#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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See #JHMChat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Journal of Hospital Medicine @JHospMedicine Welcome back! I'm @WrayCharles your moderator for tonight's #JHMChat. Go ahead and introduce yourself while we wait for others to join... |
 | Society of Hospital Medicine @SocietyHospMed #JHMChat on AMA discharges starts NOW! Join the discussion w/ @JHospMedicine @alfandremd, then claim #CME: https://t.co/vfUpu2AijW https://t.co/h8EzoHwd1x |
| Journal of Hospital Medicine @JHospMedicine After a brief summer hiatus, we're excited to be back at it…#JHMchat |
 | David Alfandre @alfandremd A delight to be here. Thanks for the invitation. Looking forward to a great discussion.... #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Don't forget to tag your tweets with #JHMChat! T1 up in a few minutes… |
 | Tony Breu @tony_breu Excited for the return of #JHMchat - great topic. Joining from VA Boston. |
| Journal of Hospital Medicine @JHospMedicine Always look forward to @gracefarris artistic additions to the #jhmchat https://t.co/158afTb7cD |
 | Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Link for #JHMChat CME can be found here --> https://t.co/eF9tllkDbU https://t.co/s89R8PCaWf https://t.co/YLJOc0u0my |
| Journal of Hospital Medicine @JHospMedicine Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight - another #CME edition! |
 | Rebecca Jaffe, MD @RJmdphilly Rebecca Jaffe joining from philly. On an actual computer instead of mobile ap so pardon me if I seem like newbie #jhmchat |
 | Nancy H. Stewart, DO, MS (she/her) @nvhstewart @JHospMedicine @WrayCharles @nvhs0401 fellow @creightonpccm happy to join tonight’s #JHMChat |
 | Robert J. Mahoney, MD @mahoneyr (Will be in and out of #JHMChat tonight - good evening, all!) |
| Vinny Arora MD MAPP @FutureDocs Just wrapping #bathtime and joining intermittently for return of #JHMChat - good luck @WrayCharles moderating tonight on a fave topic! |
| Journal of Hospital Medicine @JHospMedicine We welcome @alfandremd as an author of tonight's article on Against Medical Advice Discharges #JHMChat https://t.co/tTEkWeSjgU |
 | Andrew Parsons (h/h/h) @andrewparsonsMD @JHospMedicine @WrayCharles #JHMchat joining from UVA |
 | Ivy Melgarejo @IvyM808 Ivy Melgarejo, PGY3 from University of Hawaii. First time to join. :) #jhmchat |
| Tony Breu @tony_breu @IvyM808 Welcome! Great to have resident involvement in #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Glad to pull in the #ICU & #Pulmonology crowd! https://t.co/o7eoJH1Mqp |
| Journal of Hospital Medicine @JHospMedicine Glad to pull in the #ICU & #Pulmonology crowd! https://t.co/o7eoJH1Mqp https://t.co/aJp1TrRwNU |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Always look forward to @gracefarris artistic additions to the #jhmchat https://t.co/158afTb7cD |
| Ivy Melgarejo @IvyM808 Thanks! @tony_breu Interesting and relevant topic for house staff. #jhmchat |
| Journal of Hospital Medicine @JHospMedicine @IvyM808 Glad to have you on-board, Ivy! Look forward to hearing your thoughts #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly @FutureDocs @WrayCharles haha. kids are "in bed." I am currently ignoring the circus upstairs. Bedtime half an hour early for #JHMchat does not seem to be taking |
 | Madhusree⚕️ Singh, MD @thinkalot @JHospMedicine @WrayCharles VA doc, hospitalist at Madison,WI #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Tonight’s questions will center on 3 major themes: 1) Decisions 2) Effects & 3) Strategies & Systems on AMA DCs #JHMChat |
 | VGeslaniMD @VGeslaniMD Pretty much doing the same thing as well. #bathtime then joining #JHMchat https://t.co/NvUbMBI6JL |
| Journal of Hospital Medicine @JHospMedicine T1a: How do you decide when to discharge a patient AMA? #jhmchat |
| Vinny Arora MD MAPP @FutureDocs @RJmdphilly @WrayCharles flying solo here so #bedtime fail on all fronts #JHMchat |
| Journal of Hospital Medicine @JHospMedicine @thinkalot @WrayCharles As a fellow VA hospitalist, look forward to hearing your input on this topic #jhmchat |
| Tony Breu @tony_breu @JHospMedicine T1a: I wish I knew when to discharge ANY patient! These situations are particularly tough. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Tonight’s questions will center on 3 major themes: Tonight’s questions will center on 3 major themes: 1) Decisions 2) Effects & 3) Strategies & Systems on AMA DCs #JHMChat |
 | Lakshman Swamy (laxswamy@bsky.social) @laxswamy Lakshman here from Boston,#pulmcc fellow that recently dealt with a few AMAs from the MICU!#JHMchat |
| Tony Breu @tony_breu @laxswamy Way to up the ante Lakshman! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine @tony_breu Great point, Tony. Our jobs can be hard enough...#JHMchat |
| Society of Hospital Medicine @SocietyHospMed T1a is live! You can jump into #JHMChat at any time! https://t.co/IhcwFssFAh |
| Tony Breu @tony_breu @aoglasser This is true. These situations often arise at inopportune times. "Off-tour" in VA lingo. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine @laxswamy some might ask...'did they need to be in the MICU, then?'...#JHMchat |
| Vinny Arora MD MAPP @FutureDocs T1a when there seems to be no other choice per med legal.. I'm sure that's not the best answer but it's the truth #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu It is all too common now w overdose requiring MICU, rapid turn around before floor bed is ready... and of course she had DM1. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: T1a is live! You can jump into #JHMChat at any time! https://t.co/IhcwFssFAh |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @aoglasser This is true. These situations often arise at inopportune times. "Off-tour" in VA lingo. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly RT @JHospMedicine: Tonight’s questions will center on 3 major themes: Tonight’s questions will center on 3 major themes: 1) Decisions 2) Effects & 3) Strategies & Systems on AMA DCs #JHMChat |
| Journal of Hospital Medicine @JHospMedicine T1b: Have you ever received any formal education around these moments? Informal curriculum? #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly RT @FutureDocs: @RJmdphilly @WrayCharles flying solo here so #bedtime fail on all fronts #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @JHospMedicine Hospital flow impacts everyone! When it stops, every service becomes a general medical floor! #JHMchat |
