Signing Out AMA

In healthcare, we are all working towards the team work ethic of central and common principles of healing and health promotion. However, during that process of healing patients, we also worry about the safety and well-being of each people we care for.

In this regard, I just finished reading this article by the New York Times about an increasing number of patients signing out AMA, especially in the advanced aging population. As you know, the healthcare landscape is rapidly changing and many studies now point towards a better recovery at home (if you can do it) as compared to an acute care facility or skilled nursing facility (SNF).

As pointed out by the NYT article (here) I have also encountered the other side of the healthcare where hospitals encourage patients to stay in the hospital for as long as they can (or when insurance dictates). What is the right approach – keep the patient until they are safe or ultimately go with what the patient wishes to do with their care?

Sometimes patients are admitted for one thing and end of getting the necessary series of tests or they haven’t seen their PCP’s and end up of patients that leave the hospital too soon and ending up coming right back. A 2010 article in the Daily Mail from shows this interesting statistic – here.

Patients that often don’t do their “preventative medicine” with their PCP’s and stay up-to-date on their health – often will come in for one thing and check to see if we can do complete diagnostic work-up or “tune-up” like we call it.

In the end, as long as the patient is in a safe environment, is ready for discharge, has the appropriate support systems in place, and will be able to complete the necessary follow-ups and continued care plans, it is their decision regardless of whatever we have to say.