Help Debunk A Medical Myth About Patients Leaving AMA

This week at FutureDocs, we are working with our friend and colleague Glass Hospital as well as one of our medical students and a recent residency graduate to bring to light a medical myth about hospitalized patients who leave against medical advice.  Here is an excerpt from his post about our work which includes a new Squidoo page created by Gabe Schaefer MS3 on what to do when patients leave AMA and the video vignette below.  Let us know what you think and please share this with anyone who you think may benefit!

Excerpt from this week at GlassHospital:

Like Mikey, the Life cereal kid who died from mixing Pop Rocks and Coke, or the spider eggs in Bubble Yum that help make it so soft and chewy, Medicine has its share of urban legends.  Did you know, for example, that if you’re hospitalized and decide that you want to leave “Against Medical Advice” [AMA], that your insurer won’t pay for the hospitalization?


Apparently, this canard is pervasively believed amongst doctors and passed from generation to generation of trainees just like the nonsense about cute ol’ Mikey.  A few years ago, a medical student came to me with a case of moral distress. She had seen the doctor-in-training with whom she was working become upset at a patient for declining an invasive heart procedure.

Rather than reason with the patient and convince her that the test was indeed indicated and would be of greater benefit than possible harm, the resident doctor in question quickly informed the patient that if she refused the procedure and signed out AMA, she’d be financially responsible for the entire cost of the hospitalization, as her insurer would decline to pay.

This left our student wondering if this was true, and if there were ethical safeguards against this.   Her moral distress led to a research project that debunks this notion [we hope] once and for all.

I can’t give you the specifics (an article on our findings is under review at a medical journal) just yet, but GlassHospital and FutureDocs are happy to share with you the educational fruits of our findings to date. You can click over here to learn more in true interactive fashion, or if you prefer, watch only the cameo-encrusted video tour-de-force right below. [Who is that guy playing angry Mr. Smith? He looks familiar. And who, for heaven’s sake, does his wardrobe?]

Let us know your thoughts! On the video, the website, the urban legend. What other medical urban legends would you like to see debunked?



  1. This is indeed a widespread misconception, prevalent not only among residents and attending physicians, but among our nursing colleagues as well.

    “Against medical advice” is one of several discharge dispositions (e.g, home, skilled nursing facility, jail, etc.); however, it does not alter how or whether the insurance company reimburses for an inpatient medical stay. That reimbursement is wholly dependent upon the medical care rendered to the patient, as well as the medical documentation describing the patient’s disease course in the chart.

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