The patient wants to leave the hospital says no way.

[Brigade4Radiant]

The Patient Wants to Leave. The Hospital Says ‘No Way.’

The Nytimes is saying we as EM physicians do way to many AMAs and do not do much shared decision making. Reading the comments on the article makes me realize many people have no idea about our decision making process for admission vs discharge.

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[OccupyTheED]

Give me tort reform and freedom from ambulance chasing scumbags and you can walk out of that door with whatever you like. Until then, sign here, here and here

 

[BAM!]

The Patient Wants to Leave. The Hospital Says ‘No Way.’

The Nytimes is saying we as EM physicians do way to many AMAs and do not do much shared decision making. Reading the comments on the article makes me realize many people have no idea about our decision making process for admission vs discharge.

When grandpa with CHF get's discharged after syncope and dies at home, it's called malpractice, not "cookbook medicine."

They can't have their cake and eat it too.

 

[OccupyTheED]

IMO a lot of this comes from our attitudes about death and how unrealistic they are in this country @BAM! You and I know that that 84 yo with syncope and an extensive cardiac history has about a 30-40% chance of biting the dust in the next 30 days but somehow families think that Grandma and Grandpa should live forever. I doubt it will ever happen but if we could stop all this futile end of life care and somehow impart a realistic sense of expectations I think a lot of us would practice differently. I would rather actually send that old guy/gal home and tell them to hurry up and knock a few items off the bucket list. But thats just not the world that we live and practice in unfortunately.

 

[DeadCactus]

I agree that AMA is used too frequently but that's more because I doubt its medicolegal utility in comparison to shared decision making. Either is useless without adequate discussion/documentation and with good discussion/documentation I doubt a formal AMA form provides any real benefit. That being said, if you're so f***ing sure your family member is better off at home then sign the form. I'm not the police and the hospital isn't a jail, you can leave anytime you want, but don't expect others to take responsibility for your choice.

 

[deleted480308]

AMA isn't saying someone can't leave, it's just saying the doc and patient don't agree. There isn't a reason to try and curb those numbers

 

[Arcan57]

The problem is the patient may understand the risk they are taking, it's much less common for everyone that could potentially bring a suit on the patient's behalf to also be on board. Bedside manner doesn't mean jack when the out of state daughter senses a payday or hadn't visited mom in years and so thought of her as perfectly healthy.

 

[bravotwozero]

The problem is the patient may understand the risk they are taking, it's much less common for everyone that could potentially bring a suit on the patient's behalf to also be on board. Bedside manner doesn't mean jack when the out of state daughter senses a payday or hadn't visited mom in years and so thought of her as perfectly healthy.

....which is only a problem if patient doesn't have decision making capacity, in which case they wouldn't be discharged anyway.


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[EctopicFetus]

People are funny. Case from today 90+ year old male getting weaker. Family super distraught.. "I dont understand" etc.. Workup normal.

I tell them umm.. he is 90+. Its like they thought he would live forever.

 

[southerndoc]

I have patients that don't want to stay all the time for whatever reason. I rarely -- if ever -- make them sign an AMA form. I simply document they refused to be admitted, why they refused (always important -- whether it's a funeral they have to attend, anxiety, financial reasons, etc.), that I discussed with them the reason why they refuse to be admitted, and that I've clearly explained risks of being discharged.

One important thing to remember is refusal to be admitted is not refusal to be treated. If you see a patient with diverticulitis with an abscess, the worst thing you can do is let him/her sign out AMA and not write antibiotics. This failure cost one emergency physician his malpractice limit and cost the hospital $2.5 million as the patient became septic, required intubation for ARDS, developed a pulmonary embolism, ultimately went into DIC and subsequently died. The ER doc's defense was that the patient refused, but he considered refusal to be admitted as refusal to be treated, and the two are not the same.

You can word an AMA form however you like, but if you don't document in your chart the specifics of your discussion with the patient, then the AMA form is pointless. It is less liability for a patient to elope (provided they have all their faculties) than it is for a patient to leave AMA.

