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

David Alfandre, MD, MSPH1; John Henning Schumann, MD2
[+] 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.
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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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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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