Discharges against advice
⚠️ Quick reality check: If a patient leaves against medical advice (AMA), they don’t lose their right to safe care.
They still need meds, clear advice, and a proper discharge summary.
If it feels uncomfortable or risky - pause and escalate.
🤔 First principles - and when to call your senior
- Capacity comes first: ✅ If the patient has capacity, they’re allowed to say no - even if you think it’s a bad idea.
That said, refusal often comes from misunderstanding or fear, so slow down and explain again.
- Duty of care doesn’t disappear: Saying “no” to admission ≠ saying “no” to meds, advice, or follow-up.
- Trust your gut: If you’re uneasy, ring the registrar or consultant. This is exactly what they’re there for.
🚪 When a patient wants to leave AMA
- 📝 Write it like you’d want to read it in court:
Document capacity, what risks you explained, what the patient understood, and their decision - in plain language.
- 🤝 Don’t make it all-or-nothing:
Sometimes a compromise works - “Could you stay another 3 hours for the repeat troponin?” is very different from “admit or leave”.
- 📢 Safety-net like you mean it:
Be explicit: “If the chest pain comes back, if you get breathless, if you notice weakness or speech problems - come straight back or call 999.”
📋 Before they walk out the door
- 💊 Give the basics properly:
Prescriptions, discharge advice, and a summary. If the letter isn’t ready, arrange how they’ll get it.
- 📠 Tell the GP - promptly:
Email, phone, or fax. Make sure someone in the community knows what happened and what’s needed next.
- 🤲 Stay professional:
No judgement, no attitude. Offer transport and standard discharge support like any other patient.
🚨 High-risk territory: suicide or self-harm
- 🧠 Get psych involved early:
If there’s any concern about self-harm or suicide, call the duty psychiatrist and try to delay discharge until they’ve reviewed.
- 👨👩👧 Escalate widely if needed:
Seniors, mental health teams, family - and yes, sometimes the police - if there’s imminent risk.
- ⚖️ Assume scrutiny:
These cases are often reviewed later. Clear, careful documentation protects the patient and you.
✅ Makindo bottom line:
Respect autonomy - but don’t abandon your duty of care.
Clear communication, calm escalation, and good notes are your best friends at 3 a.m.
