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?