Leaving the Hospital Against Medical Advice

Before sharing a new study, I have to be the first to admit that I've left the hospital early myself. Perhaps not against medical advice, but by convincing my doctors that I was ready to go home before I really was. Hospitals aren't fun places to be. I know. I've spent oodles of time in them both as a physician and a patient. And they're a good place to catch nasty infections as well, if you're not careful.

Why do people leave the hospital against medical advice (called "AMA" in medical lingo?) One reason is what I just hinted at. The longer you spend time in the hospital, the more likely you are to catch one of those difficult-to-treat hospital-acquired infections. But my guess is that infection risk isn't the main reason people wish to leave early.

I would guess that finances play a role. Not just the cost of room and board in a hospital room, with a price tag outranking the finest Hilton. But the cost of having someone care for children who are at home. The cost of missing time at work. The multitude of hidden costs that accompany a hospitalization.

Another reason I'd venture is that we simply prefer to be in our own surroundings. Trying to sleep in a hospital is like trying to sleep in a video arcade. Whistles. Beeps. Flashing lights. Not to speak of constant "interruptions" from people whose job descriptions mandate they be nocturnal.

Yet tolerating the noise, and cost, and less-than-ideal atmosphere for healing might just be what the doctor ordered. Oh -- in this case she did.

What are the dangers in leaving the hospital AMA?

A new study says they may be grave. Researchers looked at nearly 150,000 hospitalizations of which over 3,500 people were discharged against medical advice. Those who checked out AMA had twice the mortality rate (meaning they were twice as likely to die), and also had a significantly greater rate of readmission than people who stayed until their doctors thought they were ready to leave.

Bottom line. If you're wishing to leave the hospital before the hospital staff thinks you're ready, think twice. Not to say you shouldn't be your own advocate. If you feel ready to leave, ask your doctor the reasons you should still be hospitalized. Perhaps you are indeed ready for discharge and an absence of a discharge order was an oversight on the physician's part. Perhaps the reasons you should remain in the hospital a bit longer weren't communicated fully. Ask questions. If finances or child care play a role in your wish to leave, ask your family and friends for help. The balance in your bank account can be replaced. Your body can't.

_Source:

_{Southern, W., Nahvi, S., and J. Arnsten. Increased Risk of Mortality and Readmission among Patients Discharged Against Medical Advice. The American Journal of Medicine. 2012. 125(6):594-602.}