| Tony Breu @tony_breu @JHospMedicine I never did. This was on-the-job training. Wasn't even a "see one, do one, teach one". Just, "go do..." #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly Should rename this #bedtimechatforhospitalists https://t.co/VR7111MPvO |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @JHospMedicine @laxswamy @JHospMedicine #jhmchat I’ve seen several of these, and most don’t “need” #icu status other than for immediate #safety @ presentation |
| Journal of Hospital Medicine @JHospMedicine .@alfandremd, Your thoughts on this? #jhmchat https://t.co/NVyXeKwTR1 |
| Society of Hospital Medicine @SocietyHospMed Don't forget to use the #JHMChat hashtag to index your tweets! |
| David Alfandre @alfandremd @JHospMedicine Also wondering when you as a clinician first learned about AMA. As a student? How did it impact you? #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu @JHospMedicine Just “go do many, and more” #JHMchat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @JHospMedicine No. #JHMchat myths passed down year after year, beginning in residency |
 | Eric Schultz @ericschul @JHospMedicine Intern here. I've never really decided to d/c AMA. Usually the patient drives the decision-making. #jhmchat |
| Ivy Melgarejo @IvyM808 T1b: we have lectures on assessing patient capacity to decide to leave AMA, very helpful but still nothing within the curriculum #jhmchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @laxswamy @tony_breu Yes. All.the time. #jhmchat |
 | Jay Miller Brenner @dr_jaybrenner I am one of the co-authors of this article, and I am happy to join in on the discussion to add an Emergency Medicine perspective... #JHMChat |
| David Alfandre @alfandremd @JHospMedicine Have been leaving out the #JHMChat hashtag. Sorry! Yes, great question |
| Rebecca Jaffe, MD @RJmdphilly #JHMchat no (short and sweet) https://t.co/j1SDhGe9Yl |
| Journal of Hospital Medicine @JHospMedicine Suspect most trained like this? Anyone know of or experience a formal education around this? Do you think we should? #jhmchat @alfandremd https://t.co/D29MAj8KwC |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @JHospMedicine Also wondering when you as a clinician first learned about AMA. As a student? How did it impact you? #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart This is wonderful you exposed even to lectures on #ama !! #jhmchat https://t.co/tEnaO6R3M3 |
| David Alfandre @alfandremd @JHospMedicine Would humbly suggest that we as clinicians always have choices. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly #JHMchat brings up issue though - if the patient not asking to leave, it can't really be AMA right? https://t.co/AyHBD9p7sN |
| Andrew Parsons (h/h/h) @andrewparsonsMD @ericschul @JHospMedicine #JHMChat but when do you ask pt to sign ama papers? |
| Tony Breu @tony_breu @JHospMedicine @alfandremd I with what @IvyM808 described (teach about capacity assessment) is more high yield. Apply it to these situations. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Glad to have you on-board, Jay! Please jump in #JHMchat https://t.co/MSJ2owdMN6 |
| Rebecca Jaffe, MD @RJmdphilly RT @JHospMedicine: .@alfandremd, Your thoughts on this? #jhmchat https://t.co/NVyXeKwTR1 |
| Journal of Hospital Medicine @JHospMedicine RT @dr_jaybrenner: I am one of the co-authors of this article, and I am happy to join in on the discussion to add an Emergency Medicine perspective... #JHMChat |
| David Alfandre @alfandremd @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their agency. #JHMChat |
| Ivy Melgarejo @IvyM808 @nvhs0401 It was from our Psychiatry department, since they receive a lot of consults for assessing capacity. #jhmchat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @aoglasser @alfandremd @JHospMedicine #JHMChat agree 100% |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart Interesting. Isn’t this also a #patientsafety issue ? #jhmchat #ama https://t.co/0Zz4vkQUQe |
| Journal of Hospital Medicine @JHospMedicine @tom_wagner2 @WrayCharles Welcome, Tom! #JHMchat |
| Vinny Arora MD MAPP @FutureDocs A prior paper of ours showed urban legends regarding AMA discharge & financial burden #JHMchat https://t.co/BHrfzwxoe3 |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @JHospMedicine Would humbly suggest that we as clinicians always have choices. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @nvhs0401: This is wonderful you exposed even to lectures on #ama !! #jhmchat https://t.co/tEnaO6R3M3 |
| Vinny Arora MD MAPP @FutureDocs RT @dr_jaybrenner: I am one of the co-authors of this article, and I am happy to join in on the discussion to add an Emergency Medicine perspective... #JHMChat |
| Tony Breu @tony_breu @gracefarris @alfandremd @JHospMedicine It was (is!) hard to not overcome the psychology that discharging the patient was the path of least resistance. #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @gracefarris @alfandremd @JHospMedicine Heard this one many times 😔 although not the best for #patientsafety #ama #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly @IvyM808 #JHMchat I think this is one of the key issues. Have to know if informed consent is really possible. For AMA and SDM both |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their agency. #JHMChat |
| David Alfandre @alfandremd Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: A prior paper of ours showed urban legends regarding AMA discharge & financial burden #JHMchat https://t.co/BHrfzwxoe3 |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @gracefarris @alfandremd @JHospMedicine The fact that AMA is enticing to interns -and it most definitely is- shows just how broken our systems are. #JHMChat #meded |
| Ivy Melgarejo @IvyM808 RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their agency. #JHMChat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @tony_breu @JHospMedicine @alfandremd @IvyM808 #JHMChat isn’t this a different issue though? Important one, no doubt |
| Society of Hospital Medicine @SocietyHospMed Don't forget to claim #CME after tonight's #JHMChat! Fill the evaluation here: https://t.co/Ef1q4nNAaN |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMchat |
| David Alfandre @alfandremd @FutureDocs Vinny and colleagues paper was a superb addition to the empiric literature on this topic. We need more! #JHMChat |
