Navigation Links
Patients being discharged against medical advice
Date:3/9/2009

ROCHESTER, Minn. -- 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."


'/>"/>

Contact: John Murphy
newsbureau@mayo.edu
507-284-5005
Mayo Clinic
Source:Eurekalert

Related medicine news :

1. Helium helps lung patients breathe easier
2. IDM Pharmas MEPACT(R) (Mifamurtide, L-MTP-PE) Receives Approval in Europe for Treatment of Patients with Non-Metastatic, Resectable Osteosarcoma
3. NxStage Reports Sustained Reduction in Clinical Depressive Symptoms for Daily Home Hemodialysis Patients After One Year
4. Patients Being Discharged Against Medical Advice
5. New published study demonstrates over-the-counter device lowers blood pressure in diabetic patients
6. New staging technique might save bladders in some bladder cancer patients
7. ADA Informs Patients About Osteoporosis Medications and Oral Health
8. Ecstasy could help patients with post-traumatic stress disorder
9. Diabetes and Elevated Levels of Cholesterol Linked to Faster Cognitive Decline in Alzheimer's Patients
10. New DNA Test Is Basis for Groundbreaking IVF Refund Plan, Easing Financial Burden for Patients
11. Saving heart attack patients in the middle of the night
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/6/2016)... ... February 06, 2016 , ... ... , MEDIA ADVISORY: 5000 PERIOPERATIVE NURSES EXPECTED AT AORN SURGICAL CONFERENCE & ... nurses in the world with an estimated 5000 perioperative nurses in attendance ...
(Date:2/5/2016)... SARASOTA, Florida (PRWEB) , ... February 05, 2016 , ... ... an event he has completed every year since it started in 2003. This year, ... attracting the attention of fellow runners and NBA team the Miami Heat. , This ...
(Date:2/5/2016)... Minneapolis, MN (PRWEB) , ... February 05, 2016 , ... ... p.m. at the Day Block Event Center in Minneapolis, Minn. Triumph Over Parkinson’s will ... , Larry Schneiderman, owner of Schneiderman’s Furniture, lives with Parkinson’s disease and is the ...
(Date:2/5/2016)... ... 05, 2016 , ... After years as an active staff surgeon and having ... surgeon Dr. Wayne Carman transitioned to chief of the Division of Plastic Surgery at ... term as chief and began a second three-year term in January of 2016. , ...
(Date:2/5/2016)... ... , ... Regular gym users know the routine: each January, they see a ... treadmills. It’s a predictable trend. After the excesses of November and December, people make ... joining gyms, starting new walking or running routines, or signing up for Zumba. And ...
Breaking Medicine News(10 mins):
(Date:2/5/2016)... York , February 5, 2016 ... Transparency Market Research report states that the global active ... 2014 and is predicted to reach US$185.9 bn by ... of 6.50% from 2014 to 2020. The title of ... Chemical/Biological, Captive/Contract Manufactured, by Geography, and by Therapeutic Area) ...
(Date:2/5/2016)... MELVILLE, N.Y. , Feb. 5, 2016  Henry ... of health care products and services to office-based dental, ... has entered into an agreement to acquire a majority ... dental supplies and equipment in Brazil ... Headquartered in Blumenau, Brazil, Dental Cremer is the dental ...
(Date:2/4/2016)... , Feb. 4, 2016 For hospitals considering ... those already participating in the program, the Health Resources ... to as the , Mega-Guidance , could have significant ... is published in September 2016. Essential Insights ... Service Marketing , summarizes the Mega-Guidance,s key proposed changes, ...
Breaking Medicine Technology: