Leaving Against Medical Advice

I had a conversation with a friend of mine yesterday who was understandably very miserable being in the hospital. I always say the hospital is the absolute worst place to be when you aren’t feeling well (ironically) and when you are there over the holidays… it can be unbearable. Without going into enormous detail about the phone conversation and my friend’s situation, I am just going to say that they weren’t handling things correctly. She needed pain medication increased and they were giving her the run around. No one was communicating. She was alone and in so much pain so after a while it becomes impossible to advocate for yourself. Close to the end of the conversation, my friend asked me if I had ever left AMA (against medical advice) which got me thinking that this would be a good topic to cover.

What does leaving against medical advice actually mean? Well it means pretty much what it sounds like – that you are leaving without the authorization of whatever doctor or medical personnel that is taking care of you. Given that every situation is different and needs to be examined on an individual basis, I am not pro or against leaving a medical facility or hospital AMA.

When I was 14 years old, I had a severe obstruction which I had had before so my mom took me to a local ER since we figured it would be easier than driving all the way into NYC. When we arrived, she told them what was wrong and exactly what needed to be done to help the situation. They ran a battery of tests which included me wearing weights on my stomach during X-rays and four hours later the doctor came over and said “Well it appears she has a severe obstruction” as if he solved some mystery for us. This was the first time I thought I actually saw fire come out of my mom’s head since we came in there four hours ago saying that exact thing. So here we were… four hours later, I was in even more agony, and I was in the exact same position I was in when we first got there. My mom looked at the doctor, told him we were leaving, she signed the AMA forms, and as we were on our way to Mt. Sinai Hospital my mom called my surgeon at home in the middle of the night (trust me, that was very much called for).

When Dr. Stephen Gorfine became my primary doctor and surgeon, the need for me to look to leave against medical advice lessened. He had performed so many surgeries on me and knew both me and my parents so well. We were closer than any person should ever be with their surgeon. However, the positive part about that was as soon as pain was the only issue – he allowed me to go home. He talked to me about how I was feeling and then spoke to my parents about their comfort level in terms of having me home and then we would make a decision together. I have been told by many doctors and nurses at Mt. Sinai that they have never seen a patient leave the hospital so quickly after such major operations. There was one time fairly recently when a resident expressed his very strong opinions about me leaving in writing which was put to rest when my parents (the two people who can make decisions for me) signed the AMA forms.

Leaving against medical advice is not something that you need to think about while you are in the hospital since nowadays; they usually discharge you as soon as humanly possible (even though it doesn’t feel like that sometimes). In all honesty though, you can always come back. Just because you sign an AMA form, doesn’t mean you are a criminal. You didn’t do anything wrong. The reason they have you sign the form is to alleviate them of any responsibilities should something happen to you. That’s all. It is a legal matter. You are your own person. You know yourself better than anyone. If you are in the hospital and are being kept there when you truly deep down feel as though you would be better off at home AND have the tools to cope at home, then by all means sign that form and leave that place!

It is so crucial to be smart. I know when I am in the hospital I allow my emotions to cloud my judgment. I am just always so miserable there that sometimes it is hard to look at the entire situation clearly. There have been times when I was so hell bent on getting home and getting out of there that I missed the big picture – it would be more devastating if I left and had to come back than if I stayed one more night just to be on the safe side. I am saying all of these semi intelligent things now because I am home. I am not attached to tubes, I did not have someone barge into my room every 2 hours last night, I am not in miserable pain and feel like a prisoner, I do not have black and blue arms and hands from random people trying to take blood or get an IV in me… Point being, I say these things now because I can be rational while at home. BUT, I also know how difficult it is to not let your emotions control you while you are a patient in the hospital. The hospital is a miserable, awful, terrible place. No one will ever tell me differently and anyone who wants to vent about the hospital, I am your girl. However, in terms of leaving against medical advice….trust your instincts, look at the big picture, sit on things for a while, and if you do trust your doctor talk it out with him/her. Maybe it would help to ask the reasons why your doctor feels it is imperative that you stay a little longer. It might help to put your mind at ease or could help you make a better decision.

And whatever decision you may make, if you sign yourself out and it turns out you aren’t ready…you can always, always go back.