Against Medical Advice (AMA)Clinical Pearls of Wisdom Q&A Case
When a patient leaves against medical advice - or AMA, the patient is leaving before their treating physician recommends discharge or despite medical advice to the contrary. This definition implies the patient received and understood the medical advice given. In practice, the term "AMA" is often used regardless of whether medical advice was given or not. Patients may lack the capacity to fully understand such decisions and their risks. Add in the fact that AMA attestation forms are often written beyond the literacy level of patients and patients, it can be difficult to prevent a patient from leaving the care center against medical advice. Let's take a look at a case and discuss how to handle a patient who wants to leave your facility against medical advice.
Against Medical Advice (AMA) Case:
A 32-year-old man has been hospitalized for a day, due to sepsis.
The source of infection was an abscess and cellulitis on the right forearm, where he had injected drugs.
His initial blood cultures, obtained in the emergency department, were positive for gram positive cocci eighteen hours after being drawn.
He was initially hypotensive, tachycardic and febrile, but his vital signs normalized with fluid administration, acetaminophen and antibiotics.
His comorbidities include ADHD, depression, and hepatitis C which has not yet been treated.
The patient’s nurse calls, saying that the patient is angry at being restricted to the hospital and was planning to leave, since ‘he had lots of things that he needed to do’.
What is the most appropriate next step in this situation where the patient is contemplating acting against medical advice?
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