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December 11, 2013

What Is Wrong With Discharges Against Medical Advice (and How to Fix Them)

Author Affiliations
  • 1VA National Center for Ethics in Health Care, NYU School of Medicine, New York, New York
  • 2Department of Internal Medicine, University of Oklahoma School of Community Medicine, Tulsa
JAMA. 2013;310(22):2393-2394. doi:10.1001/jama.2013.280887

It is estimated that as many as 2% of all US hospital discharges (approximately 500 000 per year) are designated as against medical advice1; that is, a patient chooses to leave the hospital before the treating physician recommends discharge. The risks to these patients are significant. Compared with patients discharged conventionally, readmission rates for patients discharged against medical advice are 20% to 40% higher, and their adjusted relative risk of 30-day mortality may be 10% higher.2 Furthermore, physicians and other health care staff report feeling distressed and powerless when patients choose suboptimal care, and disagreement over a discharge against medical advice can cause patient-physician and intrateam conflict.3

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