When a patient suddenly insists on leaving against our advice, we get worked up.

We beg them to reconsider. We worry about their health.

Often it's too late. A made-up mind is hard to change.

1/9

The conversation, the failure is always a jolt...

But in some ways, their sudden departure is not so sudden. It's not such a surprise.

There were signs it might happen.

2/

Maybe they kept asking how long they'd have to be here. We'd say hard to tell, and leave it at that.

Maybe they'd mention the difficult sleep, the food that doesn't agree with them.

The dog that's at home.

3/

Every time we'd see them they were still in pain.

They smoke, and maybe they mentioned how hard it is not to... or maybe they didn't.

4/

They kept asking about their shoulder pain while we kept talking about their white count.

Their arms were crossed and brows furrowed when we talked about the diagnosis.. or lack thereof.

5/

They would never ask any questions.

Or maybe they asked every question, clearly anxious.

(We treat acute pain but rarely acute anxiety - why is that?)

6/

They have a lifetime of experience. Maybe of trauma, often of prejudice. But we don't know it.

It's not easy to bring up.

"We know it's really hard being in the hospital."

Do we?

7/

Maybe they left early last time too.

Or maybe they didn't, and were actually perfectly happy with they care they received. But not the bills they got later.

8/

There's so many forces pushing and pulling folks out of the hospital.

We can buffer some of them.
Others we can't.
Others we don't have the skills to... yet.

But it definitely starts with seeing.

So. Is your patient gonna leave AMA tomorrow?

End/