The tuberculosis patient who leaves against medical advice from the San Francisco City and County Hospital.

The self-discharge patients from the San Francisco City and County Hospital were studied for the year 1952. There were 184 self-discharged patients and 524 regular-discharge patients from the entire Tuberculosis Hospital. A detailed study of all the self-discharges (74) and a control sample (69) from the Stanford service were compared statistically. It was evident from the data that the patients who go out as Signed Release are different from those who go Absent Without Leave (AWOL) in observable ways. An attempt has been made to define what characterizes the self-discharge sample from medical and social viewpoints. One can neither plan nor evaluate programs of patient care when one does not know the nature of the patient sample. It is emphasized that the patient sample, as well as the administration, vary from hospital to hospital and from year to year. Errors have been committed in formulating generalizations about tuberculosis patients without cognizance of the difference between hospitals, patient samples and also without realizing that the self-discharge population consists of two important subgroups. There were 30.7 per cent self-discharge patients, the majority of whom had far advanced disease. The majority of the control did not have far advanced disease. There was no sex difference between the total self-discharge and the total control population. The female self-discharges had a significantly greater incidence of positive sputum than the male self-discharges. The male AWOLs had a significantly greater positive sputum incidence than the female AWOLs. There was a highly significant increase in the extent of disease among readmitted self-discharge patients compared to all first admissions. The majority of self-discharge patients left within the first six months. The majority of AWOLs stayed less than three months! The majority of Signed Releases stayed more than three months. The self-discharged left sooner than the control. There was a decrease in number of self-discharges during the summer months, which was statistically significant. The majority of self-discharges were separated or divorced, while the majority of controls were married. This was highly significant statistically. A history of alcoholism was three times greater in the self-discharged as compared to the control. In the AWOLs the alcoholics predominated, while in the Signed Releases the non-alcoholics predominated. These were significant differences. It is estimated that the cost of hospitalization to the city, county and state for the 184 self-discharge patients of the entire Tuberculosis Hospital was $217,375. In their projected cost based on readmission figures it was estimated that the self-discharge sample over a five-year period represents a financial liability in excess of one and one-quarter million dollars. It is estimated that their behavior as self-discharge compared to regular discharge patients represents an added burden of approximately $2,000 per patient. If the self-discharge population were reduced by one-fourth, the savings in hospitalization would amount to $54,343 a year, or over one-quarter of a million dollars in five years. To spend money to ameliorate this situation would not only be humanely wise but economically sound. If it would be possible to define the patient population at risk from the standpoint of self-discharge, then it would be possible to compare the changes in risk factors over a period of time and in relation to adjustment of program. The lack of statistical control studies of such an important part of the tuberculosis program should spur students of the problem to extensive and careful studies.