Doctors study for years to be able to ‘dish out’ medical advice. They’re trained to know whether or not it’s safe for a patient to be discharged from hospital. Yet, every so often, they’re met with someone who thinks they know better and refuses to stay for further treatment.

Against Medical Advice, or AMA as it’s known in expert circles, can have serious repercussions and could even land you six feet under. That’s why many hospitals will ask you to sign a form stating that you’ve chosen to go AMA. It ensures you know the risks of your actions and protects the hospital from legal backlash.

A nurse asked their peers to share the “Worst patient (clinically) that you’ve seen/heard of that left AMA (Against Medical Advice),” and the replies ranged from shocking to tragic: From a man who passed away shortly after his wife wheeled him out the door, seemingly against his wishes, to another who went AMA on his birthday after stating, “I’m going to go have my fun then I’ll be back, I promise” (spoiler alert: he attended his own funeral shortly after).

Bored Panda has put together a list of the most sobering AMA tales for you to scroll through should you ever need a reminder that often it pays to just shut up, sit (or lie) down and listen.

#1

A guy with an actively bleeding gaping wound. Said he had a family emergency but really just needed a drink. I don’t know why we don’t give alcoholics a beer so we can treat them.

© Photo: Ok_Panda_483

Discharge against medical advice (DAMA) is defined as when a patient chooses to leave a hospital before the healthcare team recommends discharge from the hospital, and an increasing number of people are choosing to do it.

According to a report published in the National Library of Medicine, around 1-2% of all patients admitted to hospitals in the United States between 2011 and 2021 ended up leaving against medical advice (AMA). In some centers, that number went as high as 26%. It goes without saying that this can have serious repercussions for both the patient and the hospital.

#2

I had a patient with brand new B AKAs who had no equipment and no home but decided he hated the hospital and wanted to go. Our policy was once you sign the forms it’s up to you to get out. He crawled from his room to the elevator then down the street like the girl crawling out of the TV on the ring. I passed him a few days later when he was living under a bridge a few blocks away, he had acquired a wheelchair and a cowboy hat but was still wearing our gown.

© Photo: totallystacey

One study of 656 patients found that the risk of readmission was 12 times higher in patients who left AMA when compared to the non-AMA group. The researchers revealed that patients discharged AMA were more likely to be homeless and have multiple comorbid conditions.

“At one year follow-up, the AMA group had higher readmission rates, were predisposed to multiple readmissions and had a higher in-hospital mortality,” notes the paper.

#3

Had a woman who would frequently come to our hospital with severe pressure ulcers. She was like 500+ pounds, post CVA so she couldn’t walk, refused turns, would call people in her room every 5 minutes to scratch her back or feed things to her (her arms worked fine). The previous time she was there we kept her for like a month and made some progress in healing her huge pressure ulcers. Social work finally found a nursing home that would take her. A couple months later she comes back, septic as heck and her pressure ulcers are worse. Turns out she had left the nursing home AMA, her husband couldn’t fit her in his car so he rented a uhaul and put her in the back. You can’t make this stuff up.

© Photo: mrsmanatee

When a patient declines a recommendation from a doctor, they may be asked to sign an AMA form.

“When the AMA process is initiated, all it requires from you is to sign a form verifying your decision. The main intent of this form is to document the discussion between you and your provider,” explains the Mid-Atlantic Emergency Medical Associates (MEMA) site.

#4

Patient with a massive AAA. It was so bad the on call CT surgeon didn’t want to touch it and referred off to another doc. Patient decides to AMA in the middle of the day because they had “stuff to do.” Absolutely would not listen to any of the doctors and even signed an AMA that warned of “extremely high chance of sudden d*ath.” Got up and walked out. I heard later on that the ME’s office called later wanting to speak to the doc. The patient had made it as far as their front porch then collapsed and d*ed in front of their whole family.

© Photo: Nurs3Rob

#5

My worst in my baby career so far was an amputee patient coming to the PACU. He was AAOX4 and cranky that we had orders for NPO status and our PACU doesn’t carry real tray orders anyway. After denying him food, he accused everyone and threatened to attack me after seeing me exit the break room where we had our potluck. Explained that food was for nurses and we were not going to break his orders just because others could eat. He signed an AMA and I watched from behind security as he was wheeled out, cursing and blaming the whole world and calling us bought by the hospital. Most nurses there were unimpressed by him but having someone directly look at you with very little suppressed violence in their eyes (and clearly not in their words) was jarring.