| Tony Breu @tony_breu @alfandremd Very important. It may be irrational for the patient to desire discharge. But, this doesn't equate to a lack of capacity #JHMChat |
| Andrew Parsons (h/h/h) @andrewparsonsMD RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their agency. #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @laxswamy: @gracefarris @alfandremd @JHospMedicine The fact that AMA is enticing to interns -and it most definitely is- shows just how broken our systems are. #JHMChat #meded |
| Journal of Hospital Medicine @JHospMedicine RT @laxswamy: @gracefarris @alfandremd @JHospMedicine The fact that AMA is enticing to interns -and it most definitely is- shows just how broken our systems are. #JHMChat #meded |
 | Joanna Steinglass, MD @steinglmd RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their agency. #JHMChat |
 | Daniel Wolfson @WolfsonD #JHMChat In my experience at MGH AMA is patient preference |
| Eric Schultz @ericschul @andrew__parsons @JHospMedicine After explaining risks and benefits. If they’re insistent on leaving and have capacity, can’t force them to stay. Then ask to sign. #JHMChat |
| Tony Breu @tony_breu @andrew__parsons @JHospMedicine @alfandremd @IvyM808 I don't think it is. By asking for AMA discharge, this might suggest lack of capacity. We ought to assess patient understanding #JHMChat |
| David Alfandre @alfandremd @tony_breu Also, if patients only priority were promoting their health, then no one would smoke #JHMChat |
| Vinny Arora MD MAPP @FutureDocs @alfandremd thx! Idea emanated from #medstudent And @GlassHospital #JHMchat |
 | Alex Auseon @Ajauseon @JHospMedicine @WrayCharles Cardiology PD from Chicago #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Great discussion and insights on T1. Onto Theme/topic 2...the effects of AMA on patient care #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @andrew__parsons @tony_breu @JHospMedicine @alfandremd @IvyM808 #JHMchat I'd argue it is the first part of the AMA issue. If pt doesn't have capacity to decide, can't really engage in shared decision mkg |
| Ivy Melgarejo @IvyM808 @andrew__parsons I think #patient safety #decisionalcapacity #ama are closely entangled #jhmchat |
| Journal of Hospital Medicine @JHospMedicine T2a: What effects have you seen on patients who were discharged AMA? #jhmchat |
| Tony Breu @tony_breu @gracefarris @JHospMedicine @alfandremd @IvyM808 One must presume the capacity evaluation was informal. This is ok for many/most situations. #JHMchat |
| Ivy Melgarejo @IvyM808 @JHospMedicine T2a: they will likely do the same thing on the next admission. #jhmchat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @ericschul @JHospMedicine #JHMchat same here. But why ask to sign vs just click discharge? No reason for ama imo |
| Joanna Steinglass, MD @steinglmd RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs The crusade to address myths regarding @CostsofCare for AMA discharges continues #JHMchat https://t.co/woJRtlLSZL |
| David Alfandre @alfandremd @JHospMedicine Many of my patients tell me they feel betrayed by the hospital and have been reluctant to return. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMchat |
| Tony Breu @tony_breu @JHospMedicine Given how difficult feedback on inpt care is in general, I don't often know "what happens". I have called and had team call post-dc #JHMchat |
| David Alfandre @alfandremd @andrew__parsons @ericschul @JHospMedicine in general, we don't ask for patient's signature to decline a medical treatment. why with AMA #JHMChat |
| Daniel Wolfson @WolfsonD #JHMChat Is it possible that patients going AMA are decreasing risks rather than increasing their risks. |
| Tony Breu @tony_breu @gracefarris @JHospMedicine @alfandremd @IvyM808 I do! #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Would be incredibly interesting to see this example described in detail/research #JHMchat https://t.co/1A5oMCOd8p |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy I have cared for employees fearing for their jobs if they leave AMA. #JHMchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: T2a: T2a: What effects have you seen on patients who were discharged AMA? #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @FutureDocs: The crusade to address myths regarding @CostsofCare for AMA discharges continues #JHMchat https://t.co/woJRtlLSZL |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: T2a: T2a: What effects have you seen on patients who were discharged AMA? #jhmchat |
| Tony Breu @tony_breu @alfandremd @andrew__parsons @ericschul @JHospMedicine No, but we do document our decision making and patients declining recommended treatment. Same with AMA #JHMchat |
| Journal of Hospital Medicine @JHospMedicine @alfandremd, do we have any good data on what happens to these patients downstream? #JHMchat https://t.co/hP8RIM47q0 |
| Robert J. Mahoney, MD @mahoneyr T2 #JHMChat one of the biggest risks to patients who leave AMA is the (often false) beliefs of the providers who discharge them |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight - another #CME edition! |
| David Alfandre @alfandremd @JHospMedicine We know AMA discharges increases readmit,but interestingly, it also decreases readmit because patients report reluctance to return #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @aoglasser Yes- we can and should talk about shared decision making, but patients are people. They sometimes just make bad choices. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine Fantastic point, @WolfsonD. May not be true in all, but probably true in some...? #JHMchat https://t.co/BA3yPU5lqK |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart This is a sad reality for so many #patients leaving #AMA #jhmchat https://t.co/pNPAPlfjlx |
| Madhusree⚕️ Singh, MD @thinkalot #jhmchat T2 AMA DC are a symptom of loss of trust between patient, clinician 1/x |
| David Alfandre @alfandremd @JHospMedicine There is limited qualitative data on patient's perspective on AMA discharges, but almost all of it is negative. #JHMChat |
| Ivy Melgarejo @IvyM808 RT @alfandremd: @JHospMedicine There is limited qualitative data on patient's perspective on AMA discharges, but almost all of it is negative. #JHMChat |
 | Guilherme Barcellos @brhospitalist #JHMChat Interesting to see that you deal with the same myths them we in Brasil |
| Vinny Arora MD MAPP @FutureDocs High workloads such that patients become numbers and any discharge is a discharge #JHMchat https://t.co/puiLg2TDfL |