I have somebody every shift that I want to admit and they want to be discharged. Asthmatics with hypoxemia (last week one with an oxygen saturation of 88% on room air), pulmonary emboli, pneumonia, etc. I still write them inhalers, Xarelto, and antibiotics with documentation of risks and documentation that I encouraged the patient to return at any time if their condition changes or if they change their mind regarding whatever procedure, admission, etc.

This knowledge has came from several years of expert witness work (for the defense and state medical board).

 

[southerndoc]

7:27 PM: I have strongly advised the patient that he should be admitted to the hospital for further care (nebulizer treatments, IV steroids, oxygen). However, the patient is adamant that he cannot be admitted to the hospital because of a court appearance tomorrow. I have explained to him that we can contact the court and explain his situation, but the patient refuses to stay. His respiratory rate is 20 and oxygen saturation is 88% on room air. It is 85% with ambulation. Despite his oxygen saturation, the patient refuses to be admitted. I have explained to him (and he has voiced back to me) that his condition may worsen and he could die if his oxygen saturation or asthma exacerbation continues to worsen, which I explained has a high risk of progression. The patient appears to have capacity to make decisions as he is alert and oriented to person, place, time, and POTUS. He seems to comprehend discussions very well both at an oxygen saturation of 88% on room air as well as 99% on 4 L/min via nasal cannula. His refusal to be admitted is consistent on room air and with supplemental oxygen. The patient was encouraged to return to the ER immediately with any change in condition, if he changes his mind regarding admission, or if he is able to be admitted after his court appearance. The patient is being discharged with a prescription for an albuterol inhaler/nebulizer and methylprednisolone. Prior to his discharge, the risks/benefits were again explained and he had opportunity to ask questions (he had none). Discussion was witnessed by [nurse], RN.

 

[Siggy]

One important thing to remember is refusal to be admitted is not refusal to be treated. If you see a patient with diverticulitis with an abscess, the worst thing you can do is let him/her sign out AMA and not write antibiotics. This failure cost one emergency physician his malpractice limit and cost the hospital $2.5 million as the patient became septic, required intubation for ARDS, developed a pulmonary embolism, ultimately went into DIC and subsequently died. The ER doc's defense was that the patient refused, but he considered refusal to be admitted as refusal to be treated, and the two are not the same.

Do you have a link for that? The amount of times I've had discussions with my attendings on the inpatient side where they claim that "sending the patient home with antibiotics is condoning the fact that the patient wants to leave early, and thus leads to more liability" is insane.

 

[Gastrapathy]

@Siggy @southerndoc nailed it.

I'm not sure about a specific reference but the decision is based in core ethic of beneficence. Toss that word at an attending and explain that acting contrary to our accepted ethics is a recipe for deserved liability.

 

[Angry Birds]

I have patients that don't want to stay all the time for whatever reason. I rarely -- if ever -- make them sign an AMA form. I simply document they refused to be admitted, why they refused (always important -- whether it's a funeral they have to attend, anxiety, financial reasons, etc.), that I discussed with them the reason why they refuse to be admitted, and that I've clearly explained risks of being discharged.

One important thing to remember is refusal to be admitted is not refusal to be treated. If you see a patient with diverticulitis with an abscess, the worst thing you can do is let him/her sign out AMA and not write antibiotics. This failure cost one emergency physician his malpractice limit and cost the hospital $2.5 million as the patient became septic, required intubation for ARDS, developed a pulmonary embolism, ultimately went into DIC and subsequently died. The ER doc's defense was that the patient refused, but he considered refusal to be admitted as refusal to be treated, and the two are not the same.

You can word an AMA form however you like, but if you don't document in your chart the specifics of your discussion with the patient, then the AMA form is pointless. It is less liability for a patient to elope (provided they have all their faculties) than it is for a patient to leave AMA.