© Photo: mahalnamahal

The site adds that signing the form does not impact your care moving forward. But can actually be a helpful tool “to encourage an honest risk and benefit discussion.” MEMA’s experts say the form is there to make sure you fully understand your health service provider’s recommendation and any associated risk with your decision.

They add that the AMA process doesn’t always mean that your doctor or provider necessarily disagrees with your choice. “For example, your provider may recommend you be admitted to the hospital. But they may also understand and agree with the reasons you decide to go home instead,” explains the site.

#6

Guy who had had incision and drainage of a groin abscess the day before. Still had his central line in. Demanded it be removed and left ama. Then bled out 2 floors down outside the lifts causing that whole side of the hospital to be closed to visitors whilst he was tended to, rushed to surgery, then the pool was cleaned up.

© Photo: isajaffacakeabiscuit

One of the most common reasons people go AMA is because they don’t want to go to the ER for evaluation of a possible emergency. “Like when their doctor tells them to go to the ER because they are having worrisome chest pain,” explains MEMA’s team. Or when they refuse to be admitted to the hospital for treatment.

Some people go against medical advice when they’re asked to have certain tests performed, like a CT scan, an MRI or even blood tests. Then there are those who aren’t willing to consent to a procedure, whether it be getting stitches or having an amputation.

#7

Had one whose jaw was so broken it was completely displaced. He was a real jerk. Came back a week later with a massive infection. He wasn’t any nicer.

Not quite an AMA but had a morbidly obese man on bipap with a potassium of 10 (!) demanding everything under the sun & to leave AMA despite being unable to breathe or move, much less walk. I remember being part of the 4 person team that held his belly out of the way so we could hold a urinal in place so he could pee. He coded & died in the hallway on the way to ICU.

© Photo: lcl0706

#8

We had a guy come to the ED for chest pain, EKG revealed a STEMI.

When he heard what the plan was (cath lab, admission to hospital, etc…) he said he was leaving “for a while” but he’d be back.

We tried to convince him not to leave but he wouldn’t listen to how serious it was.

He then said “it’s my birthday and I have two hookers waiting for me at my hotel room, I’m going to go have my fun then I’ll be back, I promise”.

Singed the AMA paperwork, dropped at the exit door, we coded him multiple times but never got him back.

© Photo: GhostRN

So why do these people risk going against a doctor’s orders?

One 2019 study explored this question and found that 40.6% of the patients who left AMA had a lack of finances.18.2% had ‘domestic problems,’ 9.8% wanted to continue treatment elsewhere, and a few weren’t satisfied with the healthcare, physical arrangements, or ward routine at the hospital.

A tiny percentage cited ‘denial by payer’ as their reason for being discharged against medical advice, and 4.9% reported other reasons, among which was “feeling better.”

#9

Guy who would deSAT from everything and was getting close to being intubated. He was tired, he wanted it, but his family was freaking nuts. He wouldn’t even talk to them after a certain point. His wife was livid that we wouldn’t give him this and that treatment/medications she heard about from her “doctor friend” (aka Facebook memes) because they weren’t approved for hospital use, would cancel out his medications, end him, or simply do nothing. She signed him out AMA and my heart literally broke while watching him be wheeled out on a stretcher gasping for air and looking confused while his wife trailed behind with her arms crossed and looking pissed off. I looked him up a week later and saw his obituary stating he passed that same day. And you *know* she blamed us for his death.

© Photo: anon

#10

The worst? Guarded prisoner and DUAI patient with a pneumothorax and chest tube who didn’t care if he survived, just wanted to call his girl so she could pick up some valuable stuff that was left on the scene of his MVA. He couldn’t call from the hospital for security reasons so he insisted on leaving AMA and the police were like, “His choice, we can’t stop him. We’ll just take him back to jail and let him make his call if he signs the form.” After many attempts to explain why he shouldn’t do it, we pulled the tube and sent him off with them. Unbelievable.

