#48 AMA Discharges: At the Bedside Segment

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 4 September 2019

⏱️ 31 minutes

🔗️ Recording | iTunes | RSS

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Summary

Do we have to sign the AMA form? Do insurances deny payment for patients who leave AMA? What is your approach to AMA discharges? Core IM At the Bedside speaks to ethics researcher, Dr. David Alfandre, author of Things We Do For No Reason (https://www.journalofhospitalmedicine.com/jhospmed/article/147925/hospital-medicine/things-we-do-no-reason-against-medical-advice-discharges): Against Medical Advice Discharges Show Notes, Full Transcript and References (https://www.coreimpodcast.com/2019/09/04/ama-discharges/) Time Stamps * 3:03 Demographics of AMA discharges * 5:59 Clinician/System related factors of AMA discharges * 10:30 Strategies for mitigating AMA Discharges * 15:59 Do we have to make patients sign the AMA form? * 18:27 Do insurances deny payment for patients who leave AMA? * 23:09 Take Away Points Tags: shared-decision making, harm reduction Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	I wanted to start off the episode by telling you about the very first patient that I discharged against medical advice.
0:06.0	This was a young man who had been admitted overnight,
0:10.0	had a history of IV drug use, Heron specifically, and came in just looking really lousy,
0:18.0	febrile shaking.
0:19.7	They drew blood cultures in the emergency room and started him on broad spectrum antibiotics, and I met him first thing in the morning.
0:28.8	I saw him first for two reasons. One of them was that I was paged by the micro lab that he was growing
0:38.0	four out of four bottles with a gram-positive bacteria, and second because I had also gotten paged from the nurse who was telling me that the patient was dressed and ready to go.
0:52.0	I walked into his room and essentially explained my concerns,
0:57.0	saying that I was very worried that he might have endocarditis, might be growing bacteria in his bloodstream that were ceding his heart
1:06.9	valves, but he told me quite calmly that he had to go. I asked why he said that his mother had gotten into some legal trouble and he needed to go take care of her, but I kind of suspected from the yawning from the pilot erection that he was withdrawing from heroin.
1:28.0	I offered him some methadone to try to see if that would convince him to stay, but he declined my offer.
1:35.0	He left against medical advice, and I don't know what happened to him. one.
1:47.0	Welcome back to At the Bedside, the segment of Core I. That discusses common ethical issues in clinical care and questions that fall outside the traditional
1:54.8	realm of evidence-based medicine.
1:57.4	I'm Margo, a third-year internal medicine resident at NYU.
2:00.8	I'm Joffer, a hematology oncology fellow at UCLA. And I'm Joffer a Humatology Oncology Fellow at UCLA and I'm tomorrow currently pursuing research and
2:06.2	bioethics.
2:07.2	On today's episode we're going to discuss a topic that comes up frequently in our practice.
2:11.3	Discharges against medical advice or AMA.
2:14.0	Many of you listening have had to discharge a patient against medical advice and like us,
2:18.0	you've probably come away from those conversations with some moral discomfort,
2:21.0	or at least frustration.
	...

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