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Reframing the Phenomenon of Discharges Against Medical Advice: A Sociologist’s Perspective

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Against‐Medical‐Advice Discharges from the Hospital

Abstract

Leaving the hospital against medical advice (AMA) is uncommon. Approximately 2% of annual discharges in the USA are deemed AMA. However, a closer look at the literature reveals that the most psychosocially vulnerable patients (e.g., diagnosed with psychiatric illness, substance use disorder, or HIV) have very high rates of AMA discharges, 6–50% across studies. This chapter suggests that the phenomenon of AMA discharge contributes to health disparities and, therefore, constitutes a strategic research event, ideal for illuminating processes that generate health disparities. I propose the concepts of habitus and institutional agency as key interpretative tools. AMA discharges emerge at the interplay between the patient’s habitus from the margins and the provider’s habitus that is an amalgam of uncertainty and medical authority. Conducting institutional ethnography to discern the hospital’s institutional agency reveals its discretionary power and the influence of macro sociocultural factors on explicit and implicit hospital policies that differentially benefit patients, undermine patient-centered care and contribute to AMA discharges.

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Author information

Authors and Affiliations

  1. Nathan Kline Institute for Psychiatric Research, Division of Social Solutions and Social Research, Orangeburg, NY, 10962, USA

    Helen-Maria Lekas

  2. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA

    Helen-Maria Lekas

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  1. Helen-Maria Lekas
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Correspondence to Helen-Maria Lekas .

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Editors and Affiliations

  1. VHA National Center for Ethics in Health Care, Department of Veterans Affairs, NYU School of Medicine, New York, New York, USA

    David Alfandre

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Lekas, HM. (2018). Reframing the Phenomenon of Discharges Against Medical Advice: A Sociologist’s Perspective. In: Alfandre, D. (eds) Against‐Medical‐Advice Discharges from the Hospital. Springer, Cham. https://doi.org/10.1007/978-3-319-75130-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-75130-6_5

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-75130-6

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