| David Alfandre @alfandremd @JHospMedicine I feel like many of my tweets will be pointing out the need for more empirical research in this area. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine T2b: @alfandremd, what effects should clinicians be aware of? (tho you're beating me this question in prev responses :) #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @thinkalot: #jhmchat T2 AMA DC are a symptom of loss of trust between patient, clinician 1/x |
| Tony Breu @tony_breu @JHospMedicine @alfandremd Associated with quick "bounceback" #JHMchat https://t.co/O914dHKpn0 https://t.co/0xvsWnPtOo |
| Rebecca Jaffe, MD @RJmdphilly @JHospMedicine isn't it tautolological that AMA pts > likely 2 be readmitted? at least somewhere if not index hosp. They were not ready to leave. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @JHospMedicine I feel like many of my tweets will be pointing out the need for more empirical research in this area. #JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: T2b: T2b: @alfandremd, what effects should clinicians be aware of? (tho you're beating me this question in prev responses :) #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @JHospMedicine There is limited qualitative data on patient's perspective on AMA discharges, but almost all of it is negative. #JHMChat |
| David Alfandre @alfandremd @laxswamy @aoglasser "bad choices," or choices that don't prioritize their health? again back to the smoking analogy. #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @gracefarris @alfandremd @JHospMedicine True, but easily overstated. The AMA discharge is enticing when patients are actively undermining their care. #JHMchat |
| VGeslaniMD @VGeslaniMD Resonates with many. https://t.co/1C9MRfvrfE |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @aoglasser I never understand why feeding the cat is THAT important & why no one else can do it. But people have different values. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly I hear this a lot. #JHMchat "patient w hx of frequent AMA." Another ex of implicit bias https://t.co/JwcmfZl754 |
| Eric Schultz @ericschul @tony_breu @alfandremd @andrew__parsons @JHospMedicine Appreciate the perspectives. Only been at this a few months, so happy to learn. #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot Last patient who left AMA when he was under surgical care talked abt NGT, being scolded, moved by his night nurse. Dissatisfaction #JHMchat |
| Journal of Hospital Medicine @JHospMedicine T2c: Should we consider AMA DCs a Low-Value process? @alfandremd @WolfsonD #JHMchat |
| David Alfandre @alfandremd @JHospMedicine Clinicians should be aware of how a prior AMA discharge may affect their decision making for a current admission. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @laxswamy @aoglasser =))) winning #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @gracefarris @alfandremd @JHospMedicine Agreed, and we cannot fix all of society’s problems in a single admission. But we try. #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @RJmdphilly It is not always "implicit". Plenty of patients stay for treatment until they feel better, not until they are actually treated. #JHMchat |
| VGeslaniMD @VGeslaniMD How do we know that the patient even has the "capacity" to make the decision to leave AMA? Always struggled with this one. #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot I find lots of my patients have limited social capital. I get why they need to care for their animals Great motivation 2get better too https://t.co/yLXNiKg2jc |
| Journal of Hospital Medicine @JHospMedicine @RJmdphilly or fundamental attribution error (blaming the patient rather than the circumstance/system) #JHMchat |
| David Alfandre @alfandremd @JHospMedicine @WolfsonD Designating a discharge as AMA has never been shown to advance patient's care. We do have emerging evidence of harm. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @JHospMedicine @WolfsonD Designating a discharge as AMA has never been shown to advance patient's care. We do have emerging evidence of harm. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @JHospMedicine #JHMchat this is the patient I worry about the most. Cellulitis and likely ok on oral abx? I will not lose sleep. Bacteremia - bad news. 1/2 |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @gracefarris @aoglasser Definitely. But it doesn’t always have to make sense for it to be legitimate. #JHMchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: T2c: T2c: Should we consider AMA DCs a Low-Value process? @alfandremd @WolfsonD #JHMchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @alfandremd: @JHospMedicine Clinicians should be aware of how a prior AMA discharge may affect their decision making for a current admission. #JHMChat |
| Madhusree⚕️ Singh, MD @thinkalot Sure but trust can't be legislated or forced. Hospital stays often don't consider patient perspective. https://t.co/WjeF8VV4hX |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: T2c: T2c: Should we consider AMA DCs a Low-Value process? @alfandremd @WolfsonD #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal problems, they are entitled to be frustrated when we cannot fix things. #JHMchat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system = low-value |
 | Irfan Dhalla @IrfanDhalla There is a very interesting journal club going on right now at #JHMChat, on the topic of patients leaving hospital against medical advice. |
| Tony Breu @tony_breu @VGeslaniMD Best article on the topic. Table has great questions to ask #JHMchat https://t.co/C5Ob3f29fL https://t.co/OvDXcpzpbc |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal problems, they are entitled to be frustrated when we cannot fix things. #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly RT @alfandremd: @JHospMedicine There is limited qualitative data on patient's perspective on AMA discharges, but almost all of it is negative. #JHMChat |
| David Alfandre @alfandremd @gracefarris @JHospMedicine @WolfsonD Advise all to work with their hospital counsel. What is legally required with AMA? More than documentation of informed refusal? #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj |
| Guilherme Barcellos @brhospitalist RT @tony_breu: @VGeslaniMD Best article on the topic. Table has great questions to ask #JHMchat https://t.co/C5Ob3f29fL https://t.co/OvDXcpzpbc |
| Journal of Hospital Medicine @JHospMedicine RT @IrfanDhalla: There is a very interesting journal club going on right now at #JHMChat, on the topic of patients leaving hospital against medical advice. |
