Why do orthopaedic trauma patients leave hospital against medical advice?

Abstract

Background: Discharge against medical advice (DAMA) has emerged as a pervasive problem in hospitals. Since the incidence and reasons for DAMA varies from one society to another and among clinical conditions, this study was undertaken to evaluate the occurrence of DAMA among Orthopaedic trauma patients in a teaching hospital with a view to identifying appropriate preventive strategies.
Methodology: A prospective cohort study of Orthopaedic trauma patients who presented at a teaching hospital over a six-month period and indicated their desire to leave the hospital against medical advice. The patients were interviewed after obtaining informed consent; information obtained included sociodemographics and reasons for discharge against medical advice which were entered into a proforma. For those who indicated intention to go to the traditional bone setters for further treatment, the reasons for such a decision were obtained. Data was analysed using SPSS version 16.
Results: A total of 488 orthopaedic trauma patients presented at the Accident and Emergency unit of the hospital during the study period. Twenty nine (5.9%) of the patients, discharged themselves against medical advice. Male to female ratio was 3.8:1.0 with median age of 30 years. Main reasons for DAMA were: going to the traditional bone setter – 11 (37.9%); not satisfied with planned treatment – 10 (34.5%); no one to take care of me/children while on admission – 6 (20.7%), financial constraints – 2 (6.9%). Of the 11 patients who left hospital to go to the traditional bone setter (TBS), 7 (63.6%) indicated that they had more faith in the TBS method of treating injuries.
Conclusion: Discharge against medical advice is common among orthopaedic trauma patients in our hospital. Intensification of the campaign to purge the society of misplaced belief in the supernatural prowess of the TBS in treatment of orthopaedic trauma injuries and improvement of patient-doctor communication are advocated as preventive strategies.