Encouraging AMA?

  1. I had a patient today that expressed the wish to leave AMA. I told him that he was well within his right to leave if he wanted to and that I would be willing to call his doc and get the paperwork ready. I also gave him the standard spiel about insurance not covering costs, etc.

    I started wondering, though, this particular gentleman wasn't a terribly pleasant patient -- a real pain in the neck, actually -- who was admitted yet again for chest pain. I got to thinking that if he was more pleasant and grateful, less demanding, etc. that I might try to convice him to stay.

    I don't know what to think of this. What are the ethical implications? Certainly, if a pleasant patient really wanted to leave I wouldn't stop him -- and if a really difficult patient wanted to stay I wouldn't kick him out. Has anyone else noticed the double standard in the above situation? How do you feel about it?
    •  
  2. 10 Comments

  3. by   Genista
    I think we are obligated to at least explain to the patient why it would be in their best interest to stay, and at least try and figure out if there is some complaint or problem that could be remedied. Pts need to be informed. How you feel about them leaving AMA shouldn't matter, as long as you're professional. We all know some folks are a real PIA to take care of. Just make sure that there isn't something there that can be easily resolved.

    Sometimes people are just fed up & angry. You know how awful it is in the hospital! ;-) Who can blame them for being mad? I had a pt one time who was NPO for almost 3 days waiting for a procedure that kept getting bumped due to trauma pts getting priority. (Why couldn't they have told us that they couldn't get to him one day so we could feed him? I don't know.)

    But I know what you mean. I have a few patients whom I tried my darnest to please, and they were very unhappy & wanted to go AMA. After a certain point, you have to realize that they were informed of the risks/benefits & move on I guess. If you have been professional, and tried to address their concerns...then you did what you could. For some patients, nothing you do is going to be good enough, they don't want to contribute or discuss it & for those, let them make their informed decisons...be it going AMA or whatever. They are adults, after all.
  4. by   GPatty
    Kona, I couldn't have said it better.......
  5. by   deespoohbear
    I have decided that if someone wants to go AMA, I explain the risks etc....I also call my nursing supervisor and let her deal with it. If the patient is a competent adult and has been informed of all the legalities of AMA and still decides to leave, then so be it. Of course I notify their primary care physician and let them talk to the patient. Then I document like crazy to cover my backside...I also make sure I have witnesses with me when I talk to a patient who is threatening to go AMA...in case the patient would decide to accuse me of not informing them of the risks...


    Yeah, if someone who is a PIA wants to go AMA I don't usually argue too hard. I don't have the time....
  6. by   fab4fan
    Hate to be rude, but there are some people that make you want to burst into song..."Hit the road, Jack, and doncha come back no more, no more, no more, no more..."

    I also don't waste a lot of time with argumentative AMA's...there are too many people that want to be treated, and it's no skin off my back if someone leaves in a fit of pique, after you've tried to smooth them over.
  7. by   oramar
    It is true that an occasional AMA is a really nice person who has been handled roughly. However, my experience has been that most of them want to go out and get booze or drugs. I think that everyday people like myself want to get well soooo bad that we will avoid signing out AMA unless we think our lives are in clear and present danger. When working conditions were going down the drain there at the end of my career I rarely knew any patient well enough to judge them. Gone were the days where you got to know a unit or assignment. It was different unit everyday, ever increasing patient load of people I never saw before in my life and never would see again. How could I care what happened to them. I caught myself trying to delay AMA until end of shift to avoid the inevitable admission into the bed. Turned out the only life I could save in the end was my own.
  8. by   montroyal
    AMA= Againts Medical Advice not Againts Nursing Advise. If a patient wants to leave againts his/her physicians advise, it is the responsibility of the physician to explain the possible conseqences to the patient and ensure the patients understands why the action they want to take is not in their best interest. Nurses do not have admiting or discharge privilages. Nurses cannot write orders to restrain patients. Don't we have enough to worry about within our scope of practice. If someone wants to leave AMA, we should ask them to talk with their physician and contact that physician immediately.
  9. by   Flo1216
    Our patients sign out AMA and are usually back a few days later anyway.
  10. by   kmchugh
    Like everyone else has said, inform the patient of the consequences of leaving AMA in a straightforward way. Document like crazy. One word of caution: Don't ever do anything that might be construed as encouraging the patient to leave AMA. If anything untoward happened to the patient and family felt you had encouraged them to go AMA, you might find yourself on the wrong end of a lawsuit. To add insult to injury, I highly suspect most hospitals would let the nurse hang on this one. It isn't hospital policy to encourage AMA's.

    Kevin McHugh
  11. by   Scooby365
    Originally posted by fab4fan
    Hate to be rude, but there are some people that make you want to burst into song..."Hit the road, Jack, and doncha come back no more, no more, no more, no more..."

    I also don't waste a lot of time with argumentative AMA's...there are too many people that want to be treated, and it's no skin off my back if someone leaves in a fit of pique, after you've tried to smooth them over.

    Bravo....Bravo....Encore....Encore
  12. by   Jenny P
    As someone else said earlier, most of the people who leave AMA are doing so for booze or drugs in my experience. I once had a pt. on a vent 2 days post op open heart surgery. I called the docs and spoke with them; They said that we should extubate the pt, and let him go!! I talked to a nurse on the psych unit and learned how to do a 72 hour hold; needless to say, the pt. was in full blown DT's the next day.

    I guess the important thing is don't dance a jig when you escort the pt. to the main doors of the hospital. Oh, yeah, do CYA! Have witnesses and document up the Yahoo.

close