Yes, but you are assuming that there is a necessary link between signing an AMA form and loss of trust/rapport. It is quite possible to have patients sign AMA forms and have them leave in a perfectly good mood. In fact, I've really never had a problem with having AMA forms signed, except with drug-seekers, in which case I document their behavior and refusal to sign as part of that behavior.
I don't think so. As someone else mentioned above, patients sign a billion forms, and this is just one more form, but which adds a layer of protection for us. It also compels us to have that conversation with the patient about leaving, which is a good thing.
This is really over-analysis. The AMA form is not perfect, and is not absolutely necessary if you can't get it. But, if you can get it and get it without the patient getting upset, then there is really no reason not to get the AMA form except for contrarianism.
Really people, it's quite easy. Here's a sample script: "Hi, Mr. Jones, your test results came back OK, but even though you look like a million bucks and don't look a day above 40, your heart doesn't know that...Your heart is still 70 years old. So, I'd really like to keep you in the hospital to keep an eye on your heart because you are at risk for XYZ blah blah blah... But, I understand you want to leave? You got a hot date tomorrow? OK, I understand, well--I'm not a warden and this is not a prison so I can't keep you here against your will. She's your warden [point to wife], not me [big laugh] [same joke every time]. BUT, you know I gotta get your John Hancock on this AMA form before you go... It's just legal stuff, you know... It says that I had this conversation with you and tried my darndest to convince you to stay.... NOW, just so you know, just because you signed this form and are leaving AMA, it certainly doesn't mean you can't come back. In fact, we WANT you to come back and you're welcome to come back any time you want. We're more than happy to take care of you. Also, please please follow up with your PCP tomorrow if possible and return for any worsening, OK? Can I get a pinky promise on that? OK great, alright Mr. Jones, you have a great night and feel better! Bye bye now!"
There you go.