I have somebody every shift that I want to admit and they want to be discharged. Asthmatics with hypoxemia (last week one with an oxygen saturation of 88% on room air), pulmonary emboli, pneumonia, etc. I still write them inhalers, Xarelto, and antibiotics with documentation of risks and documentation that I encouraged the patient to return at any time if their condition changes or if they change their mind regarding whatever procedure, admission, etc.

This knowledge has came from several years of expert witness work (for the defense and state medical board).

I agree with everything you say, except for the part about not having them sign an AMA form.

My practice is:

(1) I definitely give them a prescription for antibiotics or whatever... I also give them discharge paperwork with return instructions on them. I hand type "You are leaving against medical advice, but this does not mean that you are not welcome to come back. In fact, we strongly advise you to come back for the indicated treatment, as already discussed with you."

(2) I make them sign an AMA form.

(3) I heavily document the reasons why they left, how they understand and verbalized back the risks, and how I pleaded with them if I'm really concerned, etc.

But, in my opinion, it's simply non-intuitive/illogical to not have them sign the AMA form. I've spoken to lawyers and our risk management team during residency, and they all said that it's better to have a signed AMA form. Dude, just think about it...: "Sir, is this not your signature right here, and the physician also documented the conversation that he had with you before you signed it." It's the icing on the cake.

 

[Dr Mantis Toboggan]

That hypocrite smokes 2 packs a day!

 

[WilcoWorld]

That hypocrite smokes 2 packs a day!

You gotta fight, for your right...

 

[enalli]

I don't get the indignation in the article--if patients really want to leave, they can just sign the form. People sign many forms when getting registered, but somehow I'm supposed to believe that signing one more is a huge inconvenience?

 

[Arcan57]

I don't get the indignation in the article--if patients really want to leave, they can just sign the form. People sign many forms when getting registered, but somehow I'm supposed to believe that signing one more is a huge inconvenience?

It's asking them to sign a document that makes them take responsibility for the consequences of their actions. That they don't get to dictate their care without also accepting the increased risk that comes with deviating from the standard. That's a hard message to swallow for some.

 

[turkeyjerky]

I don't get the indignation in the article--if patients really want to leave, they can just sign the form. People sign many forms when getting registered, but somehow I'm supposed to believe that signing one more is a huge inconvenience?

One thing that I took from the article is that many physicians make the decision to leave AMA a contentious one and that this can lead to hurt feelings. I don't understand that. I sign a lot of patients out AMA, but I'm very nice about it, I explain that it's purely to cover my ass, and I still provide them all the usual care. I let them know that everything the nurse just told them about leaving AMA (i.e. That they won't get prescriptions, that they can't come back and that insurance won't pay for the visit) was a lie.

 

[ucbsmd]

The "insurance will not pay for your hospital visit" that would come from inpatient nursing and attendings drove me nuts when I was on my residency inpatient services. This myth is started in med school and is very difficulty to educate physicians that this is false most of the time.


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[southerndoc]

The "insurance will not pay for your hospital visit" that would come from inpatient nursing and attendings drove me nuts when I was on my residency inpatient services. This myth is started in med school and is very difficulty to educate physicians that this is false most of the time.

Is it post-ACA? I knew it was false before ACA, but now insurers find every reason not to pay. I wonder if some use this as an excuse now.

 

[deleted109597]

Is it post-ACA? I knew it was false before ACA, but now insurers find every reason not to pay. I wonder if some use this as an excuse now.

If they're trying to go after prudent layperson this hard, you know they're probably doing the same for this.

 

[xaelia]

I never sign anyone out AMA. In fact, I pretty much tell them "It's not a prison", and (assuming capacity) they can do whatever they please as an independent citizen. They are in the Emergency Department for treatment with their consent, and to solicit my medical advice, and now they have it – take it or leave it. If they prefer to leave, I give them whatever prescriptions and expectant care instruction to give them the best chance of improvement/survival, and encourage them to return to this facility or any other nearby facility if they have further health concerns. And document generally to the gist of that discussion.

