#1
Discharge against medical advice (DAMA) is defined as when a patient chooses to leave a hospital before the healthcare team recommends discharge from the hospital, and an increasing number of people are choosing to do it.
According to a report published in the National Library of Medicine, around 1-2% of all patients admitted to hospitals in the United States between 2011 and 2021 ended up leaving against medical advice (AMA). In some centers, that number went as high as 26%. It goes without saying that this can have serious repercussions for both the patient and the hospital.
#2
When he heard what the plan was (cath lab, admission to hospital, etc…) he said he was leaving “for a while” but he’d be back.
We tried to convince him not to leave but he wouldn’t listen to how serious it was.
He then said “it’s my birthday and I have two hookers waiting for me at my hotel room, I’m going to go have my fun then I’ll be back, I promise”.
Singed the AMA paperwork, dropped at the exit door, we coded him multiple times but never got him back.
One study of 656 patients found that the risk of readmission was 12 times higher in patients who left AMA when compared to the non-AMA group. The researchers revealed that patients discharged AMA were more likely to be homeless and have multiple comorbid conditions.
"At one year follow-up, the AMA group had higher readmission rates, were predisposed to multiple readmissions and had a higher in-hospital mortality," notes the paper.
#3
When a patient declines a recommendation from a doctor, they may be asked to sign an AMA form.
"When the AMA process is initiated, all it requires from you is to sign a form verifying your decision. The main intent of this form is to document the discussion between you and your provider," explains the Mid-Atlantic Emergency Medical Associates (MEMA) site.
#4
#5
Family was walking them down when they straight up coded in the lobby…. Intubated, got back to the CCU and the daughter was mad because 1) we didn’t bring the patient back to the original room and 2) we threw out a banana from the old room that the daughter wanted to eat.
The site adds that signing the form does not impact your care moving forward. But can actually be a helpful tool "to encourage an honest risk and benefit discussion." MEMA's experts say the form is there to make sure you fully understand your health service provider’s recommendation and any associated risk with your decision.
They add that the AMA process doesn't always mean that your doctor or provider necessarily disagrees with your choice. "For example, your provider may recommend you be admitted to the hospital. But they may also understand and agree with the reasons you decide to go home instead," explains the site.
#6
One of the most common reasons people go AMA is because they don't want to go to the ER for evaluation of a possible emergency. "Like when their doctor tells them to go to the ER because they are having worrisome chest pain," explains MEMA's team. Or when they refuse to be admitted to the hospital for treatment.
Some people go against medical advice when they're asked to have certain tests performed, like a CT scan, an MRI or even blood tests. Then there are those who aren't willing to consent to a procedure, whether it be getting stitches or having an amputation.
#7
We were called for a 60ish alcoholic who fell down 5 stairs, and was witnessed to hit his head on the hardwood at the bottom and have a loss of consciousness lasting at least a minute.
He had done something similar a year prior, refused AMA, then was rushed to the hospital two weeks later and diagnosed with a bleed.
This time we arrived, and he was already up and alert/oriented x3. His speech was mildly slurred, but he admitted to drinking. He was very adamant that he was refusing to go to the hospital, despite his entire family there, crying and begging for him to go.
He was also a lawyer, so the usual trick of just putting a little pressure on him and not really presenting staying home as an option didn’t work. He was being obstinate and the more his family begged, the more stubborn he became.
I tried every trick in the book. I had a private discussion with him and searched for any hint of him wanting to take his life, he had none. I got the vibe he had no respect for us as lowly paramedics, so I spoke to my base hospital doc and had the doctor speak to him on the phone. Still he refused.
Finally I had no choice but to go through a very lengthy and thorough refusal process, witnessed by his family who were still beside themselves. I was very clear that there was a strong possibility of him having another brain bleed, and he risked permanent and life altering disability if he had another stroke. He read through the legal release of care statement I presented to him very thoroughly, then signed the refusal. I asked his wife to sign as witness.
We had to leave the house with his family literally following us out to the ambulance, begging us to take him. I had to peel the wife’s hand off my forearm.
That call bothered me for weeks. What a selfish man.
#8
So why do these people risk going against a doctor's orders?
One 2019 study explored this question and found that 40.6% of the patients who left AMA had a lack of finances.18.2% had 'domestic problems,' 9.8% wanted to continue treatment elsewhere, and a few weren't satisfied with the healthcare, physical arrangements, or ward routine at the hospital.
A tiny percentage cited 'denial by payer' as their reason for being discharged against medical advice, and 4.9% reported other reasons, among which was "feeling better."
#9
#10
She had no epidural so she signed out AMA and left and went to another hospital. Where she was also told no to a lotus birth so tried to leave there. Delivered in their parking lot. Where the ER team responded and cut the cord. One of my favorite stories.
According to Verywell Health's team, you have the legal right to leave a hospital, and there is no law that requires you to sign discharge documents. However, they note that you should still prepare a letter that explains your decision to leave. "Keep a copy of the letter and give a copy to the hospital administrator," advises the site.
#11
Guy called me every name in the book, 40 year AAOx4, obese as hell. When I moved the patients arm to get to the IV, I was told “haven’t you learned anything? When people hurt me without apologizing I’m going to start swinging, then you’ll learn.”
I stood up and said “make my day. Do it, I dare you.” On Opti-flow mind you. Patient calls mom, and I’m thinking that maybe she will talk the patient down.
Mom proceeds to get into my face and threaten me as well, so it was apparent the apple didn’t fall far from that tree. Mom and patient told me if I didn’t give the patient the food when *he* was ready (and they also added the “it better be the dinner I ordered or somebody about to get hit and fired”) they would leave the hospital. I said “I’ll grab you a form and you can go.”
Proceeded to sign AMA. Then scream at me because I wouldn’t give them an oxygen tank or a wheelchair. Patient goes “I can barely walk because of my foot pain (neuropathy), where’s my wheelchair.” I said “you signed out AMA, how you leave the hospital is your problem now.”
Mom proceeded to take patient home, not before she put blankets in the sink, turn on the water, and flood the entire room 🙃.
#12
There are certain cases where a hospital can legally prevent you from leaving. One is if a person is mentally ill or incapacitated, especially if they pose a risk to others or themselves. Another is in the case of minors and people under the legal guardianship of others. They will have to be discharged by their legal guardians.
Have you ever gone against medical advice by leaving a hospital or refusing treatment? Let us know all about it in the comments section below...
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#14
Found out later she had been taken to another ED in our system two days earlier, same symptoms, but when they found out she had been given a COVID test and would have to wait for the results before they would decide what room to give her, they left with her AMA. My question, why did they come in again if they weren't going to let her get tested and treated? I mean, read the news, people...if your unvaccinated Meemaw is short of breath and has a fever, you think she's NOT going to get tested for COVID?
I'm always going to wonder about what happened to her. I felt bad for her. I could tell she really wanted to stay in the hospital where she could get treatment. She seemed like such a tiny, sweet, scared old lady. But she was definitely more scared of her family's opinion than she was of COVID.
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#18
Came back to work the next day thinking he had a seizure and went to ICU to find he signed an AMA overnight so he could go back to work Monday.
#19
Not quite an AMA but had a morbidly obese man on bipap with a potassium of 10 (!) demanding everything under the sun & to leave AMA despite being unable to breathe or move, much less walk. I remember being part of the 4 person team that held his belly out of the way so we could hold a urinal in place so he could pee. He coded & died in the hallway on the way to ICU.
#20
