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:4/28/2017)... New york (PRWEB) , ... April 28, 2017 ... ... pleased to announce that Aditya Patel M.D. has joined the revolutionary endoscopic practice ... training and board certification in Interventional Pain Medicine. The patented, revolutionary eDiscSculpt Technique ...
(Date:4/28/2017)... ... April 28, 2017 , ... From April ... of Urgent Care Medicine will host industry leaders for the annual spring Convention ... those in the industry adapt to the issues currently affecting urgent care and ...
(Date:4/28/2017)... ... April 28, 2017 , ... Bill Howe started his ... the coastal communities. After Tina Howe joined the team, the Bill Howe brand was ... services at affordable rates, and giving back to the San Diego community in which ...
(Date:4/28/2017)... UTAH (PRWEB) , ... April 28, 2017 , ... ... Account Manager for the North East region. Côté has 20+ years of experience ... Prior to Phytomer, Côté worked with an array of high-end cosmetic brands, retail ...
(Date:4/28/2017)... ... April 28, 2017 , ... NuevaCare, a leading home care agency ... Burlingame, and Palo Alto, is proud to announce information upgrades to its blog in ... read organized content on topics such as home care (generally) as well as senior ...
Breaking Medicine News(10 mins):
(Date:4/19/2017)... EAST HANOVER, N.J. , April 19, 2017 ... study conducted by the National Heart, Lung, and ... Health (NIH) demonstrating that 58% of patients with ... at six months when treated with eltrombopag at ... treatment 1 . The study evaluated three sequential ...
(Date:4/18/2017)... April 18, 2017  Cardinal Health (NYSE: ... fiscal 2017 earnings per share (EPS) guidance and providing ... is in conjunction with this morning,s announcement of the ... and Nutritional Insufficiency businesses. Cardinal Health now ... will be at the bottom of its previous guidance ...
(Date:4/18/2017)... Viverae ® , a leader in workplace ... IBM ® Watson Campaign Automation, implementing behavioral messaging ... a personalized experience. Through digital engagement, the platform prompts ... real time. The enhanced experience drives engagement by focusing ... they are in their journey to health. ...
Breaking Medicine Technology: