Last year, a clash between doctors and a young woman and her family culminated in an escape/abduction. The family framed it as an escape, the hospital as an abduction and reported it to local law enforcement.
This highlights a growing trend of patients leaving hospitals against the wishes of their doctors. Breakdowns in the doctor-patient relationship and questions about capacity and who makes treatment decisions can all lead to conflict.
“Against Medical Advice”
Incidents of those leaving a hospital before recommended or “against medical advice” have been relatively rare, but are on the increase. Some doctors have patients ask for an early release to attend a wedding or get home to care for loved ones. Another common cause is the increasing cost of medical care. As the amount of co-pays becomes clear, patients realize they do not have the money.
In most AMA cases, a doctor grudgingly agrees to the discharge. Usually, patients are then asked to sign forms acknowledging they know what they are doing.
When is it time to return home?
A French poet, Charles Baudelaire, started a poem in the setting of a hospital where each patient wants to change beds (“Cette vie est un hôpital où chaque malade est possédé du désir de changer de lit”). One would like to suffer next to the furnace, another believes he will heal if only he could move next to the window (“Celui-ci voudrait souffrir en face du poêle, et celui-là croit qu’il guérirait à côté de la fenêtre“).
He uses it as a metaphor for life and avoiding a “grass-is-always-greener” mentality that simply moving to a new job or town can make one happy. But it can also describe how each patient has a different perspective and preference about treatment and care during illness.
For the family in the case we mentioned, they preferred to take their daughter home to heal and provide for her care themselves. They found that physicians/hospitals disagree about when to discharge a patient. The Mayo worried that the mother was unwilling to learn about post-discharge care. But doctors at another hospital sent the young woman and her family home after a couple days with simple aftercare instructions.
When your family disagrees with a medical treatment provider it can be helpful to seek a second opinion. If obstacles seem to pop up when you make this request, you may want to consult an advocate who understands long-term care and guardianship issues.