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Teachable Moment
Less Is More
January 7, 2019

Avoiding Hospital Discharge Against Medical Advice: A Teachable Moment

Author Affiliations
  • 1University of Colorado School of Medicine, Aurora
JAMA Intern Med. 2019;179(3):423-424. doi:10.1001/jamainternmed.2018.7286

I was called by the nursing team to evaluate a patient requesting to be discharged owing to concerns about our care. The patient was about 60 years old and was undergoing treatment in the hospital for community-acquired pneumonia with intravenous antibiotics and oxygen. The patient shared a list of grievances: the snoring person on the other side of the curtain, the quality of dinner, and the frequent interruptions for medications and vital signs. I attempted to persuade the patient to stay, and after minimal progress, offered the option to sign out against medical advice. Both of us frustrated and tired, the patient accepted this option. I explained the risks of leaving the hospital prematurely, highlighting the word “death” on the form, and then guided my patient to the signature line. The patient left the unit but returned shortly thereafter, sitting on a bench by the elevators, looking defeated and dyspneic. The patient apologized and asked to be readmitted to continue treatment.

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