Then of course there was the patient who had a motorcycle crash and messed up his leg, and kept leaving AMA because the PCA pumps, oral narcotics, IV push narcotics, and multimodals we hooked him up with weren’t enough to control his pain. How do you even get that desensitized? About a week after his first admission, which he AMAed from, he was admitted and AMAed twice in four days, in between which he tried to go to another local hospital (who just sent him back to us because we started his treatment, and we’re the area’s Level 1 Trauma Center anyway). That’s the only patient I’ve well-and-truly lost my cool with, when he was screaming bloody hell loud enough to be heard halfway across the floor while we were actively working to set up his morphine PCA pump (He insisted on morphine instead of dilaudid because the dilaudid didn’t help enough. Idiot.) Edit: To be clear this pt was a chronic med and even his father when he called us at one point stated that he was probably leaving AMA to do illegal substances. So yeah, I actually do know how this guy got so desensitized.

© Photo: Anonymous_Arthur

According to Verywell Health’s team, you have the legal right to leave a hospital, and there is no law that requires you to sign discharge documents. However, they note that you should still prepare a letter that explains your decision to leave. “Keep a copy of the letter and give a copy to the hospital administrator,” advises the site.

#11

70s female with active GI bleed drove herself to ED. She was admitted to my step down floor at the start of my night shift with Hgb around 6. I have her some blood and she kept talking about some lawyer from NYC flying in to handle her sons estate. She HAD to get back home to deal with this. She of course was set for scopes in the morning but went AMA before midnight and drove herself home. She was back in the ED next morning by squad.

© Photo: tajodo42

#12

I work on a Bone Marrow Transplant Unit, and none of those patients leave AMA, but pre-COVID (when we took some overflow patients) I had an interesting one. An alcoholic voluntarily checked in to detox, then 30 minutes in, he came up to the nurses station all sweaty and said “I just can’t do this, man. I’m leaving.” I felt really bad for him cause I could tell he wanted to get better but couldn’t bring himself to stay.

© Photo: miramarhill

There are certain cases where a hospital can legally prevent you from leaving. One is if a person is mentally ill or incapacitated, especially if they pose a risk to others or themselves. Another is in the case of minors and people under the legal guardianship of others. They will have to be discharged by their legal guardians.

Have you ever gone against medical advice by leaving a hospital or refusing treatment? Let us know all about it in the comments section below…

#13

Had a pt arrive to my ward from ED one Saturday night heavily withdrawing from alcohol. I hadn’t even had handover yet but just looking at him you could see he was an extremely high seizure risk.

Came back to work the next day thinking he had a seizure and went to ICU to find he signed an AMA overnight so he could go back to work Monday.

© Photo: fabiulnv

#14

All my worst AMA stories involved a resident (usually young and female) kneeling by the bedside of the patient and baby talking to them until they agree to stay.

© Photo: DanielDannyc12

#15

I had a 37 year old patient with covid that was on high-flow 50L 100%. They were rapidly heading towards intubation as sats were in the 80% maxed out on O2. Patient changed their code status to DNR/DNI, then left AMA a few hours later and WALKED HOME. Someone found them passed out outside and called EMS, when they got there, sats were in the 40’s. Patient was brought back to the ED and after quickly calling family, they did an emergency intubation. They’re now in the ICU with little to no brain activity.

© Photo: perfectlypointless

#16

COVID+ patient. screamed and cursed at us and threatened to sue the hospital because her dead husband was a lawyer so she was an “expert” in laws. her reasoning was that she was a Libra or something. she was back less that’s 24 hours later. doctor read her the riot act and told her she better not give the nurses a hard time.

© Photo: kate_skywalker

#17

Late 40’s guy with SVC Syndrome got intubated for airway, self extubated, left AMA.

*Unexpectedly*, he came back the same day after he passed out in the parking lot in front of the house supervisor. He required an emergency cricothyrotomy. After he woke up, he stayed for about four days getting diuretics and steroids. Then he left AMA again. 2 weeks later he comes in as a post-code. Family let’s him go a week later. RIP, fool. Such a shame.

© Photo: MedicalUnprofessionl

#18

Oh! Another one! Covid patient checked out ama because “covid isn’t real.” Was on bipap and still barely getting to 87%.
Family was walking them down when they straight up coded in the lobby…. Intubated, got back to the CCU and the daughter was mad because 1) we didn’t bring the patient back to the original room and 2) we threw out a banana from the old room that the daughter wanted to eat.

