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The Upstate Ethicist: Is it OK for patients to leave against medical advice?

About 1 percent of people who seek care at a hospital emergency department wind up leaving against the advice of the doctor. They may not like the doctor‘s treatment plan. They may disagree with the diagnosis. They may start feeling better and decide they don‘t want to be hospitalized.

Regardless of the reason for a patient‘s early departure, Jay Brenner MD, an assistant professor of emergency medicine at Upstate, says it‘s crucial that doctors make sure he or she is capable of making decisions, understands the diagnosis and is aware of the risks of refusing medical care -- before the patient leaves.

“Physicians should always take responsibility for their patients,” he says, noting that they should also respect a patient‘s autonomy. “At some point, there is some personal responsibility here.”

Patients who leave against medical advice present challenges for medical researchers. With no guarantee a patient will return to the same hospital, and no shared database, researchers cannot track what happens after the patient leaves. Thanks to new research at Montefiore Medical Center in the Bronx, they do know people who leave an emergency department prematurely have an increased risk of readmission within 30 days, and have higher death rate than those who are sent home when the doctor says they‘re ready.

Listen to an interview with Dr. Brenner.

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