Makindo Medical Notes

⚠️ Patients who discharge against advice (AMA) are still entitled to safe care — including medications, discharge summaries, and clear instructions. Notify the GP promptly, and escalate to a senior if unsure.

About: Escalate to Senior Registrar or Consultant if Unsure

• Right to Refuse: ✅ Patients with capacity may refuse treatment. Refusal may stem from unclear explanations — respect autonomy while ensuring they are fully informed.
• Duty of Care: Declining one intervention (e.g. admission) does not remove their right to medications, advice, and safe follow-up.

When a Patient Discharges Against Advice

• 📝 Document Thoroughly: Record capacity assessment, risks explained, patient’s response, and advice given.
• 🤝 Offer Alternatives: Negotiate compromises (e.g. agree to wait for a 3-hour troponin if full admission refused).
• 📢 Safety-Net: Clearly explain red-flag symptoms (e.g. chest pain recurrence, breathlessness, neurological deficits) and advise immediate return if these occur.

Follow-up Actions

• 💊 Provide Medications & Documentation: Issue discharge medications and a summary. If immediate letter unavailable, arrange collection later.
• 📠 Inform GP: Notify urgently (fax, email, or phone) to ensure continuity and follow-up (e.g. outpatient cardiology referral).
• 🤲 Respect the Patient’s Decision: Never punitive. Offer transport and standard discharge services like any other patient.

High-Risk Scenarios: Suicide or Self-Harm

• 🧠 Psychiatry: Involve duty psychiatrist if risk suspected. Attempt to delay discharge until review.
• 👨‍👩‍👧 Escalate: Inform family, police, psychiatric teams, and seniors if patient insists on leaving with imminent risk.
• ⚖️ Legal Considerations: Full documentation is critical. These cases may later be reviewed in coroners’ court.

✅ Balance autonomy with duty of care. Clear communication and thorough documentation are your best protections — both for patient safety and medico-legal accountability.