© Photo: HawkNurse

#19

A patient who could not stand. Had no family to take them home. Refused to take their antibiotics, and had huge open wounds. The patient was in “sound” mind so we could not hold them when they were insistent they leave. After myself, the charge and the Dr. tried to get them to stay they finally left. We called cab and the patient stated “I’m going to Walmart to buy me a wheelchair”.

© Photo: myth_king05

#20

Patient came in spO2 36% on room air. Awake and talking. Came back positive for COVID. Refused intubation because his brother was tubed the week before with COVID and died. On BiPap he never went above 75%. He signed out AMA after extensive counseling and his own mother trying to intervene. He made it to his car, arrested, we coded him in the parking lot and he died.

© Photo: dragonano

#21

A man was brought in after he was found wandering the train station totally confused/not making any sense. They started him on acyclovir and treated him as r/o meningitis. He got sent for an LP, which came back as herpes encephalitis. So he was on the correct treatment but a few days of antivirals made him more oriented and he ended up wanting to AMA. MD allowed it because he answered all questions appropriately (apparently).

He got brought back less than 24 hours later, the police found him wandering trying to find the heavy machinery he operates as part of his actual job. He ended up actually getting a repeat LP for reasons I don’t really understand. Also they incidentally found out he definitely has cancer.

#22

Patient with a blood sugar of >700. Still completely oriented so there’s nothing we could do. I hope they got care before they inevitably went unconscious.

#23

COVID + patient on 12L O2 left AMA because he was tired of “being in prison.” He had no O2 to bring home and walked off the unit on room air. Made it all the way down to the lobby before passing out and smacking his head. Had to go to the ICU from what I heard.

#24

Necrotizing fasciitis walked out. Can’t remember why. Just remember thinking she would be dead by morning.

#25

Covid patient on high flow o2 with symptoms of dysphagia. Npo. She wanted to eat. Vídeo swallow would have been that day but she couldn’t wait any longer. Walked out (mask less) with her son (also mask less) didn’t get very far on room air so the son had to pick her up and carry her out of the hospital so they could go to another ER and maybe stop at Wendy’s on the way. Our wait times in the ED are anywhere from 8-24+ hours most times in the metro these days.

#26

When I was an EMT, I ran on a guy having a full blown stemi refuse to go. He said his wife died a few months prior and he wanted to die at home so he could be with her 💔.

#27

Sickle cell crisis. Hemoglobin of 5.4. Was mad that we wouldn’t give her a higher dose of her dilaudid PCA pump because her blood pressure was bad. So she huffed and puffed herself out that door and ledt.

#28

Patient needed to be intubated, was satting 80-85 on 15L hi flow. Signed out AMA, waited for a ride for about 20 mins. We were hoping he’d decline hard while waiting for his cab, instead he walked to the cab and went home. Arrived cold and DOA the next morning. We tried, couldn’t bring him back.

#29

33 year old man with a large, fungating thyroid cancer hanging off the side of his neck. Thing was the size of a large grapefruit and had begun to impact his airway. Left AMA after he was told he’d be getting a COVID-19 swab. Said that we wouldn’t allow us to put anything in his body, because that would be “medical fascism,” while still hooked up to IV.

#30

We had someone once who was extremely septic with a ruptured large colon that signed out AMA. His reason for signing out AMA was that he felt like the doctor he had had that morning was mean to him. The patient was pleasant otherwise and we had booked transport already for him to basically go straight to the OR. We told him that imminent death would occur if he did not get this treated ASAP, but he didn’t seem to care.

#31

A hgb of 3.4 after feeling weak s/p hysterectomy. Left because family/patient was not getting blood. (Religious reasons).

#32

I’m not a nurse, but a paramedic.

We were called for a 60ish alcoholic who fell down 5 stairs, and was witnessed to hit his head on the hardwood at the bottom and have a loss of consciousness lasting at least a minute.

He had done something similar a year prior, refused AMA, then was rushed to the hospital two weeks later and diagnosed with a bleed.

This time we arrived, and he was already up and alert/oriented x3. His speech was mildly slurred, but he admitted to drinking. He was very adamant that he was refusing to go to the hospital, despite his entire family there, crying and begging for him to go.

