There are instances where patients in a medical facility want to leave against the medical advice of their doctors. For whatever reason, they have the right to do so, even if the decision poses a risk to their health. The best thing doctors can do in this situation is to try to educate their patients on the symptoms to look out for when they get home. Most physicians believe that they won’t hold any responsibility for any duty of care should a patient decide to discharge themselves against medical advice. If you choose to do this, too, you would have to sign an AMA form.
- 1 Against Medical Advice Forms
- 2 What is an against medical advice form?
- 3 AMA Forms
- 4 Why is leaving against medical advice a problem?
- 5 What happens if you go against medical advice?
- 6 AMA Paperworks
- 7 Consider this before you leave
- 8 Discharge Against Medical Advice Forms
- 9 What should your doctor do when you decide to leave against medical advice?
Against Medical Advice Forms
What is an against medical advice form?
When the against medical advice (AMA) process starts, all you need as a patient is to sign a discharge against medical advice form that verifies your decision. The main purpose of the form is to keep a record of the discussion between yourself and your doctor. It has no effect on your care when you leave the hospital. The document is a helpful tool in encouraging an honest discussion. It also ensures that you have an understanding of the reasons behind your doctor’s recommendation and any risks that come with your decision. A who declines the recommendations made by their doctor should sign the form. Here are the common reasons why people might make this decision:
- When they go to the ER for the evaluation of a worrisome condition but the symptoms go away, while they’re there.
- When they get admitted to a hospital for treatment but they don’t like getting confined.
- When they need to have a test performed but the cost is too great.
- When they receive a diagnosis but they want to get a second opinion.
Most patients would agree with their doctor’s recommendations, although they won’t always follow up or take their recommended medications. For instance, some patients won’t show up for their second consultation, while others miss their medications. But these aren’t situations scenarios where you would need an against medical advice form.
Why is leaving against medical advice a problem?
Discharge against medical advice (DAMA) has become a common issue in healthcare today. It occurs when a patient makes a decision to leave the hospital or medical facility even before their doctor recommends their discharge. These irregular discharges are very risky events where patients have a higher risk of mortality or readmission. Current studies in this area have focused on describing the characteristics of patients associated with DAMA. Unfortunately, this only supports the idea that leaving against advice is a type of deviant behavior, as seen in certain types of patients.
Many consider the DAMA a failure of the healthcare system in the aspect of helping patients achieve their medical goals. The DAMA represents a more comprehensive issue with existing delivery models, thus resulting in significant gaps in the quality of healthcare. We can view the DAMA as a product of non-patient-centered and ineffective care that affects vulnerable groups, which leads to inefficient, unsafe, and inequitable care.
What happens if you go against medical advice?
Most patients have the right to informed consent and the right to refuse medical care. There’s nothing wrong when a doctor discusses the benefits and risks of a vaccine during a check-up and the patient decides against the vaccination. But the refusal to accept treatment in a hospital setting or deciding to leave the hospital against medical advice comes with significant risk.
Caregivers are the most familiar people when it comes to taking their loved ones to the hospital and caring for them until they can go home. Most people don’t want to spend time in such an uncomfortable environment where there’s little privacy. Adding fuel to a patient’s frustrations is the regular appearance of hospital staff to diagnose, treat, and discharge patients, which results in a significant increase in their medical bills. Such situations may result in financial strain, one of the main reasons why patients decide to leave hospitals before receiving an “official” clearance to get discharged.
There are many risks involved when patients decide to leave the hospital before their doctors deem it advisable. Based on several studies, patients who file AMA paperwork and leave are at a higher risk for early hospitalization, which would likely cause them to sustain additional healthcare expenses. Also, patients who self-discharge from the hospital may experience a higher risk of mortality and morbidity.
Consider this before you leave
There are patients who think that hospitals don’t have their best interests in mind. They have a suspicious feeling that they’re kept longer by their doctors so they will get charged more. But in most cases, the reasons why patients do an AMA has something to do with safety.
Leaving the hospital prematurely is a serious decision that you shouldn’t take lightly even though many make the choice because of the costs. For example, if you have high-deductible health insurance or you pay in cash, each day you spend in the hospital will cost you more. Having too many extra days could leave you with increasing medical bills that you can’t afford. If you’re thinking about going against medical advice, consider these factors first:
One of the main concerns of people who get admitted to hospitals is the high costs of hospital care. Here are some ways to deal with this issue:
- There are people in the hospital who can help you with this issue. These include patient representatives, ombudsmen, or patient advocates. They can go through your bill and give you advice on how to get help with the costs of your treatment.
- If you aren’t insured, you can have your bill reduced. You can also show proof of low income to reduce your bill further.
- Provide evidence that you’re in extreme financial distress to request a reduction in your expenses.
