AMA stands for “Against Medical Advice”. Patients are labeled as having left AMA if they leave, well…against your advice. Our hospital does not have a formal AMA discharge sheet because they feel it sets up an adversarial relationship between doctor and patient. I usually try very hard not to use those words on dictations, but rather, explain the situation that occured, and the conversation had with the patients. Usually, patients have good reasons for wanting to leave, and I usually don’t blame them too much and just make sure they know what to do if they get into trouble. On the other hand, sometimes you can’t but help feel adversarial against your patient. Today, a young lady with documented disease (a DVT) left our emergency department because she and her husband:

a) had been waiting too long

b) didn’t get the answers they wanted from me

c) didn’t get the answers they wanted from me fast enough

d) were idiots

e) all of the above

When I returned to their room to advise them of the developments (that she would be admitted for treatment) her husband was irate, insisted that we “take that thing out” (her IV) and that he’d take her to another hospital (an hour or more away) in the morning. What was I missing? She was going get treated like, right NOW, not tomorrow, but he insisted on leaving??? I asked the wife what she watned to do, and naturally, it was what her husband wanted to do. I felt like strangling them. Why would they leave, when they were about to get the treatment she needed? Instead, they’ll see a different doctor at a different institution with even fewer records than we have (we had 2 blood tests for teh past 4 months, one of them from today…the husband couldn’t understand why we couldn’t tell them what her problem was). There was no point in trying to use logic on them. I should have shot her with a lovenox dart gun on her way out. but they would have none of it. Why are some patients so grateful to be seen, no matter what you do to them, and others are irate, no matter what you try to do? Idiots. I used the words “against medical advice” on that dictation.