Monday, September 11, 2006


Today, for the first time, one of my patients left against medical advice, or "AMA." It was tough, because I had really developed rapport with him and I could see his side of the reasoning. He's 40, but as I told my resident, "doesn't look a day over 65." He's been smoking two packs a day since before he can remember. He drinks a half case of beer a day. And he has cavitary lesions (massive, rotting holes) in his lungs that need to be treated. Finally though, his exasperation with "being poked" got to be too much, and he signed out.

Like I said, it's tough. Part of me really wanted him to stay and get the further tests we need to treat him effectively. But part of me was fed up with his behavior, and wasn't sad to see him go. It was, by our count, the third time he changed his mind about leaving AMA, and we were all as tired of the paperwork as he was.

But I had to force myself to step back and consider, not what would make me feel better in the short term, which would be to stop writing notes on someone who is so inconsiderate and self-centered, but what is best foor the patient. And so I tried my best to get him to stay. My resident pretty much surrendered to (understandable) jaded feelings and though she tried to convince him to stay, it wasn't done very emphatically. I could read between the lines. I sincerely hope I don't ever reach that point of disillusionment.

Now the hope is he'll actually survive to make it to follow-up appointments.

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