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Why do patients leave against medical advice?

ncbi.nlm.nih.gov

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Re: Why do patients leave against medical advice?

#61
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 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. For future reference, asking the hospital what your insurance covers will always result in a "we don't know" answer because they don't speak for your insurance. They can't risk saying "yes" when they aren't the ones deciding. In these cases, call the insurance company. The reps deal wit…

[deleted]

Re: Why do patients leave against medical advice?

#62

Earlier quoted context omitted.

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.

If the harm is so great to all of society, then surely all of society would ensure that no one ever has to even think about cutting any treatments short.

Or, even if it's just the knowledgeable and responsible medical profession who knows how important that is, then surely that same knowledgeable and responsible medical profession would ensure that no one ever has to think about doing something they claim to care so much about avoiding. Right?

This responsibility to others argument falls dead flat.

Re: Why do patients leave against medical advice?

#63
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.

> It’s a sticky bacterium that likes to destroy heart valves Do those grow back crooked or something?

I don’t believe they grow back at all.

Re: Why do patients leave against medical advice?

#64
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.

On a similar insurance related note... I needed an emergency appendectomy and was sent home in pain by non-medical staff.

I had gone to an urgent care clinic with abdominal pain. They pressed on my abdomen to see where the pain was and told me to immediately go to the hospital down the street and there would be a CT scan order waiting. At the conclusion of the scan, I was told to go down the hall to the ER for emergency surgery.

At the ER check-in counter, they took my information. My insurance was a PPO for which the hospital was in-network. After 20 minutes on the phone, they told me that my employer (a 6K person public company, not a small company just figuring out benefits) hadn't paid their premium so they would not admit me. I knew the head of HR and called her directly. She said that premium payments are automated and there were no issues. To make sure, she called our contact at the insurance company, and they confirmed everything was good. I told all of this to the front desk staff, and they said there was nothing they could do. They said they would contact the insurance company again the next day and call me if anything had changed.

Looking back, I should have gone straight to another hospital. But I was delirious with pain and went home to rest because I was exhausted and freezing cold from sweating profusely. The next afternoon they called and said it had been cleared up and that I need to get there immediately as it was life threatening. I got to the ER, and they started a series of tests to determine if my appendix had burst (it hadn't!). A doctor came over to review the test results, saw that the CT scan was the previous day, and yelled at me for several minutes about how I risked my life by listening to the front desk staff. I asked if I should have forced my way back to find an empty bed and just jumped into it. He continued to yell at me until a nurse physically pulled him away. I finally had the surgery late that night (with another doctor that was not so agitated), and everything went well from there.

So, I initially left the hospital against medical advice, but at the insistence of non-medical staff. A different situation, but sometimes taking medical advice is not an easy option.

Re: Why do patients leave against medical advice?

#65

This paragraph caught my eye: > The financial burden is not imposed on the patient only; the healthcare system is also affected by the consequence of leaving against medical advice. Reports have shown that the cost of an average stay was USD 3716.00 for those patients who left as planned. However, patients who left against medical advice and were readmitted had an average bill of USD 10,761.56 for staying 4.7 days in…

> This makes me laugh. As if medical care in the USA isn't already ridiculously inflated. Honestly this is an area where I'd invite Elon Musk to come in and disrupt. In the same way that he disrupted space travel and electric vehicles in part by asking, "do we need to do everything in the expected high cost manner"? Question if you need certain things to be at certain medical grade for everything. I get that staff is…

Oh, no. Musk can do nothing good for social systems. His models of social systems are oversimplified, and his methods are not for social systems. You can fail an orbital launch just to see how it will go wrong, to learn things. But such experiments on human subjects and societies are frown upon at very least. And with medical care there are people lives at stake. Thousands or maybe hundreds of thousands annually. You don't want to disrupt this system, to reform gently maybe, but without any disruptions.

Re: Why do patients leave against medical advice?

#66
post #33

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

Seriously! When my first child was born, we stayed as long as possible, basically until the nurses more or less kicked us out. There was tons of support, and it was as pleasant an environment as I can easily imagine. For baby #2, the focus was 100% on getting the nurse and doctor through their appointed tasks. 14 hour old baby is actively nursing? Too bad, hand her over, its time to do the measurements. We got so fed…

Pro tip for any spouses out there on that first night in the hospital:

Tell the nurses to screw off if baby and mom are doing fine.

We had a similar issue in that they would come around every hour and do 45 minutes of testing. Let mom and baby sleep and eat for a while, they've both been through a lot.

Also, for the first timer's out there: Your normal rhythm of doing something hard and then going to relax and recoup is not how babies work. Like, you go climb a mountain, take a test, have a hard day at work. Then you go home and relax and recharge, right?

That's not how a newborn works. The labor and delivery are the start of the 8-12 week long process of getting the newborn used to a day-night cycle and a feeding cycle. You really don't have any recouping or recharging time for the next 2-3 months. You don't have it after the 2-3 months either, but things get a bit calmer and you'll likely be sleeping more by then though.

I don't want to scare you off parenthood, but let you know that the normal way of things is not how your life is going to go now.

Re: Why do patients leave against medical advice?

#67

My ~18 month old son is medically complex, and his pediatricians send him to the ER basically every other week. ER docs run a bunch of tests, shrug and say LGTM and send us home. The hospital is an hour away, and they never get any closer to figuring out what the problem is (just follow up with X specialist in Y months). My wife and I are sick of it, but we’re worried that if we don’t take him in when they tell us to…

I don't know what medically complex means exactly but it sounds like you are being taken advantage of. Can you find a new set of pediatricians and see if they put you through the same ringer? That sounds horrendously expensive.

Re: Why do patients leave against medical advice?

#68
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.

> It’s a sticky bacterium that likes to destroy heart valves Do those grow back crooked or something?

No they get destroyed leading to hear failure and shock needing surgical replacement if you survive

Re: Why do patients leave against medical advice?

#69
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.

> It’s a sticky bacterium that likes to destroy heart valves Do those grow back crooked or something?

Adult heart cells (cardiac muscle) don't regenerate. Once they're gone, they're gone.

Re: Why do patients leave against medical advice?

#70
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.

On a similar insurance related note... I needed an emergency appendectomy and was sent home in pain by non-medical staff. I had gone to an urgent care clinic with abdominal pain. They pressed on my abdomen to see where the pain was and told me to immediately go to the hospital down the street and there would be a CT scan order waiting. At the conclusion of the scan, I was told to go down the hall to the ER for emerge…

This is so depressing, I’m sorry you went through that.
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