| Madhusree⚕️ Singh, MD @thinkalot Outcomes are worse. That's well documented. Often there are complicating circumstances $$, addiction,family dysfunction. I try to work w pt https://t.co/nqU88U7RF7 |
| Journal of Hospital Medicine @JHospMedicine RT @andrew__parsons: @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system = low-value |
| Ivy Melgarejo @IvyM808 RT @andrew__parsons: @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system = low-value |
 | Cathy Olson @cathyolson RT @thinkalot: I find lots of my patients have limited social capital. I get why they need to care for their animals Great motivation 2get better too https://t.co/yLXNiKg2jc |
| Madhusree⚕️ Singh, MD @thinkalot RT @JHospMedicine: Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj |
| Journal of Hospital Medicine @JHospMedicine T3a: What strategies do you utilize when DCing a patient AMA? #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot RT @tony_breu: @VGeslaniMD Best article on the topic. Table has great questions to ask #JHMchat https://t.co/C5Ob3f29fL https://t.co/OvDXcpzpbc |
| Robert J. Mahoney, MD @mahoneyr @JHospMedicine @alfandremd @WolfsonD Are we distinguishing btw AMA D/C itself and care that preceded it? The latter could be very high value but lead to same outcome. #JHMchat |
 | Claire Sevov @ClaireSevovMD @aoglasser #JHMchat I have seen wide variation on whether to give DC meds at all...risk of harm by commission vs. omission |
 | Andrew Auerbach @ADAuerbachMD RT @JHospMedicine: Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj |
| Andrew Auerbach @ADAuerbachMD RT @alfandremd: @JHospMedicine @WolfsonD Designating a discharge as AMA has never been shown to advance patient's care. We do have emerging evidence of harm. #JHMChat |
| Madhusree⚕️ Singh, MD @thinkalot Indeed. #sdoh is huge in AMA DC https://t.co/tvmSvDedlY |
| Journal of Hospital Medicine @JHospMedicine Great discussion point! Do you have rules you follow or case-by-case basis? #JHMchat https://t.co/nWIiXLyFQJ |
| Tony Breu @tony_breu @JHospMedicine Try to engage others (particularly SW). As noted by @laxswamy often issues prompted desire to leave are things like bills to pay. #JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal problems, they are entitled to be frustrated when we cannot fix things. #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot We should try to get fu. Most folks need ongoing care. https://t.co/FEu4CNvIWI |
| Tony Breu @tony_breu @ClaireSevovMD @aoglasser Must give medications! #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @VGeslaniMD There is a whole lot of "paternalism" bundled in the concept that patients may not know when they have the right to leave. #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot I wish we thought like this https://t.co/T0GEGWn47v |
| David Alfandre @alfandremd @JHospMedicine Treatment plan may have to change to accommodate outpatient requirements. But categorical denial of medications is problematic. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr more saying that medical team setting up a bad dynamic with patient from the start, due to assumptions that might not be correct #JHMchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal problems, they are entitled to be frustrated when we cannot fix things. #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot Social work help is key. They can be magicians in getting things done https://t.co/cHOZfiFqwM |
| Robert J. Mahoney, MD @mahoneyr @VGeslaniMD (never did find the term "paternalism" appropriate, but there is currently no better word for it) #JHMchat |
| Ivy Melgarejo @IvyM808 filled all meds prior to leaving. and hoping they take it. #jhmchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @IrfanDhalla: There is a very interesting journal club going on right now at #JHMChat, on the topic of patients leaving hospital against medical advice. |
| Guilherme Barcellos @brhospitalist RT @JHospMedicine: Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj |
| David Alfandre @alfandremd @JHospMedicine Request to leave AMA is often an "opportunity" to discuss the patient's concerns about the treatment plan. May need to modify plan.#JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @andrew__parsons: @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system = low-value |
| Journal of Hospital Medicine @JHospMedicine In AMA DC, do you prescribe or provide DC meds? #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @gracefarris @alfandremd @JHospMedicine It makes a big difference if attending will be disappointed if pt leaves AMA. That role modeling helped me a lot as an intern. #jhmchat |
| Tony Breu @tony_breu @gracefarris @alfandremd @JHospMedicine @WolfsonD True. Spent time on a well written note outlining discussion with patient and communicating with outpatient providers. #JHMchat |
 | Zackary Berger @DrZackaryBerger RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot Merits a conversation for sure. An opportunity to make things better https://t.co/d2vbz9cIyB |
| Tony Breu @tony_breu @JHospMedicine Yes. Otherwise we are abandoning or leading to coerced continued hospitalization ("I won't give meds unless you stay") is message. #JHMChat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @gracefarris @alfandremd @JHospMedicine @WolfsonD #JHMChat great point! |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @gracefarris @alfandremd @JHospMedicine As an example of making the most of a hospitalization re societal problems... https://t.co/B0kGMwbXdX?amp=1 #jhmchat |
| Journal of Hospital Medicine @JHospMedicine Great point, @alfandremd! Should we be looking at AMA DCs as opportunities rather than failures...? #JHMchat https://t.co/VzzL5P7GOV |
| Cathy Olson @cathyolson RT @thinkalot: Outcomes are worse. That's well documented. Often there are complicating circumstances $$, addiction,family dysfunction. I try to work w pt https://t.co/nqU88U7RF7 |
| David Alfandre @alfandremd @JHospMedicine Depends on what kinds of meds #JHMChat . but yes, should provide a treatment consistent with accepted standards. |
