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Why do patients leave against medical advice?

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Re: Why do patients leave against medical advice?

#41

Post by Modified3019 »

mattkrause wrote: post #8
apwheele wrote: post #5

Earlier quoted context omitted.

Part of my job I build predictive models to identify individuals at high risk of 'readmission' (it impacts billing, hence why healthcare systems are interested). Conditional on an individual's history (e.g. do you have diabetes, other comorbidities, etc.), I haven't found much evidence that leaving against Dr advisement matters all that much for predicting readmission.

The number in the GP is conditional on the patient being readmitted, so it's inflated by adverse selection: it doesn't include all the zeros where the patient recovered, but it does include all of the cases where something went wrong and they needed more/different treatment.

Yep, looks like classic “survivorship bias”: https://en.m.wikipedia.org/wiki/Survivorship_bias

Re: Why do patients leave against medical advice?

#42

Post by NoMoreNicksLeft »

_qua wrote: post #14
bstre wrote: post #3

I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.

As a physician probably my single most feared infection is a MRSA (or any Staph.) bloodstream infection. It’s a sticky bacterium that likes to destroy heart valves and joints. I’m personally a bit of a medical nihilist but antibiotics often work to treat it and I would not be eager to do the n=1 trial of the shortest effective duration.

> It’s a sticky bacterium that likes to destroy heart valves

Do those grow back crooked or something?

Re: Why do patients leave against medical advice?

#43

Post by John23832 »

Waterluvian wrote: post #35
_qua wrote: post #14

Earlier quoted context omitted.

As a physician probably my single most feared infection is a MRSA (or any Staph.) bloodstream infection. It’s a sticky bacterium that likes to destroy heart valves and joints. I’m personally a bit of a medical nihilist but antibiotics often work to treat it and I would not be eager to do the n=1 trial of the shortest effective duration.

Bankruptcy may very well do greater collective harm. Pretty horrifying to even have to weigh that variable.

As much as bankruptcy is horrible, it’s does not compare to the immediate harm of a disseminated MRSA infection.

Let’s not be hyperbolic.

Re: Why do patients leave against medical advice?

#44

Post by iamthemonster »

bstre wrote: post #3

I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.

American health insurance needs an additional layer of insurance where you pay in monthly and if you get sick a consultant with knowledge of health insurance coverage comes along and works out these things. Clearly you were mentally capable at the time, but many times people just get ripped off due to a combination of lack of understanding, will power or grief. The only other industry I can think of that waits until customers are at their most vulnerable before gouging for maximum profit is loan sharks.

Re: Why do patients leave against medical advice?

#45

Post by hondo77 »

sys32768 wrote: post #31

My five-hour Atrial fibrillation didn't convert until I left the hospital ER. The hospital was so stressful with constant beeps, patients moaning or crying, staff disappearing, that it was obviously keeping my pulse high despite meds. I honestly felt like my job was to comfort the harried staff. When I got my meds the next day, they only cost $0 because I used up my entire $6k deductible that night.

During my hospitalization for thyroid storm/afib, they had the heart monitor alarm set to too low a heart rate for what I had. It was loudly beeping constantly. I kept asking the nurses to fix it but was given various excuses. Finally I unplugged my connection and told staff that I wasn't going to let them plug me back in until the alarm was fixed. They finally adjusted it. I watched how they did it, though. So the next time someone set the alarm too low, I waited until the coast was clear and I set it back. Good nights of sleep were back!

Re: Why do patients leave against medical advice?

#46

Post by alsetmusic »

I was recovering from insomnia and slipped on a spilled drink in the night. I had thirteen stitches from my head hitting a table. When I came to, I had an orderly follow me down the hall, trying to convince me to stay as I might have a concussion. I called a cab (pre-Uber, at least for me) and went home. I just hate hospitals.

Was it stupid? Probably. Though I’d probably do it again.

Re: Why do patients leave against medical advice?