He was also a lawyer, so the usual trick of just putting a little pressure on him and not really presenting staying home as an option didn’t work. He was being obstinate and the more his family begged, the more stubborn he became.

I tried every trick in the book. I had a private discussion with him and searched for any hint of him wanting to take his life, he had none. I got the vibe he had no respect for us as lowly paramedics, so I spoke to my base hospital doc and had the doctor speak to him on the phone. Still he refused.

Finally I had no choice but to go through a very lengthy and thorough refusal process, witnessed by his family who were still beside themselves. I was very clear that there was a strong possibility of him having another brain bleed, and he risked permanent and life altering disability if he had another stroke. He read through the legal release of care statement I presented to him very thoroughly, then signed the refusal. I asked his wife to sign as witness.

We had to leave the house with his family literally following us out to the ambulance, begging us to take him. I had to peel the wife’s hand off my forearm.

That call bothered me for weeks. What a selfish man.

#33

Massive bilateral PE. Left AMA because their S.O couldn’t spend the night. Tried saying their S.O couldn’t drive at night because they had Lupus. Family called to harass us that night.

DKA with recent foot amputation left AMA because we wouldn’t feed him while he was being treated for DKA. Started throwing things.

When ever someone says they want to leave AMA I like to call their bluff and bring in paper work right away. See ya.

#34

An LVAD patient that had a clot in his VAD, couldn’t transfer independently, and required a continuous dobutamine infusion. It took me and a strong male nurse and hour to get this guy into his mother’s car. The house sup and attending MD, all of us tried to talk him out of it. I just kept asking him what his plan was when he got home, like how the hell is he going to get into the house. His elderly mother was clearly not going to be able to help him. Anyway, he was airlifted back to us within an hour.

#35

We had a patient who waited until she was 9cm dilated to tell the doctor she wanted a lotus birth (where you don’t cut the umbilical cord after baby is born and just leave them attached to their rotting placenta for weeks until the cord falls off naturally). Doctor basically told her that wasn’t going to happen no matter what legal nonsense she threatened

She had no epidural so she signed out AMA and left and went to another hospital. Where she was also told no to a lotus birth so tried to leave there. Delivered in their parking lot. Where the ER team responded and cut the cord. One of my favorite stories.

#36

My personal theory is that there is a distinct category of brain injury patient. Where they have just enough subclinical brain damage to make them irrational but not enough to be able to get POA or a legal hold on them.

That’s my only explanation for all my DKA patients who go home even with blood sugars of 700 and rising. We tell them they can die, or survive with long term damage, but they don’t care. They just have this glassy faraway look on their face as we explain exactly how much danger they’re in. My guess is they’ve DKA-ed at home multiple times and made their brain cells go all wackadoo.

#37

Had a COVID+ patient on a PCU level who was on high oxygen requirements. Patient was a complete jerk to everyone, fired 4 nurses the day before and 3 that day before 11am. He was on the rapid list so they asked me to help out.

Guy called me every name in the book, 40 year AAOx4, obese as hell. When I moved the patients arm to get to the IV, I was told “haven’t you learned anything? When people hurt me without apologizing I’m going to start swinging, then you’ll learn.”

I stood up and said “make my day. Do it, I dare you.” On Opti-flow mind you. Patient calls mom, and I’m thinking that maybe she will talk the patient down.

Mom proceeds to get into my face and threaten me as well, so it was apparent the apple didn’t fall far from that tree. Mom and patient told me if I didn’t give the patient the food when *he* was ready (and they also added the “it better be the dinner I ordered or somebody about to get hit and fired”) they would leave the hospital. I said “I’ll grab you a form and you can go.”

Proceeded to sign AMA. Then scream at me because I wouldn’t give them an oxygen tank or a wheelchair. Patient goes “I can barely walk because of my foot pain (neuropathy), where’s my wheelchair.” I said “you signed out AMA, how you leave the hospital is your problem now.”

Mom proceeded to take patient home, not before she put blankets in the sink, turn on the water, and flood the entire room 🙃.