| Rebecca Jaffe, MD @RJmdphilly @alfandremd @JHospMedicine @WolfsonD but calling it something different doesn't help. How to improve process for a requested d/c when MD has concerns? #JHMchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @tony_breu @gracefarris @alfandremd @JHospMedicine @WolfsonD We should make sure to try to spend just as much time educating pt on why to not leave #ama as we do documentation #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @RJmdphilly Some (but not all) AMA discharges are due to bad care dynamics - these we should be addressing prospectively #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #JHMchat |
| Ivy Melgarejo @IvyM808 @JHospMedicine depends which medication, antibiotics are usually filled. narcotics, anticoagulants can be tricky. #jhmchat |
| Guilherme Barcellos @brhospitalist RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #JHMchat |
| Tony Breu @tony_breu @nvhs0401 @gracefarris @alfandremd @JHospMedicine @WolfsonD Thank you for saying this! #JHMchat |
| Vinny Arora MD MAPP @FutureDocs RT @alfandremd: @JHospMedicine Request to leave AMA is often an "opportunity" to discuss the patient's concerns about the treatment plan. May need to modify plan.#JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @laxswamy: @mahoneyr @gracefarris @alfandremd @JHospMedicine As an example of making the most of a hospitalization re societal problems... https://t.co/B0kGMwbXdX?amp=1 #jhmchat |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: @JHospMedicine Depends on what kinds of meds #JHMChat . but yes, should provide a treatment consistent with accepted standards. |
| David Alfandre @alfandremd @ctiMD @ClaireSevovMD @aoglasser Some may feel they are complicit with the patient's inadvisable medical decision. But this is essence of harm reduction! #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @RJmdphilly But repeated AMA discharges (often involving multiple teams) suggest more than team dynamics. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine @nvhs0401 @tony_breu @gracefarris @alfandremd @WolfsonD Some would argue that you need to spend more (w/patient) #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @nvhs0401 @tony_breu @gracefarris @alfandremd @JHospMedicine @WolfsonD I'll be honest, there are times a patient has showed me that DC is perfectly reasonable. They can think outside of our boxes. #jhmchat |
| Andrew Parsons (h/h/h) @andrewparsonsMD @RJmdphilly @alfandremd @JHospMedicine @WolfsonD #JHMChat document document document |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD But I feel like better preceding care may prevent AMA. Need 2 understand drivers of AMA in order 2 improve #JHMchat |
| Journal of Hospital Medicine @JHospMedicine T3b: Does your hospital have any systems or procedures in place for AMA DC? #JHMchat |
| Vinny Arora MD MAPP @FutureDocs @alfandremd @gracefarris @JHospMedicine @WolfsonD legal implications AMA Dc seem like an area poorly understood #JHMchat |
| Claire Sevov @ClaireSevovMD @ctiMD @aoglasser #JHMchat **not my opinion** but colleagues have cited risks with diuretics etc that may cause new acute problems w/o monitoring |
| Robert J. Mahoney, MD @mahoneyr @VGeslaniMD Just seems like an unfair indictment of fathers everywhere #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot Sometimes folks just hate each others guts. Especially with sleep disruption disagreements balloon out of proportion https://t.co/7XE0EaVmQw |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart Absolutely! I would agree. But we focus so much on documnt for “legal,” that pt care can get forgotten #jhmchat https://t.co/mnPhyDuQIe |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @mahoneyr @RJmdphilly Agreed. Not all AMAs are alike. Some are entirely outside of our control. (note i did not say entirely on the patient) #jhmchat |
| Journal of Hospital Medicine @JHospMedicine excellent point. Not all meds are created equal #JHMchat https://t.co/Es7CcqffGQ |
| Guilherme Barcellos @brhospitalist RT @JHospMedicine: Great point, @alfandremd! Should we be looking at AMA DCs as opportunities rather than failures...? #JHMchat https://t.co/VzzL5P7GOV |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @gracefarris @alfandremd @JHospMedicine Interns hope for many things. Much of the attending's job is to set limits for those hopes. #JHMchat |
| David Alfandre @alfandremd @JHospMedicine The best reason to see it as a failure is from a QI perspective. That it involves not just the patent,but also the team,hospital..#JHMChat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: T3b: T3b: Does your hospital have any systems or procedures in place for AMA DC? #JHMchat |
| Tony Breu @tony_breu @ClaireSevovMD @ctiMD @aoglasser Good example. The risks/benefits need to be weighed in these situations. Hard to do, but we're up to making these tough calls #JHMchat |
| Jay Miller Brenner @dr_jaybrenner Best prospective study would have Code AMA to bring team to pt to address concerns if possible and if not then to discharge safely #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly RT @tony_breu: @VGeslaniMD Best article on the topic. Table has great questions to ask #JHMchat https://t.co/C5Ob3f29fL https://t.co/OvDXcpzpbc |
| Madhusree⚕️ Singh, MD @thinkalot RT @JHospMedicine: excellent point. Not all meds are created equal #JHMchat https://t.co/Es7CcqffGQ |
| Guilherme Barcellos @brhospitalist RT @nvhs0401: Absolutely! I would agree. But we focus so much on documnt for “legal,” that pt care can get forgotten #jhmchat https://t.co/mnPhyDuQIe |
| Vinny Arora MD MAPP @FutureDocs My overall strategy is one day at a time -ask to stay for "one more day" sometimes buys time to figure things out/get info #JHMchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart @JHospMedicine Not that I know of, except “fill out the form/sign here” #jhmchat |
| Robert J. Mahoney, MD @mahoneyr @RJmdphilly @JHospMedicine @alfandremd @WolfsonD The challenge is that the AMA discharge may follow perfectly good care - which itself did not prevent the AMA discharge. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine Interns hope for many things. Much of the attending's job is to set limits for those hopes. #JHMchat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine Interns hope for many things. Much of the attending's job is to set limits for those hopes. #JHMchat |
| Tony Breu @tony_breu @FutureDocs One more HOUR is often enough to create a transition plan. #JHMChat |
| David Alfandre @alfandremd @JHospMedicine We avoid them; choose to have a single discharge process; promote good f/u if choose to leave. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine And therein lies the rub... #JHMchat https://t.co/Io5NHSenki |
