Leaving an Emergency Department Against Medical Advice
Posted August 5, 2023 | Reviewed by Gary Drevitch
Several weeks ago, I was feeling dizzy all day and short of breath, with heart palpitations. I knew these symptoms were related to my chronic anemia. The question was how low had my blood counts fallen and did I need a blood transfusion? When this had happened in May with similar symptoms, I did require a unit of blood. I made my way to the local emergency department (ED) after work and as it turned out, my hemoglobin was low, but I didn’t need blood. I got fluids, but I was still feeling dizzy and short of breath. By the time everything got worked up it was around 2 am, and I had to be at my desk for work at 8:00 that morning. The doctor ordered my blood pressure lying down, sitting, and standing to see if I had orthostatic hypotension, which I did. Not only that, but when I stood up, my heart rate increased substantially.
At 3 am, the doctor told me I should stay in the ED and be observed at least until the morning to see if the orthostatic hypotension and increased heart rate resolved. In May, I had missed two days of work due to being admitted to the hospital and I was fearful that if I had to call my supervisor and tell her I was in the ED and couldn’t come to work, she might think I wasn’t capable of consistently showing up at my job. I don't know whether this was a realistic fear or just me being, well, paranoid. I know my fear and hypersensitivity about this topic goes back to an old job to where the executive director took every opportunity to comment, sometimes publicly, each time I took a sick day. I also know I tend toward health anxiety, which has been more severe in the past, so I tend to wonder if I'm making a big deal about nothing.
I also needed to get home and walk and feed my dog. I knew that with the shift change at 7 am, even if my symptoms did resolve, there was no way the staff at the ED would be organized enough to get me out the door in time for me to get home, walk my dog, and be at my desk at 8.
I told the doctor I needed to leave and she told me I’d be leaving against medical advice (AMA). I told her I understood. In a study that explored the reasons for leaving an emergency ward against medical advice, the most-often cited were no reason mentioned (44.1%), incomplete workup (30.5%), refusing admission (12.4%), financial reasons (7.9%), and long wait times (2.9%).
The same study noted that the rate of return visit to an emergency department after leaving AMA was 9.8%. The next day, I was exhausted from lack of sleep and I continued to feel dizzy and short of breath, but I was determined not to return to the ED. I knew I didn’t need a blood transfusion, so there was nothing they could do for me. Since I work from home, I was able to grab a quick nap during a break from seeing clients, which helped.
In another study focusing on emergency-department discharges against medical advice, the majority of the charts studied (67%), interestingly, reflected the competence of the patients: The physicians documented that the patients understood their diagnosis (36%), proposed treatment (44%), alternative therapy (2%), and the clinical consequences of refusal (57%).
I don’t know what was written in my chart following my AMA discharge. Honestly, I’m not sure I want to know.
Thanks for reading.