In response to “Discharge against medical advice: How often do we intervene?”
We believe medications can safely be prescribed tomost patients who leave against medical advice(AMA), and that follow-up should be offered to mostif not all such patients. Why should we do this? Con-sider a wheezing asthma patient who leaves AMA.She or he is probably more likely to return to theemergency department (somewhere) or be readmitted(somewhere) and cost more money (to the system)than if given an inhaler and steroid taper.Dr. Querques et al. suggest that doctors shouldpotentially not prescribe and should not offer follow-upto certain patients who want to leave AMA, particu-larly those who show disinterest in heeding the doctor’sadvice and have already demonstrated a lack of adher-ence. How should doctors make those judgments?Patients leave AMA for a variety of reasons: for exam-ple to avoid cost, because they feel better, or poor com-munication. Certainly, not all patients who want toleave AMA are categorically nonadherent. Conversely,up to 50% of all continuity patients are not fully adher-ent to the lifestyle changes and medications their physi-cians prescribe,