Navigation Links
Patients Being Discharged Against Medical Advice

Mayo Clinic Proceedings author reviews the consequences

ROCHESTER, Minn., March 9 /PRNewswire-USNewswire/ -- 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."

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at

About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy that "the needs of the patient come first." More than 3,300 physicians, scientists and researchers and 46,000 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to ( is available as a resource for your health stories. For more on Mayo Clinic research, go to

SOURCE Mayo Clinic
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Fluctuating eye pressure associated with visual field deterioration in glaucoma patients
2. Comparison of obstetric outcomes between on-call and patients own obstetricians
3. Vision restoration therapy shown to improve brain activity in brain injured patients
4. Diabetes appears to increase risk of death for patients with acute coronary syndromes
5. Ambulatory oxygen rarely a benefit in COPD patients without resting hypoxemia
6. Restricting Blood Flow May Help Heart Bypass Patients
7. Patients with Medicaid and those lacking insurance have higher risk of advanced laryngeal cancer
8. Study provides hope that some transplant patients could live free of antirejection drugs
9. Study provides hope that some transplant patients could live free of anti-rejection drugs
10. Longer ambulance journeys boost death risk for seriously ill patients
11. Expenses Overshadow Optimism for Kidney Failure Patients
Post Your Comments:
(Date:10/12/2017)... , ... October 12, 2017 , ... ... now treating sleep apnea using cutting-edge Oventus O2Vent technology. As many ... sleep disorder characterized by frequent cessation in breathing. Oral appliances can offer significant ...
(Date:10/12/2017)... ... 12, 2017 , ... IsoComforter, Inc. ( ), one of ... innovative new design of the shoulder pad. The shoulder pad provides optimal support ... your pain while using cold therapy. By utilizing ice and water that is circulated ...
(Date:10/12/2017)... ... October 12, 2017 , ... ... that we intend to develop to enable prevention of a major side effect ... hearing loss, especially in pediatric patients. For cisplatin, hearing loss is FDA listed ...
(Date:10/12/2017)... ... October 12, 2017 , ... Leading pediatric oncology experts at Children’s National ... 49th Congress of the International Society of Paediatric Oncology (SIOP) Oct. 12-15. ... for Cancer and Blood Disorders at Children’s National, and Stephen P. Hunger, M.D., ...
(Date:10/12/2017)... ... October 12, 2017 , ... Health ... interactive health literacy software tool, and the Cancer Patient Education Network (CPEN), an ... education, today announce a new strategic alliance. , As CPEN’s strategic partner, ...
Breaking Medicine News(10 mins):
(Date:9/28/2017)... Hill-Rom Holdings, Inc. (NYSE: HRC), will host ... webcast on Friday, November 3, 2017, beginning at 7:00 ... approximately 8:30 a.m. (CDT) / 9:30 a.m. (EDT). ... performance and guidance for 2018, Hill-Rom executives will also ... performance, and long-range financial outlook through 2020. ...
(Date:9/25/2017)...  EpiVax, Inc., a leader in the fields ... announced the launch of EpiVax Oncology Inc., a ... cancer vaccines. EpiVax has provided $500,000 in seed ... technologies to the new precision immunotherapy venture. Gad ... as Chief Executive Officer. Gad brings over 25 ...
(Date:9/19/2017)... --  ZirMed Inc ., a recognized leader in cloud-based revenue ... been ranked #1 by its users for the seventh consecutive ... Survey. ZirMed was recognized as the top-ranked end-to-end revenue cycle ... over 200 beds and holds one of the longest #1 ... ...
Breaking Medicine Technology: