Wednesday, August 2, 2017

Against Medical Advice

A friend has had his gall bladder removed. He’s recovered, and you’ve agreed to drive him home. He is dressed and ready when you arrive. Hospital rules require the surgeon to examine him and approve the discharge, but after two hours the surgeon has not appeared. When asked, the nurse says he has been delayed. Asked an hour later, the nurse admits that no one knows where he is. They must wait.

An hour later, the exasperated friend announces that he will leave. You can’t do that says the nurse. If you do, you must sign this. She produces an impressive document that relieves the hospital of responsibility and lists terrible things that might happen when the signer leaves Against Medical Advice.

“Another thing,” adds the nurse. “If the doctor doesn’t sign the discharge, your insurance won’t pay.” Naturally, your friend decides to stay.

This happens all the time, but it’s nonsense.

First, you don’t have to sign an Against Medical Advice form. You can just leave.

Second, according to surveys, almost all doctors and nurses believe that medical insurance doesn’t pay if a patient leaves AMA, but it’s not true. Insurance pays.

Surveys also show that patients who leave AMA have a much higher rate of complication and readmission. Generally, it’s not a good idea. But, except for certain psychiatric cases, hospitals have no legal right to keep you.

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