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Patients who discharge themselves need further thought

BMJ 2011; 343 doi: (Published 10 August 2011) Cite this as: BMJ 2011;343:d5054
  1. David R Warriner, clinical research fellow and honorary specialist registrar in cardiology, Sheffield
  1. D.R.Warriner{at}

A 24 year old man is admitted with a history of central crushing chest pain at 3 am on a Saturday. He has no drug or family medical history and despite denying illicit drug use is probably drunk and certainly disorderly. Unfortunately, despite his being referred within the four hour target from the emergency department, his wait in the medical assessment unit is considerable, so much so that he decides to discharge himself. After being given the necessary paperwork he is deemed to be taking responsibility for his actions, which is carefully documented in the medical and nursing notes, and he leaves, destination unknown.

Cynically, you could argue that cases such as this, termed “self discharge against medical advice,” which makes up 1-2% of all admissions, is a win-win situation for patients and doctors. Firstly, the patient is happy because he can rapidly return home to a warm bed without delay and avoid the repetitive history and examination merry-go-round—and any painful and unnecessary procedures. Secondly, there is …

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