| Rebecca Jaffe, MD @RJmdphilly and find out as much as possible about why they are leaving. #JHMchat https://t.co/121oM9Gd2n |
 | lauren meade (she/they) 🏳️🌈🏳️⚧️🔯😇 @laurenbmeade RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @thinkalot I'd like to think that it is part of the job description for providers not to hate their patients. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs Agree. Especially if it's the hour antibiotics are going in! #JHMchat key is buy time for safe transition https://t.co/xzYBsJuo1C |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @tony_breu @FutureDocs Not easily done, to reschedule scans, consults, procedures... But often it is possible. But. It. Is. Just. So. Hard. #JHMchat |
| David Alfandre @alfandremd @laxswamy @nvhs0401 @tony_breu @gracefarris @JHospMedicine @WolfsonD Beware of the AMA discharge bc patient didn't want to wait 3 hours for paperwork. Now seen as "difficult" on next admission. #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly because really its all about #handoffs #JHMchat https://t.co/ZtQWWwyuLo |
| Journal of Hospital Medicine @JHospMedicine Well, we have about 10 minutes left in our discussion. Any final key points or thoughts, @alfandremd? #JHMChat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @RJmdphilly This is key - what is out of control of the provider is not necessarily in the control of the patient #JHMchat |
| Daniel Wolfson @WolfsonD #JHMchat Is an AMA a failure of comm, of pat trust & a legal system not working in the best interest of pats. How many adverse outcomes? |
| Jay Miller Brenner @dr_jaybrenner @WolfsonD says AMA is patient preference. I have yet you have a patient request to leave AMA, they simply request to leave. #jhmchat |
| Ivy Melgarejo @IvyM808 @RJmdphilly Exactly. Sometimes just taking the time to know why they wanna leave, is an opportunity to convince them to stay. #jhmchat |
| Tony Breu @tony_breu @gracefarris @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD We get "warning shots" and tend to ignore them. Then, the big one comes at 2am. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @RJmdphilly: because really its all about #handoffs #JHMchat https://t.co/ZtQWWwyuLo |
| David Alfandre @alfandremd @gracefarris @ctiMD @ClaireSevovMD @aoglasser My experience is that many find the idea of harm reduction philosophically challenging and inconsistent with primary obligations. #JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @WolfsonD: #JHMchat Is an AMA a failure of comm, of pat trust & a legal system not working in the best interest of pats. How many adverse outcomes? |
| Andrew Parsons (h/h/h) @andrewparsonsMD @dr_jaybrenner @WolfsonD #JHMChat take home point |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD yes but something missed. Might not have been the quality of the care.Expectation setting? Understanding Social issues? Timeliness? #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @VGeslaniMD To me, "paternal" is "fatherly". So "paternalistic" as "dismissive" feels like an indictment. Maybe a subject for another chat..... #JHMchat |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Well, we have about 10 minutes left in our discussion. Any final key points or thoughts, @alfandremd? #JHMChat |
| David Alfandre @alfandremd Also, establishing expectations on day of admission. That can help patient appreciate LOS. #JHMchat |
| Madhusree⚕️ Singh, MD @thinkalot I try my best to work out an amicable plan which works for patient https://t.co/YVewVB8Xv5 |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @alfandremd @gracefarris @ctiMD @ClaireSevovMD @aoglasser And needle programs and SIFs and the list goes on and on. Stigma vs helping people. #JHMChat |
| Jay Miller Brenner @dr_jaybrenner @WolfsonD says AMA is patient preference. I have yet to have a patient request to leave AMA, they simply request to leave. #jhmchat #jhmchat |
| David Alfandre @alfandremd Also, get help with your patients suffering from substance use disorders. Biggest barrier to remaining hospitalized. #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @tony_breu: @gracefarris @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD We get "warning shots" and tend to ignore them. Then, the big one comes at 2am. #JHMChat |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: Also, establishing expectations on day of admission. That can help patient appreciate LOS. #JHMchat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart Yes! And would add, be cautious w label “difficult pt” if simply bc of #AMA . Let documentation speak. #jhmchat @JHospMedicine https://t.co/ZWaj6N4Jjl |
| Rebecca Jaffe, MD @RJmdphilly @mahoneyr yes - I was referring only to opening lines of new patient presentation, and including pattern of AMAs. Sets the stage badly #JHMchat |
| Society of Hospital Medicine @SocietyHospMed Thanks to our partners @ABIMFoundation @CostsofCare for your support! #JHMChat |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart RT @dr_jaybrenner: @WolfsonD says AMA is patient preference. I have yet to have a patient request to leave AMA, they simply request to leave. #jhmchat #jhmchat |
| Vinny Arora MD MAPP @FutureDocs Would be interesting to see what legal perspectives are on this- local practice may be derived from legal norm #JHMchat |
| Robert J. Mahoney, MD @mahoneyr @tony_breu @gracefarris @RJmdphilly @JHospMedicine @alfandremd @WolfsonD Some of the "warning shots" are actionable. Not all of them. #JHMchat |
| David Alfandre @alfandremd @nvhs0401 @JHospMedicine We advise the term, "difficult to help," or "difficult encounter."Puts the onus back on professional responsibilities, not patient.#JHMChat |
| Journal of Hospital Medicine @JHospMedicine Very lively and insightful conversation tonight! So much to take in. Big thanks to @alfandremd for joining us! #JHMchat |
| Jay Miller Brenner @dr_jaybrenner @laxswamy has a good point about patients leaving to feed the cat. One study showed that pet care was 9% of the AMA reasons. Sad :( #jhmchat |
| Vinny Arora MD MAPP @FutureDocs RT @JHospMedicine: Very lively and insightful conversation tonight! So much to take in. Big thanks to @alfandremd for joining us! #JHMchat |
| Tony Breu @tony_breu @JHospMedicine @alfandremd Great to have #JHMchat back. Thank you @WrayCharles and @alfandremd for a great discussion! |
| Journal of Hospital Medicine @JHospMedicine Here it is, ladies & gentlemen! #JHMchat https://t.co/usWR8XfhPV |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: Thanks to our partners @ABIMFoundation @CostsofCare for your support! #JHMChat |
