How do I deal with a patient who insists on leaving AMA?

It’s frustrating to try to help patients who refuse offers of help. Odds are you’re feeling angry, overwhelmed and helpless. It’s tough to understand when a patient wants to leave AMA.

Put your emotions aside. You’ll have time to deal with your feelings later. Your first duty is to your patient.

Try to find out why your patient insists on leaving the hospital. It might take some creative talking to get them to open up, but you might be surprised by what you hear. If your patient is worried about their cat being at home alone, for instance, you might be able to arrange for someone to look after the cat while the patient stays in the hospital. If they’re a smoker and simply can’t take the hospital’s no-smoking policy anymore, a nicotine patch might help.

Or not. The truth is you won’t be able to talk every patient into staying. Contact the physician as soon as it becomes apparent that your patient is determined to leave. If at all possible, try to delay the patient’s departure until after the physician has had a chance to talk to the patient in person.

The physician should inform the patient wanting to leave AMA of the risks of leaving against medical advice (including the possible need for readmission), and the patient will need to sign a form signifying their awareness of these risks and absolving hospital personnel of any liability, should an adverse event occur as a result of early discharge.

What if the patient won’t sign the form or storms out before you manage to find it? Document, document, document! Document what you saw, what the patient said and what you did. Your documentation will provide a paper trail should anything happen to the patient after her “discharge.” It will also help with billing for a patient leaving AMA and shield you from consequences of the discharge against medical advice. Should you have any concerns or specific questions, check your facility’s leaving against medical advice policy.