Frankly, I have way more difficulty with patients who want to stay, rather than ones who don't ....

 

[Siggy]

The "insurance will not pay for your hospital visit" that would come from inpatient nursing and attendings drove me nuts when I was on my residency inpatient services. This myth is started in med school and is very difficulty to educate physicians that this is false most of the time.


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I've quoted this study to fellow residents when they use the "insurance doesn't pay" argument to try to keep patients from leaving.

Financial Responsibility of Hospitalized Patients Who Left Against Medical Advice: Medical Urban Legend?

 

[Angry Birds]

I never sign anyone out AMA. In fact, I pretty much tell them "It's not a prison", and (assuming capacity) they can do whatever they please as an independent citizen. They are in the Emergency Department for treatment with their consent, and to solicit my medical advice, and now they have it – take it or leave it. If they prefer to leave, I give them whatever prescriptions and expectant care instruction to give them the best chance of improvement/survival, and encourage them to return to this facility or any other nearby facility if they have further health concerns. And document generally to the gist of that discussion.

Frankly, I have way more difficulty with patients who want to stay, rather than ones who don't ....

I tell them "it's not a prison" as well but then have them sign an AMA form. In prison they don't let you just leave AMA. Pretty sure.

 

[racerwad]

I tell them "it's not a prison" as well but then have them sign an AMA form. In prison they don't let you just leave AMA. Pretty sure.

One is usually sent to prison because they were found guilty of breaking a social contract and incarceration is their punishment. While their choices likely lead to their position, they are not in prison of their own volition as they would be in their local ED. I think the point others are making is that a patient's refusal to sign an AMA form is meaningless and, therefore, they aren't going to focus on this form unnecessarily.

Honestly, if you feel as though the person really needs to stay, and they really wish to leave and compelling them to sign a form undermines their trust in you when they might otherwise taken your expectant advice seriously; how does that help that patient? I document that I asked them to sign and that they did or did not and leave it at that. Hounding them to sign something just makes us lawyers' stooges rather than our patients' advocates.

 

[anbuitachi]

Somehow it's always the doctors fault. If the patient signs out AMA, its the docs fault. If the patient stays and do worse, its the docs fault. Everythings the docs fault. Don't listen to your doctors advice? its your doctors fault

 

[Angry Birds]

Honestly, if you feel as though the person really needs to stay, and they really wish to leave and compelling them to sign a form undermines their trust in you when they might otherwise taken your expectant advice seriously; how does that help that patient?

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.

Hounding them to sign something just makes us lawyers' stooges rather than our patients' advocates.

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.

 

[dchristismi]

Birds summed up my AMA conversation quite well. Although I generally say "I'm not going to tie you to the bed... you're a grown up, and you take your life into your own hands driving down the street in this town every day. I really think it would be safest to stay, but I understand you have x,y,z issues. If you feel worse, PLEASE come back. I still love you, and don't want anything to happen to you. I will ask you to sign this form basically saying that we talked about it, so my boss doesn't come looking for me asking why the hell I sent you home. And I'm going to call you tomorrow and check on you to make sure you're still ok."

There have been a couple of articles in the throw-away journals talking about physician follow up calls. Although I was quite opposed for a LONG time (I mean, I do EM so I don't have to see people in an ongoing basis), I do call most of these folks the next day to check on them. And they love it - calling on their time means that the calls are generally pretty quick, can answer any questions they might have, and gives me another chance to recheck them, especially if they can't get timely followup. And I get thanked, which was the thing that made me decide to keep doing it. (FWIW, I live really close to the hospital, so I just swing by and call from there - especially if I think that there's no way I want the patient to have my number. The handful of times I've used my own cell were always cases where I really wanted to talk to them... in fact, one of these cases actually landed me a formal thank-you via an obituary - which the patient's widow texted me. That was a first.)

