Absconded : AMA : LAMA Left Against Medical Advice : DAMA Discharged Against Medical Advice : Discharge at request : Discharge

Absconded : AMA : LAMA Left Against Medical Advice : DAMA Discharged Against Medical Advice : Discharge at request : Discharge

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What is the difference between

• Absconded
• Left Against Medical Advice
• Discharged Against Medical Advice
• Discharged at request
• Discharged

All these related to situations when an alive patient has left the hospital. If the patient is dead, then we have situations like Found Dead, Brought Dead, Dead on Arrival and Expired which are discussed in this page. The question whether Unconscious Patients / Patients on Ventilatory Support be discharged Against Medical Advice AMA, DAMA, LAMA is dealt separately, but you are advised to first read this article and then go there

Now let us define the various situations in simpler terms

Absconded

• Patient went out of the hospital without Doctor’s or other staff’s Knowledge.
• Hospital does not know that the patient left and they do not know when the patient left
• They found out during next rounds
• Patient may not may not have discussed with the doctor / hospital about going out
• It is wrong to write, For example, that the patient absconded at 7 PM. If the doctor (either directly or through other paramedical staff) knows the time patient went out, it is not absconded, it is Left Against Medical Advice
• The proper way of recording in Case Sheet is “Patient found to have been missing from _______. Patient has been Reported Absconded from the ward before ____” In this way, the medical officer is safe

AMA or Against Medical Advice

may refer to LAMA or DAMA

LAMA : Left Against Medical Advice :

• Doctor asked the patient to stay / continue treatment.
• Patient / Patient’s Relatives did not inform their plan of leaving the hospital, but they left suddenly.
• But the Hospital was aware of them going out and the time patient left.
• Doctor had said that Taking the patient out may endanger life
• Patient / Patient’s Relatives did not sign anything
• Hospital may not give any discharge summary
• In fact, Patient may not may not have discussed with the doctor / hospital about going out
• Since the doctor (either directly or through other paramedical staff) knows the time the patient is going out, it should be recorded as “Patient left Against Medical Advice at ____. Since the patient did not inform prior to leaving, discharge summary has not been given to the patient”

DAMA : Discharged Against Medical Advice :

• Doctor has clearly explained that Taking the patient out may endanger life, but still patient / patient’s relatives want to take the patient to some other hospital
• They sign a declaration saying that the risks were informed to them – by taking the patient out of hospital, they are immediately endangering the life
• Hospital gives a discharge Summary
• The proper way of recording in Case Sheet is “Patient has been discharged against Medical Advice on ____ at _____. Discharge Summary has been given to the patient”

Discharge at request :

• Here, treatment is not complete, but by taking the patient out of hospital, there is no immediate danger to life
• Patient signs
• Hospital Gives Discharge Summary

Discharge :

• Treatment is complete
• Discharge Summary is Given

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We can also look at this from the Other way

• Treatment Over -> Doctor says Discharge
  • Gives Discharge Summary –> Routine Discharge
• A major part of treatment / or the most important part of treatment is over -> Active surgical or medical intervention is needed and hospital supervision is not needed –> Only observation is needed -> Doctor says discharge after few days, but not today, Patient wants to go
  • Patient signs, discharge summary given -> Discharge at request
• A major part of treatment / or the most important part of treatment is not completed -> Active surgical or medical intervention is needed and hospital supervision is mandatory -> Doctor says no discharge –> Doctor says continue treatment –> Patient wants to go
  • Patient signs, discharge summary given -> Discharge against Medical Advice
• A major part of treatment / or the most important part of treatment is not completed -> Active surgical or medical intervention is needed and hospital supervision is mandatory -> Doctor says no discharge –> Doctor says continue treatment –> Patient wants to go
  • Patient does not sign, just leaves, no discharge summary is given -> Left against Medical Advice
• Irrespective of Treatment Stage, Irrespective of Doctor’s opinion –>
  • Patient not found in ward –> Absconded

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In Short
Based on Knowledge of Patient Leaving the Hospital

• If the Staff of the hospital is aware, It can be Discharge, Discharge at Request, DAMA ie Discharge Against Medical Advice, LAMA Left Against Medical Advice
• If the Staff of the Hospital is not aware about patient leaving – It is Absconded

Based on whether the patient / patient’s relatives, planned with the doctor about going out

• If the patient / patient’s relatived has discussed the plan with the doctor, it can be  Discharge, Discharge at Request, DAMA ie Discharge Against Medical Advice, LAMA Left Against Medical Advice,
• If the patient / patient’s relatived has not discussed the plan with the doctor, it can be LAMA Left Against Medical Advice, Absconded

Based on whether Discharge Summary is given or Not

• If Discharge Summary is given, it can be  Discharge, Discharge at Request, DAMA ie Discharge Against Medical Advice, LAMA Left Against Medical Advice,
• If Discharge Summary is not given, it can be LAMA Left Against Medical Advice, Absconded

Based on whether Patient / Patient’s Relatives sign or Not

• If they sign, it can be  Discharge, Discharge at Request, DAMA ie Discharge Against Medical Advice, LAMA Left Against Medical Advice,
• If they do not sign, it can be LAMA Left Against Medical Advice, Absconded

Based on whether shifting out of hospital may cause immediate danger to life or not

• If shifting out of hospital may not cause immediate danger to life, it can be  Discharge, Discharge at Request,
• If shifting out of hospital may cause immediate danger to life, it can be DAMA ie Discharge Against Medical Advice, LAMA Left Against Medical Advice,, Absconded

Based on whether the treatment is complete or not

• If the treatment is complete, it is discharge
• If they do not sign, it can be Discharge at Request, DAMA ie Discharge Against Medical Advice, LAMA Left Against Medical Advice,, Absconded

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Should Discharge Summary be given for Discharged AMA – Discharge against Medical Advice

• Yes. Discharge Summary must be given for Discharged AMA ie Discharge Against Medical Advice.
• It is not needed for Left Against Medical Advice and cannot be given for Absconded

Is it possible to record Absconded if the patient is unconscious / non ambulant

• If the patient had been on Ventilator, it is highly unlikely that the time of patient leaving the hospital was not know to the hospital staff
• If the patient had been non Ambulant, it is highly unlikely that the time of patient leaving the hospital was not know to the hospital staff
• Hence it is better to record Left Against Medical Advice for Such Patients
• As we have already seen, Discharge Summary is not needed for such patient

Related Posts

• If the patient is dead, then we have situations like Found Dead, Brought Dead, Dead on Arrival and Expired which are discussed in this page.

• The question whether Unconscious Patients / Patients on Ventilatory Support be discharged Against Medical Advice AMA, DAMA, LAMA is dealt separately