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Going Against Medical Advice
Salomon Says

Going Against Medical Advice

What to do when you disagree with your doctor.

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Published: October 23, 2011

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Visitor Comments: 89

(84) ER Doc, December 3, 2011 7:28 AM

This ER doc agrees with that situation

I stumbled upon your post in more search for material for a talk about AMA discharge I will be giving , so it is a question I have thought a lot about. For many physicians, especially in the ER, the default position is the most conservative one: If I can't rule out any and all badness, I should admit the patient and continue the search for badness. I have had more than one patient sign out AMA with whom I secretly agreed. When is it OK to sign out AMA? It is always a deeply personal question. A common dilemma is the 40 or 50-something patient whose chest pain is probably not his or her heart (or lungs, etc)... but I haven't reached he point of diagnostic certainty that will allow me to comfortably send the patient home. When the patient starts to worry about his bill, or missing work, or taking care of his kids, I have to honestly say that yes, I probably AM expending your time and money to NOT find anything wrong. But the consequences of NOT finding the problem you still have a 5% chance of having are too disastrous to stop. And then I usually pull the old "Your kids would rather not see you tonight and your paying off your bill for a few years than to have tonight be the last time they see you." (Yes, that is a sucker punch.) The question that YOU (the patient) must answer is is the gamble worth it.... do you even agree with me that it is a gamble? Is your own feeling that you are fine a real assessment or wishful thinking? In cases such as your mothers, I think you made as great decision. Once one reaches the point of no longer wanting aggressive care, there is no point in having an aggressive work-up. Further, frail elderly are the people most likely to be harmed by hospitalization. At the end of the day, the doctor has the better medical knowledge, but the patient and family are the experts on their own lives and values. Both kinds of knowledge are crucial to informed care, or the decision to refuse care.

(83) Esther, November 11, 2011 10:28 PM

Thank you as always for such amazing Videos. I just want to say that I think the perpous of everything is for the sake of Emunah (Trust) and the more trust we have in G-D in these situations that is doing the right thing!

(82) Leah, November 11, 2011 4:18 PM

100% the right decision

Not only were you correct in taking Mom home I believe you should not leave a parent alone in the hospital when they must be there. Wrong tests & procedures are done all the time. B"H my mother (60s at the time)was smart enough to refuse a test that she shouldn't have. Her doctor was grateful too.

(81) mintzi, November 2, 2011 8:46 PM

I agree with your descision.

There is a time when one is forced to face having to evluate the health care that is to be adminiastered to our parents. I believe it comes down to what is going to contribute to the quality of their lives. Clearly putting an older frail Mother through several tests will not improve the quality of her life and what of the findings? Does it make sense to put her through unpleasant procedures or worse still possible surgery. You absolutely did the right thing.

(80) Anonymous, November 1, 2011 12:54 AM

you were 100% right. My mother was taken to the hospital the doctors did not check with us. we knew she had a small lump in her stomach. We knew. Her Dr. said leave it alone it will not hurt her. At the hospital they immediately operated to take it out. It was benign tumor very small did not grow or move. She was at least 88 . She had her stomach upset She had herring and icecream. When her dr. found out that they operated . They did not call her Dr. or her children. She was healthy in every other was. YOU DID THE RIGHT THING!

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