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In health care law, Against Medical Advice (AMA) is a legal term used for a patient who checks him- or herself out of the hospital in opposition to a doctor's counsel. Also known as a Discharge Against Medical Advice, or DAMA, patients who leave a medical care facility against the professional advice of doctors are considered to be discharging themselves without completing the proper course of medical treatment. In most jurisdictions, patients leaving against medical advice are required to fill out a standard form that is filed with their medical records.
Many instances of patients leaving against medical advice necessitate a doctor's consideration, first and foremost, of the desires of the patient. Though it may be imprudent for the patient to leave the hospital without getting the proper care, the doctor is obligated to honor the wishes of the individual patient. Medical staff may try to talk a patient out of her decision, but in the end, the choice is ultimately the patient's, and the process can be carried out rather quickly.
This is not always the case, however. Patients who are admitted to mental health institutions fall under a different set of rules regarding the AMA law. A patient who has voluntarily admitted him- or herself does have the right to leave the facility against a doctor's wishes, but in most areas, the patient must give a 24-hour notice before vacating. This notice is put in place for two very important reasons. One reason is that the notice will hopefully give the patient time to realize the necessity of staying in the hospital; the other reason is for a doctor to fill out commitment paperwork if he or she deems the patient a risk to himself or others.
When doctors demand a patient stay in the hospital and continue treatment, they are not only looking out for the patient's welfare, but also safeguarding themselves against potential legal action. If a patient leaves against a doctor's wishes and becomes sicker or dies, the doctor could be faced with a malpractice lawsuit. This is where the AMA paperwork protects doctors and medical institutions.
A typical AMA form will include a rundown of the possible risks a patient is taking, the implications of what he or she is doing, and the steps in place for continuing medical care at a later time. The form is signed by the patient and a witness. It also includes the exact time of release, the doctor's name and contact information, and how the patient vacated the premises: by him- or herself, with a family member, or with a law enforcement officer.
I think I'd have to have a pretty compelling reason to leave a hospital against medical advice. I suppose some people do it to avoid racking up a huge medical bill they know they can't afford. The only time I ever considered leaving an emergency room early was when I came in with a kidney stone attack and I passed the stone while waiting for the ER doctor. I sat in an exam room for nearly 7 hours, and I felt like there was no reason for the doctor to see me.
Since the doctor hadn't actually examined me yet, I don't know if it would be have been considered leaving against medical advice. He hadn't given me any advice at that point. I decided to stay so I could find out if I had any other medical problems other than the kidney stone. I'm glad I did, since the doctor found a bladder infection, too.
I have only left an emergency room once against medical advice. The ER physician was not happy about my decision, but he understood why I was doing it. He was urging me to undergo surgery for my injured leg, but I had an elderly relative who depended on me for just about everything at the time. I told the doctor that I couldn't afford to be off my feet for that long, and I could still get through my day with a painful leg.
The nurse brought me an against medical advice form to fill out. The ER doctor gave me a prescription for strong painkillers and told me to come back if the sutures broke or became infected. I promised him I would be back for the surgery once I found someone who could take care of my relative for three weeks.
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