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We need to talk about a lie that healthcare providers use to violate the human rights of patients, coercing them into staying in hospital when they want to leave:
"if you sign out AMA your insurance won't cover anything." That's false. Not true. A lie. 1/ https://twitter.com/RiderToast/status/1355341227223298048
"if you sign out AMA your insurance won't cover anything." That's false. Not true. A lie. 1/ https://twitter.com/RiderToast/status/1355341227223298048
First, "AMA" here stands for "against medical advice"
Second, peer reviewed research has determined it simply IS NOT TRUE that leaving AMA causes a patient's insurer to not pay claims. That's a straight up lie. 2/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378751/
Second, peer reviewed research has determined it simply IS NOT TRUE that leaving AMA causes a patient's insurer to not pay claims. That's a straight up lie. 2/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378751/
Unless we're talking about a special & narrowly cabined domain (i.e. involuntary psych treatment), patients (or their agents) are autonomous.
Patients. Are. Autonomous.
That is a foundational principle of both medical ethics and law. /3
Patients. Are. Autonomous.
That is a foundational principle of both medical ethics and law. /3
"Patients are autonomous" is not an empty slogan. We fought a goddamn world war to, in some part, vindicate that principle of bodily autonomy. It fucking matters. /4
We must not let "goals of care" "informed consent" "capacity" etc. become mere buzzwords divorced from deep meaning and ethical practice.
When someone wants to leave AMA, it is imperative to ask "why?" instead of reaching for coercion via lies. /5
When someone wants to leave AMA, it is imperative to ask "why?" instead of reaching for coercion via lies. /5
But far too many HCPs reach for that coercive lie instead of asking why:
"I've been an inpatient for 29 days, unless I leave now, they'll take away my SSI. I'll lose my apartment + be homeless"
"If I call out sick, I'll lose my job"
"There's no one to care for my kid" /6
"I've been an inpatient for 29 days, unless I leave now, they'll take away my SSI. I'll lose my apartment + be homeless"
"If I call out sick, I'll lose my job"
"There's no one to care for my kid" /6
[cn med abuse/trauma]
And, let's be honest, far too many HCPs are, themselves, abusers.
I have been assaulted by HCPs while inpatient.
I have been battered by HCPs while inpatient.
I have been tortured* by HCPs while inpatient.
* I do not use that term at all lightly /7
And, let's be honest, far too many HCPs are, themselves, abusers.
I have been assaulted by HCPs while inpatient.
I have been battered by HCPs while inpatient.
I have been tortured* by HCPs while inpatient.
* I do not use that term at all lightly /7
That HCPs can't or won't listen to patients who want to exercise their right to bodily autonomy & refuse treatment, instead reaching for the lie that "if you leave you will be hit with staggering debt & this hospital will probably sue you"?
A staggering indictment of medicine /8
A staggering indictment of medicine /8
Some will object, saying physicians actually believe the lie to be true. I have 2 replies:
First, prior to 2012, some experts (e.g. pt side lawyers) knew it was a lie. But in 2012 that study (cited
) was published. There's no excuse now. /9 https://www.uchicagomedicine.org/forefront/news/do-patients-pay-when-they-leave-against-medical-advice
First, prior to 2012, some experts (e.g. pt side lawyers) knew it was a lie. But in 2012 that study (cited
) was published. There's no excuse now. /9 https://www.uchicagomedicine.org/forefront/news/do-patients-pay-when-they-leave-against-medical-advice
If medicine actually valued informed consent, if it actually valued patient autonomy, then over 8 years later, it would be common knowledge – the myth would be busted. There would have been a systemic, concerted effort. 10/
Second, relatedly, I've had this lie used against me. I was inpt (story for a diff time). When I tried to do a little bedside teaching? I was...not believed.
Now look, if you're talking to a JD handing you peer-reviewed studies telling you you're wrong about a matter of law? 11/
Now look, if you're talking to a JD handing you peer-reviewed studies telling you you're wrong about a matter of law? 11/
And you could spend three minutes pulling up the DOI for yourself if you doubt the veracity of the printout, but instead you're like "bullshit" – I don't actually believe it's about a lack of education. I think it's about control and coercion. /12
It's really, really telling that hospital administrators (as well as medical educators) keep perpetuating this lie. /13 https://twitter.com/jm_rives/status/1355361433119166465?s=20
