Leaving Against Medical Advice

Leaving Against Medical Advice Opinion ON THE BRAIN Shewasneverevensupposedtobeinthehospital.Wegot treatment.Ipausedtogiveherachancetoobject,butnone David Dongkyung Kim, MD a telephone call from an ophthalmologist who suspected came. I explained that her MRI had revealed strokes in Department of Clinical a stroke in a woman in her early 70s after finding a visual multipleareas,butsomeweresosmallthatsheeitherdid Neurological Sciences, field defect. She had gone to the clinic because she was notnoticethemorhadrecoveredquickly.Ireferredtoher Western University, bumping into objects for a few days, but she expected to medicalhistoryandhowshewasatahigherriskofcardio- London, Ontario, Canada. doafewtests,getadiagnosis,andgohome,becausewhat- embolicstrokegiventheimagingfindings.Withadditional everwaswrongdidnotevenbotherhermuch.Instead,she considerations that included her individual bleeding risk, wastreatedtoanadmissiontoourstrokecenterandanoth- properinformationwasnecessarybeforechoosingatreat- ing by mouth designation overnight after she failed the ment plan that may include anticoagulation. After I explained this, she looked down as if she was nurse’s swallowing screening. The ambient music of the ward—the echoes, beeps, snoring, and nurses and physi- afraidIwouldconsiderheradifficultpatient.Thenshequi- cians shuffling about—meant she did not get much sleep etly repeated that she had been in the hospital for a few that night. daysandjustwantedtogohome.Iconcededsomeofthe The next morning, the junior resident physician pre- tests could be done as an outpatient, but cautioned that sentedhercase:thepatientwithamedicalhistoryinclud- it was difficult to have them rushed. If she was lost to fol- ingsystemiclupuserythematosusandmultipleorganfail- low-up without a proper treatment plan, she could be at ure, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Neurology American Medical Association

Leaving Against Medical Advice

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Publisher
American Medical Association
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
ISSN
2168-6149
eISSN
2168-6157
D.O.I.
10.1001/jamaneurol.2017.4896
Publisher site
See Article on Publisher Site

Abstract

Opinion ON THE BRAIN Shewasneverevensupposedtobeinthehospital.Wegot treatment.Ipausedtogiveherachancetoobject,butnone David Dongkyung Kim, MD a telephone call from an ophthalmologist who suspected came. I explained that her MRI had revealed strokes in Department of Clinical a stroke in a woman in her early 70s after finding a visual multipleareas,butsomeweresosmallthatsheeitherdid Neurological Sciences, field defect. She had gone to the clinic because she was notnoticethemorhadrecoveredquickly.Ireferredtoher Western University, bumping into objects for a few days, but she expected to medicalhistoryandhowshewasatahigherriskofcardio- London, Ontario, Canada. doafewtests,getadiagnosis,andgohome,becausewhat- embolicstrokegiventheimagingfindings.Withadditional everwaswrongdidnotevenbotherhermuch.Instead,she considerations that included her individual bleeding risk, wastreatedtoanadmissiontoourstrokecenterandanoth- properinformationwasnecessarybeforechoosingatreat- ing by mouth designation overnight after she failed the ment plan that may include anticoagulation. After I explained this, she looked down as if she was nurse’s swallowing screening. The ambient music of the ward—the echoes, beeps, snoring, and nurses and physi- afraidIwouldconsiderheradifficultpatient.Thenshequi- cians shuffling about—meant she did not get much sleep etly repeated that she had been in the hospital for a few that night. daysandjustwantedtogohome.Iconcededsomeofthe The next morning, the junior resident physician pre- tests could be done as an outpatient, but cautioned that sentedhercase:thepatientwithamedicalhistoryinclud- it was difficult to have them rushed. If she was lost to fol- ingsystemiclupuserythematosusandmultipleorganfail- low-up without a proper treatment plan, she could be at ure,

Journal

JAMA NeurologyAmerican Medical Association

Published: Apr 26, 2018

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