Featured Research

from universities, journals, and other organizations

Patients Being Discharged Against Medical Advice

Date:
March 9, 2009
Source:
Mayo Clinic
Summary:
When patients choose to leave the hospital before the treating physician recommends discharge, the consequences may involve risk of inadequately treated medical conditions and the need for readmission, according to a new review.

When patients choose to leave the hospital before the treating physician recommends discharge, the consequences may involve risk of inadequately treated medical conditions and the need for readmission, according to a review in the March 2009 issue of Mayo Clinic Proceedings. Additionally, the article examines the effect of costs as well as predictors and potential interventions to help manage and improve this important issue.

Although studies to date are limited, research shows that against medical advice discharges represent as many as 2 percent of all hospital discharges. Those patients represent an at-risk group for both morbidity and mortality, according to the article. Within 30 days, the review states patients with asthma, for example, who were discharged against medical advice had a four-times-higher risk of readmission to the emergency department within 30 days and an almost three-times-higher risk of readmission to the hospital. Further, in a study of general medicine service, patients who left against medical advice were seven times more likely to be readmitted within 15 days, almost always for the same diagnosis. Such readmissions clearly indicate higher health care costs, the review concludes.

At the heart of the problem is an ethical dilemma for physicians. When a patient wishes to leave against medical advice, this may be contrary to the physician's attempt to do what is believed best for the patient. The struggle is between patient autonomy and physician beneficence, according to the review. In practice, managing this issue presents more complications than simply identifying and potentially prioritizing the relevant ethical principles, the review reports. Physician-patient communication, informed consent, and underlying psychiatric issues are all relevant to practical management.

Identifying patients likely to leave against medical advice is crucial, according to the article. Studies to date have shown these groups to include patients with alcohol or drug history, financial issues, sickness within the family and individuals who begin feeling better. General psychiatric health also is an important consideration.

"Particularly because many patients request to leave the hospital for personal or financial reasons, the clearer these motivations are, the better the physician can discuss the need for hospitalization," states the review's author, David Alfandre, M.D., Department of Veterans Affairs National Center for Ethics in Health Care, New York Harbor Healthcare System. "For example, when a physician determines that an increasingly angry and 'demanding' patient wants to leave the hospital to care for his homebound mother, not because he has little concern for his elevated blood pressure, the physician can attempt to reduce the patient's burden by focusing on that issue, rather than on the mounting discharge conflict between physician and patient."

The review in Mayo Clinic Proceedings adds, "Informed consent in deciding to leave against medical advice is one of the most important elements of care for patients who make this decision. An informed decision means that the patient has arrived at the decision in consultation with his or her physician without being subjected to coercion and with a full understanding and appreciation of the risks."

The review recommends more studies and says, "Focusing on providing informed consent, with attention to the vulnerabilities and health literacy levels of hospitalized patients, can ensure the best care possible for patients while respecting autonomy."


Story Source:

The above story is based on materials provided by Mayo Clinic. Note: Materials may be edited for content and length.


Cite This Page:

Mayo Clinic. "Patients Being Discharged Against Medical Advice." ScienceDaily. ScienceDaily, 9 March 2009. <www.sciencedaily.com/releases/2009/03/090309105102.htm>.
Mayo Clinic. (2009, March 9). Patients Being Discharged Against Medical Advice. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2009/03/090309105102.htm
Mayo Clinic. "Patients Being Discharged Against Medical Advice." ScienceDaily. www.sciencedaily.com/releases/2009/03/090309105102.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Dangerous Bacteria Kills One in Florida

Dangerous Bacteria Kills One in Florida

AP (July 31, 2014) Sarasota County, Florida health officials have issued a warning against eating raw oysters and exposing open wounds to coastal and inland waters after a dangerous bacteria killed one person and made another sick. (July 31) Video provided by AP
Powered by NewsLook.com
Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Peace Corps Pulls Workers From W. Africa Over Ebola Fears

Peace Corps Pulls Workers From W. Africa Over Ebola Fears

Newsy (July 30, 2014) The Peace Corps is one of several U.S.-based organizations to pull workers out of West Africa because of the Ebola outbreak. Video provided by Newsy
Powered by NewsLook.com
Weather Kills 2K A Year, But Storms Aren't The Main Offender

Weather Kills 2K A Year, But Storms Aren't The Main Offender

Newsy (July 30, 2014) Health officials say 2,000 deaths occur each year in the U.S. due to weather, but it's excessive heat and cold that claim the most lives. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile: iPhone Android Web
      Follow: Facebook Twitter Google+
      Subscribe: RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins