Core IM | Internal Medicine Podcast #48 AMA Discharges: At the Bedside Segment
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Sep 4, 2019 
Dr. David Alfandre, an ethics researcher and author, dives into the complex world of discharges Against Medical Advice (AMA). He discusses the demographics and factors influencing these decisions, emphasizing the critical role of clinician communication. The conversation reveals the challenges health professionals face when patients leave despite risks. Alfandre also explores the ethical dilemmas involved and shares strategies for improving shared decision-making, ensuring patient autonomy while enhancing care outcomes.
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Vulnerable Populations and AMA
- AMA discharges disproportionately affect vulnerable populations.
- These patients often face barriers to accessing healthcare, highlighting systemic issues.
Individualized Conversations
- Individualize patient conversations to understand their reasons for wanting to leave AMA.
- Explore their competing priorities, such as family obligations or social service payments.
Systemic Factors
- Non-patient factors, like hospital type and clinician demographics, can influence AMA discharges.
- Research suggests urban and non-teaching hospitals have higher rates, indicating systemic impacts.