#38

Patient (late 30’s) was there for CVA. They can only speak 2 words but AOx4 by pointing and writing. Wild story about road rage but family believed the boyfriend was ab*sing her. Boyfriend was the only one who “witnessed the road rage that cause the stroke”. Family requests no overnight visitors and social worker agrees, as does MD. She flips out demands to leave AMA. I bring her the form and she proceeds to smash the clipboard into my face and shove me by the shoulders out of the room. She left. Horrible person and has a history of firing and being horrible to staff whenever she is there. No one was surprised. I pressed charges but I’m sure this won’t go anywhere.

#39

These AMA stories are wild. I’m a pediatric nurse, there’s really no such thing at least at my hospital. If a guardian wants to leave there is a 10 page policy that includes calling social work, the administrator on duty, chief of staff, security, and police to the bedside. They can’t just pick up their kid, sign a paper, and leave.

#40

In icu, severely hypoxic COPDer, current smoker, high flow 40L 60% FIO2, 3 person assist, screaming at me to get him outta bed by myself after he kept taking off his O2 and desatting to 30s. Left AMA, night RN wheeled him to lobby on room air, taxi took him home, and he called 911 because he couldn’t get up stairs. Ended up in the same icu bed an hour later.

#41

Had a patient who coded due to a reaction to contrast. We resuscitated them and obviously admitted them but there was going to be a wait for a bed upstairs. They didn’t want to wait in the ED so they left. They ended up coming back into the ED because the compressions we did on him messed him up pretty good.

#42

I had a pt (precovid-19) that was on high flow , bariatric that we need a lift to stand her up. She would instantly desat. She said she had to go to the bank. We have a policy of not helping pts or providing W/C to pt leaving AMA. She signed the paper work some how managed to get herself up 10 minutes later she managed to walk one room distance like 10 yards and couldn’t handle it any more. I ended up calling a RRT and readmitted her back in her room.

#43

Mine isn’t nearly as dramatic as most of these, but it still broke my heart. Elderly foreign-born lady came in very SOB and COVID+ per PCR test. Chest x-ray confirmed covid pneumonia. Breathing hard and desatting just to get on and off BSC. Put her on 4L O2, hooked her up to the first of two IV Abx’s to be followed by loading dose Remdesivir, and the next thing you know she is crying and hitting the call bell and handing me her phone. On Face Time is her angry granddaughter who is claiming that there is NO way she has COVID since she lives with them and nobody in the family is sick and that we are only calling it COVID because the doctors get paid more. She demands we give her grandma AMA papers to sign. I called the hospitalist. She talked to the patient and the family but was unable to get the family to budge on this. I looked at this patient, and she was really scared, but she agreed to go AMA because her family had basically browbeaten her into it. I unhooked everything and took her down to the lobby where angry granddaughter was waiting to whisk her away from us lying and dishonest people.

Found out later she had been taken to another ED in our system two days earlier, same symptoms, but when they found out she had been given a COVID test and would have to wait for the results before they would decide what room to give her, they left with her AMA. My question, why did they come in again if they weren’t going to let her get tested and treated? I mean, read the news, people…if your unvaccinated Meemaw is short of breath and has a fever, you think she’s NOT going to get tested for COVID?

I’m always going to wonder about what happened to her. I felt bad for her. I could tell she really wanted to stay in the hospital where she could get treatment. She seemed like such a tiny, sweet, scared old lady. But she was definitely more scared of her family’s opinion than she was of COVID.

#44

Pediatric clinical rotation. Mom accused the nurse of stealing her phone then walked out AMA with the IV still in her kids arm.

#45

Flu patient (pre-covid times.)

Sats in the 80s on bipap, but didn’t like how it felt on his face. No idea what the room air sat was because he wouldn’t let us take vitals. Left AMA.

Back the next day, found down at home. This time he got intubated.

#46

Pt came is with “eye pain”-unrelated but worth noting for a chuckle she was an esi 4 (was spanish speaking and was not actually assessed in triage). The pain was due to a penitrating trauma sustained 6 hrs PTA. Allegedly she was climbing a metal chain link like fence chasing her cat when she lost footing and was stabbed in eye by top of fence (not sure I believe mechanism but she had an open globe injury). Ophthalmology was preparing to take her to OR. She left AMA as we would not give her a turkey sandwich.

#47

Had a guy leave with an unstable C4# from falling down the stairs drunk. Took his aspen off in the parking lot.

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