Not to change the subject and probably open a can of worms, but that's another thought on how to stay "on the patient's team" rather than become oppositional.

 

[Angry Birds]

Birds summed up my AMA conversation quite well. Although I generally say "I'm not going to tie you to the bed... you're a grown up, and you take your life into your own hands driving down the street in this town every day. I really think it would be safest to stay, but I understand you have x,y,z issues. If you feel worse, PLEASE come back. I still love you, and don't want anything to happen to you. I will ask you to sign this form basically saying that we talked about it, so my boss doesn't come looking for me asking why the hell I sent you home. And I'm going to call you tomorrow and check on you to make sure you're still ok."

There have been a couple of articles in the throw-away journals talking about physician follow up calls. Although I was quite opposed for a LONG time (I mean, I do EM so I don't have to see people in an ongoing basis), I do call most of these folks the next day to check on them. And they love it - calling on their time means that the calls are generally pretty quick, can answer any questions they might have, and gives me another chance to recheck them, especially if they can't get timely followup. And I get thanked, which was the thing that made me decide to keep doing it. (FWIW, I live really close to the hospital, so I just swing by and call from there - especially if I think that there's no way I want the patient to have my number. The handful of times I've used my own cell were always cases where I really wanted to talk to them... in fact, one of these cases actually landed me a formal thank-you via an obituary - which the patient's widow texted me. That was a first.)

Not to change the subject and probably open a can of worms, but that's another thought on how to stay "on the patient's team" rather than become oppositional.

This is some pro-level stuff here. I'm gonna steal this line here: "I will ask you to sign this form basically saying that we talked about it, so my boss doesn't come looking for me asking why the hell I sent you home." That's pure gold.

One added pro-tip: just dial *67 before you enter the patient's phone number and this will block your number so it won't show up on caller ID.

 

[Gastrapathy]

This is some pro-level stuff here. I'm gonna steal this line here: "I will ask you to sign this form basically saying that we talked about it, so my boss doesn't come looking for me asking why the hell I sent you home." That's pure gold.

One added pro-tip: just dial *67 before you enter the patient's phone number and this will block your number so it won't show up on caller ID.

Doximity Dialer

 

[deleted109597]

Doximity Dialer

Call from the hospital.

 

[Jlaw]

did she think the medics were there to take her out for ice cream or something??? I mean she seems low risk and all lol.


"Barbara Barg, a Chicago poet, collapsed at a bus stop this spring. She suffered a heart attack in 2014 and had been feeling vaguely nauseated for several months. She was en route to see her primary care doctor about the nausea when a bystander who saw her falter called 911.
Ms. Barg, 70, didn’t want to go to an emergency room, but that was the only place paramedics would take her. “I was freaking out,” she acknowledges. “I’d just gotten out of the hospital, and I didn’t want to go back in.” She’d had two recent hospital stays, one to replace a pacemaker lead, another to look for a blocked artery (none was found)."

 

[BAM!]

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.

wow you put it on pretty thick. do you talk to all your patients like that? isn't it tiresome, or does it come naturally?

 

[Angry Birds]

wow you put it on pretty thick. do you talk to all your patients like that? isn't it tiresome, or does it come naturally?

I generally do yes. I don't get tired of it unless they ask a million questions. But I definitely try to be the endearing doctor especially with old people. "I must be in the wrong room. This says the patient is 72 years old." Same corny jokes all the time but they work. People have a low bar for doctors.

 

[Birdstrike]

The Patient Wants to Leave. The Hospital Says ‘No Way.’

The Nytimes is saying we as EM physicians do way to many AMAs and do not do much shared decision making. Reading the comments on the article makes me realize many people have no idea about our decision making process for admission vs discharge.

Right from the headline, it's obvious they miss the point. AMA doesn't mean, "No way!" you can leave.

It means, "Sure you can leave. But if you do, don't you (and your lawyer) blame us for your bad decision."


