Abstract
This chapter examines transference and countertransference experiences in various clinical scenarios involving requests for discharge against medical advice (AMA). It highlights those psychiatric disorders more highly associated with AMA discharges. Transference and countertransference toward patients, including those without psychiatric diagnoses, can impact how the primary team makes decisions regarding the patient’s request to sign out. It is always worthwhile to ask, “What about my feelings towards the patient might influence my willingness or lack of willingness to agree with the patient’s request?” Patients with psychiatric diagnoses are more likely to request discharge AMA, especially those patients with substance use disorders. Consultation-liaison psychiatrists are particularly equipped to assess patients with active psychiatric disorders who are requesting discharge AMA or patients who are requesting discharge and whose capacity to do so is unclear. They are a resource for the physician to guide the process to allow a patient to leave or to not allow a patient to leave.
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References
Albert HD, Kornfeld DS. The threat to sign out against medical advice. Ann Intern Med. 1973;79:888–91.
Schlauch RW, Reich P, Kelly MJ. Leaving the hospital against advice. N Engl J Med. 1979;300:22–4.
Pedersen B, Oppedal K, Egund L, Tønnesen H. Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review. BMC Surg. 2011;11:26.
Viederman M, Perry SW. Use of a psychodynamic life narrative in the treatment of depression in the physically ill. Gen Hosp Psychiatry. 1980;2(3):177–85.
Muskin PR. The request to die: role for a psychodynamic perspective on physician-assisted suicide. JAMA. 1998;279(4):323–8.
Choung AL, Joon PC, Sang CC, Hyuk HK, Ju OP. Patients who leave the emergency department against medical advice. Clin Exp Emerg Med. 2016;3(2):88–94.
Seaborn Moyse H, Osmun WE. Discharges against medical advice: a community hospital’s experience. Can J Rural Med. 2004;9(3):148–53.
Saia M, Buja A, Mantoan D, Bertoncello C, Baldovin T, Callegaro G, Baldo V. Frequency and trends of hospital discharges against medical advice (DAMA) in a large administrative database. Ann Ist Super Sanita. 2014;50(4):357–62.
Duñó R, Pousa E, Sans J, Tolosa C, Ruiz A. Discharge against medical advice at a general hospital in Catalonia. Gen Hosp Psychiatry. 2003;25(1):46–50.
Holden P, Vogtsberger KN, Mohl PC, Fuller DS. Patients who leave the hospital against medical advice: the role of the psychiatric consultant. Psychosomatics. 1989;30(4):396–404.
Ti L, Ti L. Leaving the hospital against medical advice among people who use illicit drugs: a systematic review. Am J Public Health. 2015;105(12):e53–9.
Jankowski CB, Drum DE. Diagnostic correlates of discharge against medical advice. Arch Gen Psychiatry. 1977;34(2):153–5.
Henson VL, Vickery DS. Patient self discharge from the emergency department: who is at risk? Emerg Med J. 2005;22(7):499–501.
Stranges E, Weir L, Merrill CT, Steiner C. Hospitalizations in which patients leave the hospital against medical advie (AMA); 2007. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb78.pdf. May 11, 2017.
Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc. 2009;84(3):255–60.
Hwang SW, Li J, Gupta R, Chien V, Martin RE. What happens to patients who leave hospital against medical advice? CMAJ. 2003;168(4):417–20.
Stuppaeck CH, Barnas C, Falk M, Guenther V, Hummer M, Oberbauer H, et al. Assessment of the alcohol withdrawal syndrome – validity and reliability of the translated and modified Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-A). Addiction. 1994;89:1287–92.
Prochaska J, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47(9):1102–14.
Lenounis P, Arnaout B, Marienfeld C. Motivational interviewing for clinical practice. Arlington: American Psychiatric Publishing; 2017.
Ness D. Discussing treatment options and risks with medical patients who have psychiatric problems. Arch Intern Med. 2002;162:2037–44.
Miller MC. Personality disorders. Med Clin N Am. 2001;85(3):819–37.
Kahana R, Bibring G. Personality types in medical management. In: Zinberg N, editor. Psychiatry and medical practice in a general hospital. New York: International Universities Press; 1964. p. 108–23.
Kornfeld DS, Muskin PR, Tahil FA. Psychiatric evaluation of mental capacity in the general hospital: a significant teaching opportunity. Psychosomatics. 2009;50:468–73.
Kahn DR, Bourgeois JA, Klein SC, Iosif AM. A prospective observational study of decisional capacity determinations in an academic medical center. Int J Psychiatry Med. 2009;39(4):405–15.
Appelbaum PS. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007;357:1834–40.
Pesanti S, Hamm B, Esplin B, Karafa M, Jimenez XF. Capacity evaluation requests in the medical setting: a retrospective analysis of underlying psychosocial and ethical factors. Psychosomatics. 2017;58:483–9.
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Allen, N., Muskin, P.R. (2018). To Thy Own Self Be True: Contributions from Consultation-Liaison Psychiatry. In: Alfandre, D. (eds) Against‐Medical‐Advice Discharges from the Hospital. Springer, Cham. https://doi.org/10.1007/978-3-319-75130-6_9
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DOI: https://doi.org/10.1007/978-3-319-75130-6_9
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