Against medical advice

I was sitting in my office Monday afternoon after hours getting some paperwork done, when my cell phone goes off, "Doctor, this is the hospital switchboard, is your pager not working?" I quickly grabbed it. "There are no pages on it," I said. "Well, the ER has been looking for you for about an hour." Oh no, I was thinking to myself. I hope there wasn't anything urgent going on. So, I rushed over to the hospital which is only across the street.

"Sorry, I don't think my pager is working," I said. "I thought as much because you usually call back pretty quick," the ER doc said. "We've got a 54 year-old guy that passed out at home and brought in my his wife. I'm thinking that he probably needs to be admitted."

I go into room 10, "Hello, I'm Dr. A. What happened at home today?" "Well," the patient's wife said, "he was just at home watching TV when he stopped breathing and was out for about 30 seconds. I think his eyes may have rolled back, too, but I'm not really sure."

After a few more minutes talking, I said, "What's going to happen now is that I'm going to do some paperwork to get you admitted to the hospital." "Doc, I don't think I need to stay tonight." What! I thought to myself. "Sir, I don't think it's a good idea for you to go home." "Well, doc, I think I have it figured out. My blood sugar must have been low." As I'm looking at his 320 pound frame, I'm not thinking that LOW blood sugar was his problem.

"Here's the thing," I said, "I have no idea what happened to you today, so I recommend that you be admitted for further testing." I was hoping that I didn't have to go into 'bad cop' mode, but I felt the situation escalating quickly. More discussion back and forth occurred for the next 20 minutes.

"Ok sir," I was fed up at this point, "You certainly have the right to be discharged. All you have to do is sign a paper stating that you are leaving the hospital against medical advice, and you're free to go." "Whoa! What does that mean?" "It means that I, as your doctor, am free of all responsibilty for your medical condition. It also means that YOU are accepting of all the possible complications to your condition which include heart attack, stroke, seizure..." I listed a few more and ended with, "....and possible death." I really hate it when I sound like a lawyer.

"YOU are not going to bully me around like that," he barked at me, "All you doctors are the same, just want to scare us and run needless tests that will turn up nothing anyway." "Sir, it looks like you've made your decision. I've said what I need to say. Let me get the nurse. You can sign the paper, and you can be home in an hour."

I left the room really second guessing myself. Was I too hard on the guy? Could I have de-escalated the situation? What should I have done differently? Maybe I should go back in there and apologize for my tone.

The patient's wife then came to the nurses station to talk to me. She looked sullen with her shoulders dropped and soft voice. I finally got through to them and made them understand. I may have been a little forceful about it, but, in the long run, I think I did the right thing.

"Doc, we've got family coming in tonight. When is the nurse coming in so that we can be discharged and go home?"