This is a nice review article that shows a mix of different issues associated with signing a patient out AMA. It’s a strange practice environment we have here, where EM is turning into an increasingly customer-centric practice specialty – yet unless we have airtight documentation, our customers can litigate against us for the choices they make.
In principle, our patients have the autonomy to make their own decisions – but our cultural values have drifted away from accepting responsibility for our actions. To best protect ourselves, the authors recommend using a specific AMA form – not because having the patient’s signature on a form confers any extra legal protection, but because it’s a structured document that helps remind clinicians to document the two key elements of the AMA: that the patient had medical capacity to make the decision, and that the patient was adequately informed of the risks. After you satisfy both those conditions, the key is simply complete documentation in the medical record, and you should be afforded some protection given the patient has now terminated the legal duty to treat and assumed the risk for further poor outcomes.
“The Importance of a Proper Against-Medical-Advice (AMA) Discharge”
www.ncbi.nlm.nih.gov/pubmed/21715123