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[doctorFred]

I've spent the last several years listening to everyone from medical students and interns to seasoned attendings feed me the same lines: "The AMA form isn't worth the paper it's printed on", "AMA forms offer no real protection in a court of law", "AMA forms offer a false sense of security", blah, blah, blah. Whenever I ask the basis for these opinions, they usually fumble, mumble, and change the subject. I've yet to hear anyone offer a compelling list of examples where plaintiff verdicts were returned in cases where an AMA form was filled out appropriately. What do I mean by "appropriately"? Patient had capacity, physician documented their discussion with the patient, and physician did not mistake a patient leaving "against medical advice" with a patient not wanting treatment of any kind.

I fill out AMA forms on a relatively regular basis, and will continue to do so until someone can prove that they do not act as (in the very least) a partial deterrent from a patient/family filing suit, or that they do not reduce the likelihood that a suit will result in a plaintiff verdict.

 

[Birdstrike]

I've spent the last several years listening to everyone from medical students and interns to seasoned attendings feed me the same lines: "The AMA form isn't worth the paper it's printed on", "AMA forms offer no real protection in a court of law", "AMA forms offer a false sense of security", blah, blah, blah. Whenever I ask the basis for these opinions, they usually fumble, mumble, and change the subject. I've yet to hear anyone offer a compelling list of examples where plaintiff verdicts were returned in cases where an AMA form was filled out appropriately. What do I mean by "appropriately"? Patient had capacity, physician documented their discussion with the patient, and physician did not mistake a patient leaving "against medical advice" with a patient not wanting treatment of any kind.

I fill out AMA forms on a relatively regular basis, and will continue to do so until someone can prove that they do not act as (in the very least) a partial deterrent from a patient/family filing suit, or that they do not reduce the likelihood that a suit will result in a plaintiff verdict.

When people say "an AMA form isn't worth the paper it's printed on," they (hopefully) mean, "An AMA form doesn't completely protect you from liability, but it's better than nothing."

No documentation completely protects us from lawsuits. It's about risk reduction, not risk 'elimination.' In other words, an AMA form is necessary, but not sufficient reduce liability. It's not perfect. But we still do it

Wearing a seatbelt doesn't guarantee I'll survive a car crash, but if I have a car crash, I'd rather have one for protection, than none at all.

AMA forms are the same.


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[Angry Birds]

When people say "an AMA form isn't worth the paper it's printed on," they (hopefully) mean, "An AMA form doesn't completely protect you from liability, but it's better than nothing."

No documentation completely protects us from lawsuits. It's about risk reduction, not risk 'elimination.' In other words, an AMA form is necessary, but not sufficient reduce liability. It's not perfect. But we still do it

Wearing a seatbelt doesn't guarantee I'll survive a car crash, but if I have a car crash, I'd rather have one for protection, than none at all.

AMA forms are the same.


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Birdstrike, as one bird to another, I agree with you about your view towards AMA here, but I do *not* think that's what many people mean when they say the AMA is not worth the paper it's written on, evidenced by the fact that people in this very thread are saying they rarely ever have patients fill out AMA paperwork... which I think sends the wrong message.

It's simply logical that a properly filled out AMA form will add a layer of protection to you, so why on God's green earth are some people saying otherwise.

 

[Birdstrike]

Birdstrike, as one bird to another, I agree with you about your view towards AMA here, but I do *not* think that's what many people mean when they say the AMA is not worth the paper it's written on, evidenced by the fact that people in this very thread are saying they rarely ever have patients fill out AMA paperwork... which I think sends the wrong message.

It's simply logical that a properly filled out AMA form will add a layer of protection to you, so why on God's green earth are some people saying otherwise.

I agree. Some people are leaving themselves exposed for no good reason. That's why if you read that line I qualified it with "(hopefully)." I was being charitable and giving benefit of the doubt. But, whatever. People don't have to care about risk reduction if they don't want to care about risk reduction. I suspect much of it's burnout. Many are at the point they just don't give a ***k anymore. I get it. It happens.


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