| Journal of Hospital Medicine @JHospMedicine Here it is, ladies & gentlemen! #JHMchat https://t.co/usWR8XfhPV https://t.co/SE5uSI7A1m |
| Vinny Arora MD MAPP @FutureDocs Patients Pets need care too #JHMchat https://t.co/jYdB7oHguB |
| David Alfandre @alfandremd @FutureDocs Your sentiment is shared by many.The more we can reassure clinicians legally, the easier it will be to have them focus on patients.#JHMChat |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy @aoglasser @mahoneyr @VGeslaniMD It starts with an AMA story. Perfect ! #jhmchat |
| Rebecca Jaffe, MD @RJmdphilly last AMA was pt w DKA on adm. resolved but hypo the night before. @ 10 pm decided 2 leave. sugars ok, but PGY2 not empowered to dc. #JHMchat https://t.co/WhQNHOsXVb |
| Journal of Hospital Medicine @JHospMedicine Mark ur calendars -- #JHMChat will be back 11/27 at 9PM - Discussing @jeannemfarnan & @oliver_hulland's "What's the Purpose of Rounds?" |
| Vinny Arora MD MAPP @FutureDocs Awesome return of #JHMchat 👏 thx @WrayCharles @alfandremd @JHospMedicine @SHMLive https://t.co/7i3rCcTlyq |
| Nancy H. Stewart, DO, MS (she/her) @nvhstewart Great terms to consider when documenting a pt case of #AMA #jhmchat @JHospMedicine https://t.co/5yALAklCmV |
| David Alfandre @alfandremd Thanks everyone for your thoughtful comments. I learned lots. Let's keep the conversation and the research going! #JHMchat |
| Daniel Wolfson @WolfsonD #JHMChat Should we think about AMA as a system failure & poor patient-physician relationship. Or I have a social need I need to attend. |
| Society of Hospital Medicine @SocietyHospMed RT @JHospMedicine: Mark ur calendars -- #JHMChat will be back 11/27 at 9PM - Discussing @jeannemfarnan & @oliver_hulland's "What's the Purpose of Rounds?" |
| Tony Breu @tony_breu @JHospMedicine @jeannemfarnan @oliver_hulland Will this bleed into noon conference? #JHMchat |
| Journal of Hospital Medicine @JHospMedicine RT @alfandremd: Thanks everyone for your thoughtful comments. I learned lots. Let's keep the conversation and the research going! #JHMchat |
| Jay Miller Brenner @dr_jaybrenner @andrew_parsons was describing a pt leaving without being discharged (LWBD). This is a different situation from AMA. #jhmchat |
| Tony Breu @tony_breu @gracefarris @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD Which means that 30% left off-hours. I suspect that's a higher % than non-AMA. #JHMchat |
| Vinny Arora MD MAPP @FutureDocs Why people need insurance ! but that could be a whole other #JHMchat https://t.co/Fv3SZOJXKC |
| Rebecca Jaffe, MD @RJmdphilly Take homes: twitter chat on desktop much harder to keep up! #jhmchat |
| David Alfandre @alfandremd @WolfsonD To consider AMA as a patient problem only is short sighted.Physician components, hospital components,environmental components, etc.#JHMChat |
| Vinny Arora MD MAPP @FutureDocs RT @alfandremd: Thanks everyone for your thoughtful comments. I learned lots. Let's keep the conversation and the research going! #JHMchat |
| Society of Hospital Medicine @SocietyHospMed #JHMChat evaluation is now open: https://t.co/hnvGkelfza |
| David Alfandre @alfandremd @RJmdphilly I'm exhausted. It's like speaking to 50 people at once! #JHMChat |
| Rebecca Jaffe, MD @RJmdphilly sounds like a fishbone to me. #QI #CauseAnalysis @JeffIMchiefs https://t.co/JneFWpj9Gu |
| Vinny Arora MD MAPP @FutureDocs Cannot wait #JHMchat post #thanksgiving with the crew https://t.co/9dAlDIHwqT |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: Thanks to our partners @ABIMFoundation @CostsofCare for your support! #JHMChat |
| Jay Miller Brenner @dr_jaybrenner AMA is a hospital problem. Glad to have so many weighing in on the issue. Happy to continue chat by email brennerj@upstate.edu #jhmchat |
 | Charlie M. Wray, DO, MS @WrayCharles This can't be retweeted enough #JHMchat https://t.co/c85VQ4lKhm |
| Robert J. Mahoney, MD @mahoneyr @laxswamy @nvhs0401 @tony_breu @gracefarris @alfandremd @JHospMedicine @WolfsonD It's a learning opportunity for the physician when the patient comes up with a better (and sooner) discharge plan. #JHMchat |
| David Alfandre @alfandremd Thanks everyone. Keep in touch. Back to the kiddies and bedtime.... #JHMchat |
| Andrew Auerbach @ADAuerbachMD RT @JHospMedicine: Mark ur calendars -- #JHMChat will be back 11/27 at 9PM - Discussing @jeannemfarnan & @oliver_hulland's "What's the Purpose of Rounds?" |
| Journal of Hospital Medicine @JHospMedicine RT @SHMLive: #JHMChat evaluation is now open: #JHMChat evaluation is now open: https://t.co/hnvGkelfza |
| Andrew Auerbach @ADAuerbachMD RT @tony_breu: @JHospMedicine @alfandremd Great to have #JHMchat back. Thank you @WrayCharles and @alfandremd for a great discussion! |
| Andrew Auerbach @ADAuerbachMD RT @JHospMedicine: Very lively and insightful conversation tonight! So much to take in. Big thanks to @alfandremd for joining us! #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @gretchendiemer @JeffIMchiefs @estewart2099 I know you guys have opinions on this one https://t.co/3EKtwAWvw4 |
| Journal of Hospital Medicine @JHospMedicine RT @ADAuerbachMD: RT @JHospMedicine: RT @JHospMedicine: Very lively and insightful conversation tonight! So much to take in. Big thanks to @alfandremd for joining us! #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly RT @nvhs0401: Great terms to consider when documenting a pt case of #AMA #jhmchat @JHospMedicine https://t.co/5yALAklCmV |
| Vinny Arora MD MAPP @FutureDocs @RJmdphilly try tweetchat website ? #jhmchat tips |
| Lakshman Swamy (laxswamy@bsky.social) @laxswamy #JHMchat totally missed my chance to leave 5 min early against moderator advice. |
| Vinny Arora MD MAPP @FutureDocs @laxswamy I left early for bedtime but got readmitted #JHMchat |
| Rebecca Jaffe, MD @RJmdphilly @JeffIMchiefs @TJUHospital @RichWebsterTJUH Not an uncommon approach We need this https://t.co/VbqSKkcywQ |
| Vinny Arora MD MAPP @FutureDocs RT @SHMLive: #JHMChat evaluation is now open: #JHMChat evaluation is now open: https://t.co/hnvGkelfza |
 | Rupesh Prasad @rupeshp011 RT @FutureDocs: The crusade to address myths regarding @CostsofCare for AMA discharges continues #JHMchat https://t.co/woJRtlLSZL |
 | Marty Fried, MD @Marty_Fried Had a blast following #JHMChat today on AMA discharges. New appreciation for reluctance to return for care post-AMA. Thanks @alfandremd |
#JHMChat content from Twitter.