Signing AMA form

[UnderwaterDoc]

I am wondering what people's thoughts are about this.

I have had a number of conversations with lawyers, including one who is also an EM doc, who tell me that having people sign the AMA form does not afford you any legal protection and what really matters at the end of the day is your documentation. Hence my practice has been do document thoroughly every AMA encounter and I rarely if ever have the patient sign the form, except on very egregious cases.

Wondering what people's practice is and if anybody can share any particular case where signing the AMA form actually helped.

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[Siggy]

The way I look at it is that the form itself simply means that we had a conversation. It's still up to me to document what that conversation included (risks/benefits, including any specific disease process that hasn't been ruled out yet, that the patient needs to follow up outpatient with his PMD, and that he should go to any hospital, including this hospital, if he wishes to be evaluated and treated further) and my assessment (patient is A/O x 4 and comprehends the conversation, including repeating back in his own words).

 

[Angry Birds]

I disagree. Documentation is important, but having a signed document from the patient him/herself is nice to have.

 

[Jlaw]

I think what they are saying is that if you are grossly negligent in your treatment/documentation that won't be overlooked because the patient survived long enough to sign out AMA. Kind of like how parking garages all say that by parking there you can't hold them liable for damage or theft, but in most cases you can if you can prove that they didn't take reasonable precautions to prevent it.

 

[e30ftw]

I think what they are saying is that if you are grossly negligent in your treatment/documentation that won't be overlooked because the patient survived long enough to sign out AMA.

No.

They're saying: you can do everything right for the patient, including spend lots of time on the phone with consultants arranging admission, treatment with abx/meds/ivf, arranging follow up, advising them on further treatment, writing admission orders, etc, but if you just make them sign the form after they refuse further treatment, rather than document medical decision making capacity, exact terms of your conversation, verbalized understanding, risks of discharge, benefits of treatment, family members in room, willingness to reevaluate, etc in a perfectly described legally approved statement, you are liable.

Has nothing to do with any sort of negligence in care. You may treat the patient appropriately, but if the pt decides to sign out AMA, has a bad outcome, and you didn't document every one of those things, you may be liable.

 

[link2swim06]

Basically, I feel like a jury would be more sympathetic to you if you seemed to actually care about the patient.

In other words, my paragraph about decision making capacity, consequences, etc. is carefully worded. I basically write it so that if it was read aloud to a jury...they would say, damn the doctor cared, liked the patient, is a good guy, and tried but the patient is ultimately responsible.

This is also one of the charts I look for dictation errors more carefully (much higher risk chart and chance of being read verbatim in court).

 

[gman33]

One of the hospitals where I trained was chaired by a well know medmal doc.
The ama form they used was extremely detailed and accounted for almost every scenario.
It required multiple signatures from the patient and a whole lot of initialing.

It was a giant pain and took a long time to complete.

This doc is a true expert and had been involved in thousands of cases, so I'll concede that he knows a lot better than me whether this form is helpful.

 

[deleted77919]

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[Hercules]

I rarely make anyone sign the form. I have a detailed conversation with the patient's nurse in the room and then have both of us document the conversation. Two medical record descriptions of the events seems much better than a boiler plate AMA form that the patient didn't read.

 

[Angry Birds]

I rarely make anyone sign the form. I have a detailed conversation with the patient's nurse in the room and then have both of us document the conversation. Two medical record descriptions of the events seems much better than a boiler plate AMA form that the patient didn't read.

I think that *with* a signed AMA form is even better.