OWN DISCHARGE

Cause of action for medical malpractice is sometimes complicated by hospital discharge Against Medical Advice (AMA). Such incident may prove to be medicolegally irrelevant, a novus actus interveniens which may or may not be fatal to the success of the action, or a symptom of the inappropriateness of the medical care provided. Sometimes it represents professional failure adequately to assess competence to consent to, or refuse, medical treatment (see Suicide Risk).
 

Refusal to accept medical advice to initiate or continue hospitalisation is the tip of the iceberg of doctor-patient failure to negotiate an effective and acceptable treatment plan. Various studies have shown that only about 50% of patients comply with long-term drug therapy, and less than 10% act on advice to make life-style changes ¹.  Against this background, irregular discharge may be viewed as a more assertive and immediate response to a failure of the parties to achieve a treatment contract ².
 
 

Psychiatric patients who repeatedly discharge themselves AMA tend to be young men with diagnoses of substance abuse, personality disorder, or schizophrenia ³.  They have a high rate of spontaneous return for medical care ⁴.
 
Chest pain sufferers who irregularly discharge themselves from emergency rooms are intermediate in risk for myocardial infarction, and prognosis between those who are consensually discharged or admitted as an inpatient ⁵.

Notwithstanding the right of self-determination in medical care, physicians have an ethical and legal responsibility to disclose the potential complications of AMA discharge.
 
While there may be documentation of the patient’s competence to refuse, a record that s/he understood the diagnosis and treatment is less common ².

Copyright © 2009 Electronic Handbook of Legal Medicine