Against medical advice


Key Documentation Points

  • Document the patient's mental status at time of conversation
  • Document who was in the room at time of conversation (nurse, family members, interpreter etc.)
    • Have nurses write a brief note about AMA conversation if they are in the room
  • Document what was said to the patient about specific risks of leaving against medical advice
  • Document that patient understood risks and was able to verbalize them back
  • Document that you discussed return precautions and that they may return at any time
    • Write these on discharge instructions as written proof that you reviewed them with the patient

Determining Capacity

Four components necessary:

  1. Able to understand the relevant information
  2. Able to appreciate the situation and its consequences
  3. Able to reason through treatment options
  4. Able to communicate a choice

Sample Documentation

The patient is clinically not intoxicated, free from distracting pain, appears to have intact insight, judgment and reason and in my medical opinion has the capacity to make decisions. The patient is also not under any duress to leave the hospital. In this scenario, it would be battery to subject a patient to treatment against his/her will. I have voiced my concerns for the patient's health given that a full evaluation and treatment had not occurred. I have discussed the need for continued evaluation to determine if their symptoms are caused by a condition that present risk of death or morbidity. Risks including but not limited to death, permanent disability, prolonged hospitalization, prolonged illness, were discussed. I discussed the specific benefits of additional treatment, as well as tried offering alternative options in hopes that the patient might be amenable to partial evaluation and treatment which would be medically beneficial to the patient. However, the patient declined my options and insisted on leaving. Because I have been unable to convince the patient to stay, I answered all of their questions about their condition and asked them to return to the ED as soon as possible to complete their evaluation, especially if their symptoms worsen or do not improve. I emphasized that leaving against medical advice does not preclude returning here for further evaluation. I asked the patient to return if they change their mind about the further evaluation and treatment. I strongly encouraged the patient to return to this Emergency Department or any Emergency Department at any time, particularly with worsening symptoms.

See Also

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