Mr. Hassle’s Long Underpants
Doc Shazam had one of those frustrating moments in medicine, and was healthy enough to blog about it instead of ruminating. This gave me pause, and I decided to try to explain how I approach this issue.
First, Leaving AMA is a medico-legal minefield. It is not cured by having the patient sign an AMA form (I recall an attorney explaining that the signature on an AMA form only means they were awake when they left, no more).
So, before they leave, I generally try to talk to the patient, and their family. First, ‘why do you want to leave’? Anger/time/unfulfilled expectations are the vast majority. Some are mad they had to wait 8 hours (for a 3 month outpatient workup), and just leave out of pique. I have never managed to persuade these patients to stay, though I try.
Others have to be home to care for their families, etc. I can occasionally get them to put their health first, but it’s rare, and usually involves some calls to get their home roles filled.
The unfulfilled expectations are usually not grounded in medical reality; you’re going to admit me for pain management/observation? I wanted my (expensive, tricky and/or dangerous surgery) today (invariably night/weekend/holiday). I try to connect the dots about timing, necessity, etc., and get about 1/2 to stay.
I have adopted an idea from one of my colleagues, and I ask the family of the patient, “how do you feel about this? They aren’t going to sue me when they die, you are, so what do you think?” Even if they don’t stay, I got them to think about the future beyond the car keys.
I try very hard to make this whole thing non-adversarial, and offer all the services of the hospital, and tell them I don’t care about the cost, I care only about their care. Then, if they still elect to leave, I assure them that there are no hard feelings on our part, and that we’d be glad to have them come back. I usually always mean it.
Medicine isn’t perfect, and neither are people. I really think we try hard for each individual, and I never like it when the AMA form comes out.
Wow, I sound like Mary Poppins. I’m not, trust me.
Update: And, yes, the Texas Dems left AMA too. They didn’t sign the form.