EXECUTIVE SUMMARY
Patients who refuse care and leave against medical advice pose significant liability risks to hospitals and other providers. There must be a protocol in place for addressing patients who wish to leave, and following up afterward.
- Avoid confrontations and respect a patient’s right to refuse.
- Offer alternatives to the care being refused.
- Carefully document attempts to contact a patient who has left, including unsuccessful efforts.
Patients who leave against medical advice (AMA) create dilemmas for physicians and staff who want to provide the best care possible, and they pose major liability risks and require extra attention.
Healthcare organizations must have policies and procedures in place that formalize how clinicians respond to a patient refusal, including careful documentation processes and follow-up.
AMA actually can involve several different scenarios, and each requires a different sort of planning and response, notes Kevin Klauer, DO, EJD, FACEP, chief medical officer for hospital-based services and the chief risk officer for Knoxville, TN-based TeamHealth.
The scenario that comes to mind first for most people is one in which the patient has been seen by a clinician and then refuses further care or certain types of care, he says. In this case, there has been an interaction with the physician or other clinician and there is the opportunity to counsel the patient about the possible consequences of refusing care.The focus in that situation would be on educating the patient about why care is necessary, trying to learn why the patient is refusing, and trying to address those concerns, he says.
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