#47

Post by hotnfresh »

DavidPeiffer wrote: post #16
4death4 wrote: post #9

Earlier quoted context omitted.

Couldn’t you have enrolled in a plan that would have covered your treatment after the fact? I think you have 30 days to do so after losing coverage. I agree that the current system in the US is insane, but what was your plan originally for when you lost coverage?

GP could be referring to treatment being covered under the prior year deductible or max out of pocket. I have a friend who was hospitalized on December 30th and released on January 2nd. And that's how they hit their max out of pocket two times over the course of 4 days. It's an awful edge case. If they'd gotten terrible vertigo a couple days earlier or later, it would have cost them half as much.

Weird America-only medical bullshit: it costs way more money to have a pregnancy that spans 2 calendar years, than if you keep it all in one year.

Re: Why do patients leave against medical advice?

#48

Post by hondo77 »

jeffbee wrote: post #20
zabzonk wrote: post #13

people want to be back in their own homes. i was in hospital a year ago (nhs, fractured ankle) and the guys in the whole ward i was on were literally desperate to get out of the place (which wasn't horrible, and i think the nhs is brilliant). it took me probably an extra week to get discharged that it needn't have done. but there is a lot of arse-covering going on.

> people want to be back in their own homes Seriously why are "bad food" and "noisy nurses" not on the list of reasons? People want to eat and sleep and if they feel like their acute medical problem is manageable I can see why they'd want to leave.

This. I was hospitalized for 12 days a couple months ago. At the end, I was going to leave if I wasn't discharged by a certain day because I couldn't take the food anymore. Fortunately, it didn't come to that but, my god, the food was horrible. And I'm not a fussy eater. I did my best to work with what I had, and had friends bring in food from the outside (I wasn't on any restrictions) but I finally reached the end of my rope.

Re: Why do patients leave against medical advice?

#49

Post by 0xcde4c3db »

gumby wrote: post #39
bstre wrote: post #3

I left on day 4 of 6 combatting a MRSA infection. I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd. Turns out I was right in my estimations that the course of IV would suffice and also that the remaining days would not be covered. I feel like I 'survived' the hospital system, not MRSA.

> I feel like I 'survived' the hospital system, not MRSA. You survived the insurance system (or rather, despite it). The hospitals can't tell you what is covered at the time of service, only well post facto (I literally got a call last week about a copay from surgery I had in May 2022). IMHO most of that blame lies with the insurance companies, but the hospitals are complicit.

The more exposure I have to the health insurance system, the more convinced I am that nobody actually knows what they're doing. For all the insight the average action has, the corresponding actor might as well be a computer program that only compiles on Borland Turbo C++ trying to parse a policy expressed in malformed XML edited by an unpaid intern a decade later.

I once got a bill nearly a year after the actual treatment, with a line item that differed only by the description field's whitespace and punctuation from a charge I knew I'd already paid. There was a smaller line item on that bill that I probably hadn't paid, but just through the magic of calling the phone number and sitting through hold, I was told not to pay anything.

Re: Why do patients leave against medical advice?

#50

Post by zetazzed »

kjhughes wrote: post #23

The shockingly low priority hospitals give to patient sleep might be a factor that the authors missed.

Yes, I have not gone AMA but I have heavily pressed a doc to get me out RIGHT AWAY because I was getting worse in a hospital rather than better. Sleep was the top concern, and my biggest frustration was how nurses and doctors would all chuckle, smile a little, and say "oh, we know, everybody has a hard time with lack of sleep here" like it's some charming quirk of the system. Often these would be like "pill at midnight, vitals check at 2am, labs at 5am, vitals again at 6am." I mean at least lump vitals together with other existing wakeups! Nurses also vary greatly, and the best ones would work out ways to improve sleep a bit and the worst were just unbearable in slavish adherence to schedules in the chart, even when some of them are obviously arbitrary or flexible. (Don't wake me up to give me a scheduled pain pill! If I'm sleeping well, I'm not in pain.)
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