- Many hospitals offer payment plans with 0% interest so you should ask about these.
Sometimes, patients choose to leave before they’re allowed to because they have other complaints. These include:
- They don’t feel like they’re receiving proper medical care.
- They don’t agree with the type of care they’re receiving.
- They feel that errors made in the hospital have placed their lives at risk.
If a patient experience any of these complaints, they shouldn’t leave without filing an official complaint first. They can either talk to a hospital social worker or reach out to the hospital administration. Most hospitals take these complaints seriously, especially since they want to avoid legal consequences. They usually take quick action to correct the errors or help the patients find a solution. In some cases, they might even transfer the patient to another hospital.
Patients shouldn’t sign anything that would absolve the hospital of any liability for their complaint until the hospital has resolved the concern and the patient feels satisfied. It’s also important to have a patient advocate present to help out with the negotiations. In some cases, the solution that the hospital offers increases the medical costs of the patient. In such a case, the patient could insist that the hospital covers those costs. If the patient makes a valid complaint, the hospital should agree to shoulder the cost.
Other factors that could prompt patients to leave before getting officially discharged include:
- Many patients choose to leave because they don’t like hospitals. Some may have had bad experiences in the past or they might have apprehensions about infections and germs. In such a case, the patient should talk to their doctor. It’s important for the patient to keep an open mind during their conversation.
- Before deciding to leave, the patient should try to see their situation objectively. Weighing the benefits and costs of leaving with the benefits and risks of staying could help them make a sound decision.
- Patients in poor health might not have the capacity to make an informed decision by themselves. In such a case, a family member, private patient advocate, or trusted friend can act on their behalf.
If you ever find yourself thinking about leaving the hospital against your doctor’s medical advice, you should know the following points:
- You probably can leave unless you suffer from mental health issues or your doctor deems you at risk of harming yourself or other people.
- AMA discharges don’t void your insurance terms. Leaving against your doctor’s advice won’t result in a payment refusal nor will it trigger an insurance premium increase. But it’s possible that you would incur more medical expenses if you get readmitted after some time.
- You need to sign discharge papers. This document differs from any complaint you might have filed. The documents state that you have voluntarily chosen to leave against your doctor’s advice.
- You aren’t legally required to sign those documents. But you do have the legal right to leave. There isn’t any law that requires you to sign discharge documents. But it’s a good idea to prepare a letter with a reason why you chose to leave. Keep a copy of your letter and give a copy to the hospital administrator.
Discharge Against Medical Advice Forms
What should your doctor do when you decide to leave against medical advice?
Medical practitioners would do their best to make their patients feel comfortable. They use their skills and experience so their patients won’t think about leaving the hospital against their medical advice. Unfortunately, no matter how hard these doctors try, there are still some patients who always choose to leave even before they complete their evaluation.
AMA patients are at high-risk and doctors should take a rational and calm approach when talking to patients who want to leave early. If they fail, it might lead to a medical problem for the patient and a malpractice suit for the doctor. If the issue goes to court, the decision will depend on many factors aside from the leave against medical advice form. Here are the dos and don’ts for doctors to keep in mind when dealing with AMA:
- The doctor should determine the patient’s decision-making capacity. The patient should have the capacity to make such a decision. They should understand the consequences, benefits, and risks as explained by the doctor.
- The doctor should apologize if the patient has waited too long because of delays in their healthcare process.
- The doctor should talk to the family of the patient to convince them to stay. Most patients often trust their loved ones more than their doctors.
- The doctor should document the “informed refusal” of the patient to accept diagnostic testing, procedures, or treatments in detail.
- The doctor should record the details of the AMA patient encounter in the chart of the patient. The doctor should also include details about the decision-making capacity of the patient, the benefits of the proposed treatment, and the risks of leaving against medical advice. Also, the doctor should take note of what they said or did to convince the patient to stay and their interest in having the patient come back for follow-up. The doctor should have the patient sign an AMA form that includes all of these details.
- The doctor shouldn’t ignore a patient who wants to leave AMA. If possible, they should focus on the patient and address the issue.
- The doctor shouldn’t berate or blame the patient for their desire to leave the hospital. Patients have the right to accept treatment and the right to leave. Doing these things will only make the situation worse.
- The doctor shouldn’t ask a nurse or any other hospital stall to have the patient sign a generic AMA form and allow them to leave. Simply signing an AMA form isn’t enough as it provides little protection for the doctor.
- The doctor shouldn’t express their anger and frustration to the patient. Instead, they should try to convince the patient that their main interest is the patient’s health and well-being. The doctor should help the patient realize that they are on the same side.
The doctor shouldn’t refuse to provide treatment as the patient could interpret this as abandonment. The doctor should still provide the right treatment, give prescriptions, set follow-ups, and write down discharge instructions for the patient.