Annals for Hospitalists Inpatient Notes - Challenging the Myths of the Against Medical Advice Discharge
Authors: David Alfandre
Journal: Annals of Internal Medicine (2021)

Web ExclusivesOctober 2021Annals for Hospitalists Inpatient Notes - Challenging the Myths of the Against Medical Advice DischargeDavid Alfandre, MD, MSPHDavid Alfandre, MD, MSPHU.S. Department of Veterans Affairs National Center for Ethics in Health Care and New York University Grossman School of Medicine, New York, New York (D.A.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3450 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Against medical advice (AMA) discharges, when a patient leaves the hospital before reaching a physician-recommended end point, constitute 2% of hospital discharges in the United States, with worse disparities among African Americans; persons experiencing homelessness; and patients with mental illness, substance use disorders, and Medicaid insurance (1). Against medical advice discharges are also associated with increased 30-day hospital readmission and mortality rates. Patients regularly report feeling stigmatized by health care providers when leaving AMA and, in some cases, report a reduced willingness to follow up for care because of perceived mistreatment (2, 3). A holistic approach to higher-quality care includes ...References1. Alfandre D, Brenner J, Onukwugha E. Against medical advice discharges. J Hosp Med. 2017;12:843-845. [PMID: 28991952] doi:10.12788/jhm.2796 CrossrefMedlineGoogle Scholar2. Onukwugha E, Saunders E, Mullins CD, et al. Reasons for discharges against medical advice: a qualitative study. Qual Saf Health Care. 2010;19:420-4. [PMID: 20538627] doi:10.1136/qshc.2009.036269 CrossrefMedlineGoogle Scholar3. Jerrard DA, Chasm RM. Patients leaving against medical advice (AMA) from the emergency department—disease prevalence and willingness to return. J Emerg Med. 2011;41:412-7. [PMID: 20097503] doi:10.1016/j.jemermed.2009.10.022 CrossrefMedlineGoogle Scholar4. Devitt PJ, Devitt AC, Dewan M. An examination of whether discharging patients against medical advice protects physicians from malpractice charges. Psychiatr Serv. 2000;51:899-902. [PMID: 10875955] CrossrefMedlineGoogle Scholar5. Berger JT. Discharge against medical advice: ethical considerations and professional obligations. J Hosp Med. 2008;3:403-8. [PMID: 18951403] doi:10.1002/jhm.362 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: U.S. Department of Veterans Affairs National Center for Ethics in Health Care and New York University Grossman School of Medicine, New York, New York (D.A.).Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs, the U.S. government, or the Veterans Health Administration National Center for Ethics in Health Care.Disclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3450.Corresponding Author: David Alfandre MD, MSPH, U.S. Department of Veterans Affairs National Center for Ethics in Health Care, New York University Grossman School of Medicine, 423 East 23rd Street (10P6), New York, NY 10010; e-mail, david.[email protected]gov. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - October 2021 Megan Mack , Matthew Luzum , and David H. Wesorick Challenging the Myths of the Against Medical Advice Discharge Matthew W. Wright Challenging the Myths of the Against Medical Advice Discharge Ronald Hirsch Challenging the Myths of the Against Medical Advice Discharge Karen E. Clark Challenging the Myths of the Against Medical Advice Discharge David Alfandre Metrics Cited by"They Just Assume That We're All Going to Do the Wrong Thing With It. It's Just Not True": Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject DrugsChallenging the Myths of the Against Medical Advice DischargeMatthew W. Wright, MDChallenging the Myths of the Against Medical Advice DischargeKaren E. Clark, MDChallenging the Myths of the Against Medical Advice DischargeRonald Hirsch, MD October 2021Volume 174, Issue 10Page: HO2-HO3KeywordsBioethicsHospitalistsHospitalizationsInpatientsPatient advocacy ePublished: 19 October 2021 Issue Published: October 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...