The patient who threatens to self-discharge

Abstract

Patients who take the hospital discharge decision into their own hands, leaving against medical advice, are familiar to all doctors. No data exist on precise numbers – but as most selfdischarges are not logged on any hospital database, there is no way to know. From the author’s personal experience, the vast majority of patients who self-discharge tend to be those seen acutely as emergencies and most of these patients only see doctors-in-training as opposed to a consultant. These patient episodes are often only witnessed by one doctor and a handful of agency nursing staff at night. Thus, no large studies have been published containing detailed clinical information to help doctors and hospital managers to determine the predictors of such discharge. Furthermore, as such data are lacking, the incidence of potentially dangerous outcomes is difficult to assess.