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

  • Helen-Maria Lekas
Chapter

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.

Keywords

Against medical advice (AMA) discharge Habitus Health disparities Institutional agency Institutional ethnography Patient-centered care Strategic research event 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nathan Kline Institute for Psychiatric Research, Division of Social Solutions and Social ResearchOrangeburgUSA
  2. 2.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia University Medical CenterNew YorkUSA

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