A doctor discussing why a patient wants to leave his practice.

Communicating Through the Patient AMA Choice

When a patient wants to leave against medical advice, what are your responsibilities?

As a physician, it’s a difficult situation when a patient chooses to leave against medical advice (AMA). Your patient’s decision could be based on any number of factors, including lack of understanding, fear, cost of care, long wait, alleviated symptoms, family obligations, or dissatisfaction with the treatment.

No matter what the reason, you may able to prevent their premature departure with proper communication. It can make all the difference.

What You Can Do

  1. Think about medical care from the patient’s perspective. If they don’t fully understand why they need to stay, they may not understand the ramifications of leaving. It may seem logical to you, but without knowing important information, it may not be as obvious to your patient.
  2. Take the time to talk with the patient. Ask him/her why they want to leave. Address each one of their concerns or misunderstandings. Explain that you have their best interest in mind and the reasons that continued care and treatment are necessary.
  3. Determine the patient’s ability to understand the risks and to make such a medical decision and if that could be a factor in the decision to leave.

If They Still Leave

Sometimes, even after your best efforts to communicate with the patient, they may still decide to leave AMA. In that case, ask them to sign an AMA form. If the patient is willing to listen, explain details regarding medicine, necessary follow-up items and discharge instructions. It will be imperative that you thoroughly document your conversation and the patient’s declination in detail.

Documentation Should Include:

  • Reason(s) for their decision to leave AMA
  • Your explanation of why they should stay
  • Patient’s ability to make medical decisions
  • Patient’s refusal to be admitted or pursue treatment or request to be discharged
  • Discussion of the possible risks of leaving AMA
  • Benefits of treatment/admission explained
  • Patient’s ability to understand and state the risks and benefits of pursuing treatment, with  the names and relationship of anyone witnessing the discussion
  • Answering questions about their medical condition
  • Patient’s awareness that they may return for care
  • Follow-up plan

What Not To Do

As hard as the situation may be, don’t get upset with your patient. He or she has justified leaving in their mind. While you may not be able to change that, you want them to be receptive to whatever parting information they let you provide. Be cautious about refusing future treatment; it could be construed as patient abandonment.

You want the best for your patients. When they leave AMA, it’s especially frustrating because you know how serious the consequences could be. With thoughtful communication throughout the entire patient care journey, you may be able to avoid it from happening.