To the Editor.—
Patients leave the hospital against medical advice for a variety of reasons.1-3 The medical importance of this phenomenon has not been well studied. We have investigated patients leaving against medical advice from a county hospital, in addition to the association between signing out against medical advice and substance abuse.
We reviewed discharge dispositions and diagnoses for the period of July 1, 1977, through June 30, 1978, of medical, general surgical, and orthopedic patients at Highland General Hospital, a 300-bed county hospital in Oakland, Calif. Primary and secondary diagnoses were classified according to the International Classification of Diseases of the World Health Organization (revision 8). Patients were considered to be drug or alcohol abusers if they carried a diagnosis that a previous study at this hospital had shown to be associated with substance abusers in greater than 90% of cases.
A total of 5,394 patients were