Risk and reward are inherent to providing medical care. As such, it is essential that patients understand all potential outcomes when making personal healthcare decisions, including the decision to forgo care against medical advice (AMA). According to medical writer Kristen Fuller, MD, it is common for healthcare workers to negatively view such patients as noncompliant and ungrateful because leaving AMA increases the likelihood of morbidity or hospital readmittance. While frustration is certainly understandable, physicians are at risk for letting their frustration destroy existing physician–patient relationships.
Dr. Fuller has first-hand experience with patients who choose to leave AMA. For example, she treated a cardiac patient who was hospitalized for heart failure and required a valve replacement. After lengthy discussions attempting to convince her patient to stay, Dr. Fuller concluded that this patient would be better off leaving due to mental health concerns. The patient was suffering more by staying in the hospital without family by her side. Dr. Fuller and her medical team arranged a follow-up appointment for a few days later. The patient attended the appointment and then returned to the hospital for elective valve replacement surgery. This case serves to remind healthcare professionals that patients are not merely bodies in hospital beds; they are human beings whose holistic needs and concerns should be valued.
According to a JAMA article, some patients who leave AMA may decide to forgo ongoing medical care, to their own detriment, because of how physicians react to their decision to leave. Dr. Fuller notes that some healthcare professionals even threaten patients to no longer treat them if they leave AMA. Other physicians actually abandon patients who leave AMA, rather than trying to understand why they chose to leave. These physicians neither attempt to schedule follow-up appointments nor provide patients with necessary prescriptions. They simply drop patients, without considering their lives beyond the hospital’s perimeter.
Patients often leave AMA due to financial burdens, family issues, and dissatisfaction with care plans. Based on a Journal of General Internal Medicine article, a significant number of patients who leave AMA are poor, young males who are battling underlying substance abuse and mental health disorders. Ultimately, Dr. Fuller asserts, physicians should consider their patients’ mental and emotional health before casting judgment on their decision to leave AMA. After all, mental and emotional health are equally as important as physical health.
