Challenging the Myths of the Against Medical Advice Discharge
Authors: David Alfandre
Journal: Annals of Internal Medicine (2022)

LettersMarch 2022Challenging 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 YorkAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: I am grateful for the thoughtful comments from my colleagues; they highlight real challenges for physicians tasked with balancing patient needs with hospital and institutional requirements. I understand Dr. Wright's point that physicians rely on legal counsel to assure them that their actions are consistent with relevant state or federal regulation. Specifically, the optimal way to provide high-quality care when there are concerns about legal liability is to work collaboratively with legal counsel.Physicians, whose primary obligation is to the patient, should be dissuaded from relinquishing their central role in patients' care plans. Lawyers' valued expertise is with ...References1. N.Y. Comp. Codes R. & Regs. tit. 10, § 405.9. Google Scholar2. Onukwugha E, Alfandre D. Against medical advice discharges are increasing for targeted conditions of the Medicare Hospital Readmissions Reduction Program. J Gen Intern Med. 2019;34:515-7. [PMID: 30652272] doi:10.1007/s11606-018-4765-3 CrossrefMedlineGoogle Scholar3. Alfandre D, Bipin Gandhi, Onukwugha E. Adverse discharge outcomes associated with the Medicare Hospital Readmissions Reduction Program among commercially insured adults. J Healthc Qual. 2022 Jan-Feb 01;44:1-10. [PMID: 33724963] doi:10.1097/JHQ.0000000000000302 CrossrefMedlineGoogle Scholar4. Onukwugha E, Nagarajan M, Offurum A, et al. Multi-level predictors of discharges against medical advice: identifying contributors to variation using an all-payer database. J Healthc Qual. 2021 Jan-Feb 01;43:e8-19. [PMID: 32134810] doi:10.1097/JHQ.0000000000000252 CrossrefMedlineGoogle Scholar5. Nolan NS, Marks LR, Liang SY, et al. Medications for opioid use disorder associated with less against medical advice discharge among persons who inject drugs hospitalized with an invasive infection. J Addict Med. 2021;15:155-8. [PMID: 32804690] doi:10.1097/ADM.0000000000000725 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 YorkDisclaimer: 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. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists Inpatient Notes - Challenging the Myths of the Against Medical Advice Discharge David Alfandre 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 Metrics March 2022Volume 175, Issue 3Page: W23-W24KeywordsBioethicsHospitalistsHospitalizationsInpatientsPatients ePublished: 15 March 2022 Issue Published: March 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...