Hospitals are not fun. It can be hard to sleep with the noise and interruptions. You miss the comforts of home. You can be exposed to infections and other safety hazards. And they’re expensive. Why stay longer than needed? What about leaving the hospital against your doctor’s advice? Will your health suffer? The primary reason to stay is, of course, because your doctor said you should. But what if there are alternatives?
What are the risks of discharge against medical advice?
If you leave before your doctor thinks you should, it’s called a “Discharge against medical advice” (DAMA), which is associated with greater risk of hospital readmission as well as increased risk of death and higher costs. A recent study showed that patients leaving against medical advice were 2x more likely to be readmitted to the hospital within 30 days.
How common is this?
It’s not that common, but the rates are increasing.
From 2003 to 2013, the percent of patients leaving against advice increased in individuals aged 18 to 64 (from 1.44% to 1.78%) and for patients 65+ (from 0.37% to 0.42%).
Although the number of DAMA patients increased for all adults, people 65+ were four times less likely to discharge themselves against medical advice than those 18-65 years old.
What factors play a role?
Patients admitted for mental health issues had the highest risk of leaving against medical advice, among all age groups. Additionally, elderly patients who were Black, Hispanic or low-income have an increased risk of DAMA. This suggests that race/ethnicity and poverty are significant risk factors for DAMA in the elderly.
Considering leaving the hospital against your doctor’s advice?
Before you make any hasty decisions that could lead to a decline in health and an increase in expenses, consider these steps:
- Get a second opinion. If more than one doctor advises you to stay, take this advice seriously.
- Ask your doctor why he/she thinks it’s necessary to stay. What are the risks associated with a DAMA?
- Ask your doctor about alternative plans. Would you need medical equipment? Nursing support? Frequent check-ins with your medical team?
- Be realistic with yourself about at-home care. Being very sick, or taking care of a very sick loved one, is a difficult, often overwhelming task. Are you up for it? Do you have the resources to do this safely?
- If finances are your main concern for wanting to DAMA, remember that leaving early is associated with increased costs in the long run. If your out of pocket expenses are beyond your means, there may be help available. Ask to speak to someone in the hospital about your bill, talk to your insurance company about coverage, and look up resources for financial help on this Zaggo webpage.
For information on reducing the risk of complications after discharge, read my post Tips for Hospital Discharges.
Being an engaged member of your medical team can help you get the best care and outcome possible. Read these blog posts for more information:
- 10 Tips to Communicate Better with Doctors.
- Understanding Medical Information Is Harder Than Most Realize.
- How Can Patients Protect Themselves from Hospital Infections?
- Germs in Hospitals and Doctor Offices – Watch Out!
- Why is Hand Washing in Healthcare So Important? What You Need to Do to Stay Safe.
- Why is Sepsis so Dangerous?