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Why Do Patients Leave the Hospital against Medical Advice

Mary, a  35 year old mother of two presented in the emergency unit of a teaching hospital with difficulty in breathing, noisy breathing and chest pain. After initial treatment for probable acute asthma, she got up as soon as she felt better, refusing further tests and treatment. She insisted on going home against medical advice because no one will look after the kids.

Mary’s decision to leave the hospital against the doctor’s advice is not uncommon in medical practice. The phenomenon popularly called discharge against medical advice (DAMA) occurs worldwide

What kind of patients DAMA and why? That was the aim of a  new study recently  conducted in the US. The researchers explored why a patient that has sought treatment of his own free will would insist on leaving against medical advice.

The study was published June, 2017 in the Journal of the American Geriatrics Society.

According to the authors, older, male patients who had mental disorders were most likely to leave against medical advice.  In the review of patients  data in the United States, patients were more likely to abscond when a communication gap exists between doctors and the patients.

According to a news release published by Healthday,   Dr. Liron Sinvani   said  “a person’s decision to leave the hospital against the advice of his or her care provider often represents a breakdown in communication between patients, family members and providers.” This highlights the important role having good communication skills facilitates doctor-patient relationship.

DAMA accounts for about 1-2% of all discharges from the hospital. Not surprisingly, patients that leave against medical advice have been found to experience more health problems and be readmitted in the hospital.

According to a study in   Nigeria, common reasons for discharge against medical advice include:

  • Financial constraints
  • Seeking alternative therapy such as herbal treatment
  • Hopelessness

In Nigeria and other developing countries, relatives and family members have a key role to play in healthcare decision-making. In some cases the relative funding the treatment may override or upheld the patient’s decision to continue receiving care in the hospital. Some patients fall prey to charlatans who lure the patients out of hospital with the hope of better treatment options.

Although challenging, doctors may need to realize that from the patient’s perspective, health goes beyond the physical well- being, but includes mental and emotional well-being too. So, just trying to help the patient rescind the decision to leave purely on medical grounds may not always be sufficient. Maintaining a holistic view helps the doctors to continue managing the patient by scheduling follow-up appointments and providing prescriptions.

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