Patients Leaving Against Medical Advice–A National Survey

Abstract

Background Leaving against medical advice (LAMA) is a common health concern seen worldwide. It has variable incidence and reasons depending upon disease, geographical region and type of health care system. Materials and methods We approached anesthesiologists and intensivists for their opinion through ISA and ISCCM contact database using Monkey Survey of 22 questions covering geographical area, type of healthcare system, incidence, reasons, type of disease, expected outcome of LAMA patients etc. Results We received only 1154 responses. Only 584 answered all questions. Out of 1154, only 313 respondents were from government medical colleges or hospitals while remaining responses were from private and corporate sector. Most hospitals had >100 beds. ICUs were semi-closed and supervised by critical-care physicians. LAMA incidence was maximum from ICU (45%) followed by ward (32%) and emergency (25%). Most patients of LAMA had ICU stay for >1 week (60%). Eighty percent of the respondents opined that financial constraints are the most common reason of LAMA. Unsatisfactory care was rarely considered as a factor for LAMA. Approximately 40% patients had advanced malignancy or disease. Nearly 2/3rd strongly believed that insurance cover may reduce the LAMA rate. Conclusion Most patients get LAMA from the ICU after a stay of week. Financial constraints, terminal medical illness, malignancy and sepsis are major causes of LAMA. Remedial methods suggested to decrease the incidence include a good national health policy by the state; improved communication between the patient, caregivers and heathcare team; practice of palliative and end-of-life care support; and lastly, awareness among the people about advance directives. How to cite this article Paul G, Gautam PL et al . Patients Leaving Against Medical Advice-A National Survey. Indian J Crit Care Med 2019;23(3):143-148.

Contra Consilium Medicinae: A Strange Malady Affecting Indian Healthcare!!

“…In this issue, Mahajan, and Paul et al 4,5 report findings of their studies about this important issue. The first study is a retrospective analysis of patients Leaving against medical advice in a tertiary care teaching hospital.…”

“…Paul and Gautam et al 5 conducted a National Survey of Doctors, mainly anesthesiologist and intensivist, to get a better perception of geographical variability, burden of this strange malady across the nation and importantly the doctors perception and understanding of reasons for DAMA. The self-developed 22 items and four-section questionnaire covered patients' demographics, types of hospital, doctor's perception about factors related to DAMA and doctor's perception about the reasons for DAMA.…”

“…The point of concern in this survey is the fact that majority of patients (94%) went DAMA from acute care areas (62% from ICU, 32% from Emergency department) alluding to the fact that patients and families requesting DAMA were doing so more from acute care areas 5 .…”

“…The two studies bring out some very important apects in effective delivery of healthcare in India. 4,5 The first study despite its single center can be extrapolated to most of the tertiary care institutes across the country. 4 The clinical dilemma faced by doctors, when their patients seek DAMA, is not because of ineffective care, but more due to cost constrains.…”

“…The second study brings forward the perceptions of doctors about DAMA/LAMA 5 . It clearly highlights the cost as a major issue.…”