme example of non-adherence, and this situation creates high potential for serious errors. Recognition of the reasons patients leave can help negotiate these encounters. They leave for a variety of reasons including personal and financial obligations, breakdown of communication between the patient and medical staff, dissatisfaction in care, and not understanding the need for further testing or treatment. Every effort should be made to determine what is driving the patient’s decision-making process. There may be times when the provider is at a loss to understand why a patient would walk out prior to receiving necessary care. Even in this circumstance, treatment without consent can be deemed as battery, as patients do have the right to refuse care.
Some courts have ruled that it is illegal for a hospital to require a patient to sign a waiver of liability as a “condition of their release” (Dedely V. Kings Highway Hospital Center, 617 NYS 2d 445 Supp (1994)). Therefore, the better approach consists of documenting the following eight criteria:
Documentation proficiency of patients who leave the emergency department against medical advice
Risk management for the emergency physician: competency and decision-making capacity, informed consent, and refusal of care against medical advice
“I’m Going Home”: Discharges Against Medical Advice
Association of Hospital Discharge Against Medical Advice With Readmission and In-Hospital Mortality (JAMA Network Open)
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