Why Patients Leave the Hospital Against Doctor's Orders

It's a growing problem, and patient age and insurance status is often key to this unhealthy decision, study finds

By Robert Preidt

Monday, June 19, 2017

MONDAY, June 19, 2017 (HealthDay News)-- It's a not uncommon occurrence: Patients discharge themselves from the hospital against their doctor's best advice.

Now, new research on over 29 million hospital stays sheds light on which types of patients are most prone to this behavior -- and why.

Using 2013 U.S. hospital data, researchers found that younger patients are much more likely than older patients to leave the hospital against the advice of their doctor.

In fact, patients aged 65 and older were four times less likely to leave the hospital against medical advice than were adults under 65, according to a team led by Dr. Jashvant Poeran, of the Icahn School of Medicine at Mount Sinai in New York City.

Other factors played a role as well. Regardless of their age, men were more likely to to leave the hospital against medical advice than were women, the study found. A lack of insurance, being covered by Medicaid, and the presence of a mental health disorder also raised the risk.

And among older patients, the risk of leaving the hospital against medical advice was 65 percent higher for blacks and 57 percent higher for those with low incomes, the researchers noted.

Incidents like these are on the rise, Poeran's team added. Between 2003 and 2013, rates of unadvised self-discharge for adults under 65 rose from about 1.4 percent of all patient stays to nearly 1.8 percent, the team said.

And the consequences of such actions -- for patient well-being and the health care system -- can be dire. According to the researchers, leaving the hospital against a doctor's orders is linked with a higher risk of hospital readmission, illness and death, as well as increased costs.

The study was published June 19 in the Journal of the American Geriatrics Society.

"One of the reasons mentioned in previous studies for leaving the hospital against medical advice is suboptimal communication, which may indeed affect older minority patients more," Poeran said in a journal news release.

Dr. Liron Sinvani directs the Geriatric Hospitalist Service at Northwell Health in Manhasset, N.Y. She agreed with Poeran that, "a person's decision to leave the hospital against the advice of his or her care provider often represents a breakdown in communication between patients, family members and providers."

She said the study "highlights the significance of communication between the patient and the care team."

Discharging oneself from the hospital despite a doctor's orders can have legal ramifications, too, said Michael Duffy.

He's a personal injury attorney and expert in malpractice law practicing in Uniondale, N.Y.

Duffy believes patients often feel pressure to discharge themselves from care because of coverage decisions made by their insurance company.

"We cannot allow insurance companies and hospital bean counters to determine when a patient is discharged," Duffy said. "It is immoral for those who concern themselves only with the bottom line to overrule and contradict the expertise of health care providers."

Poeran added that, "more research is needed to find out why exactly race/ethnicity and poverty are more pronounced as risk factors in older patients, especially since Medicare theoretically offers universal health coverage for patients aged 65 years or older."

SOURCES: Liron Sinvani, M.D., hospitalist and director, Geriatric Hospitalist Service, Northwell Health, Manhasset, N.Y.; Michael Duffy, personal injury attorney, expert in malpractice law, Uniondale, N.Y.; Journal of the American Geriatrics Society, news release, June 19, 2017

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