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Comparative Study
. 2008 Oct;23(10):1698-707.
doi: 10.1007/s11606-008-0728-4. Epub 2008 Jul 22.

Providers' perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice

Donna M Windish  1 , Neda Ratanawongsa
Affiliations
Comparative Study

Providers' perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice

Donna M Windish et al. J Gen Intern Med. 2008 Oct.

Abstract

Background: Patients who leave hospitals against medical advice (AMA) may be at risk for adverse health outcomes. Their decision to leave may not be clearly understood by providers. This study explored providers' experiences with and attitudes toward patients who leave the hospital AMA.

Objective: To explore providers' experiences with and attitudes toward patients who leave the hospital AMA.

Methods: We conducted interviews with university-based internal medicine residents and practicing internal medicine clinicians caring for patients at a community hospital from July 2006 to August 2007. We approached 34 providers within 3 days of discharging a patient AMA. The semi-structured instrument elicited perceptions of care, emotions, and challenges faced when caring for patients who leave AMA. Using an editing analysis style, investigators independently coded transcripts, agreeing on the coding template and its application.

Participants: All 34 providers (100%) participated. Providers averaged 32.6 years of age, 22 (61%) were men, 20 (59%) were housestaff from three residency programs, 13 (38%) were faculty, hospitalist physicians, or chief residents serving as ward attendings, and one (3%) was a physician assistant.

Main results: Four themes emerged: 1) providers' beliefs that patients lack insight into their medical conditions; 2) suboptimal communication, mistrust, and conflict; 3) providers' attempts to empathize with patients' concerns; and 4) providers' professional roles and obligations toward patients who leave AMA.

Conclusion: Our study revealed that patients who leave AMA influence providers' perceptions of their patients' insight, and their own patient-provider communication, empathy for patients, and professional roles and obligations. Future research should investigate educational interventions to optimize patient-centered communication and support providers in their decisional conflicts when these challenging patient-provider discussions occur.

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Figures

Figure 1
Figure 1
Conceptual depiction of providers’ perceptions of what is thought, said, and heard when a patient chooses to leave the hospital against medical advice from an interview study of 34 providers in a Connecticut Hospital.
See this image and copyright information in PMC

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References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '11549951', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11549951/'}]}
    2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academies Press; 2001. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.2105/AJPH.2006.100164', 'is_inner': False, 'url': 'https://doi.org/10.2105/ajph.2006.100164'}, {'type': 'PMC', 'value': 'PMC2089112', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC2089112/'}, {'type': 'PubMed', 'value': '17971552', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17971552/'}]}
    2. Ibrahim SA, Kwoh CK, Krishnan E. Factors associated with patients who leave acute-care hospitals against medical advice. Am J Public Health. 2007;97(12):2204–8. Dec. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.amjmed.2007.08.024', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.amjmed.2007.08.024'}, {'type': 'PubMed', 'value': '18060925', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/18060925/'}]}
    2. Fiscella K, Meldrum S, Barnett S. Hospital discharge against advice after myocardial infarction: deaths and readmissions. Am J Med. 2007;120(12):1047–53. Dec. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC143546', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC143546/'}, {'type': 'PubMed', 'value': '12591781', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12591781/'}]}
    2. Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ. 2003;168(4):417–20. Feb 18. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC122025', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC122025/'}, {'type': 'PubMed', 'value': '12358196', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12358196/'}]}
    2. Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O’Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. CMAJ. 2002;167(6):633–7. Sep 17. - PMC - PubMed

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