#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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J 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
J 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
J 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.
Grace Farris MD @gracefarris
@JHospMedicine @WrayCharles Grace Farris joining from @MountSinaiNYC #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
joining #JHMchat from the west coast in PDX OR, representing @OHSUIMRes & @OregonACP
J 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
J Hospital Medicine @JHospMedicine
Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight - another #CME edition!
Rebecca Jaffe @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 @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!
Grace Farris MD @gracefarris
@JHospMedicine Thanks! Better get out my pens... #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@OHSUIMRes @OregonACP and I will really be joining as soon as I can find the darn ketchup for the kiddos' fish sticks... #JHMchat #worklifebalance
J 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 @andrew__parsons
@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
J Hospital Medicine @JHospMedicine
Glad to pull in the #ICU & #Pulmonology crowd! https://t.co/o7eoJH1Mqp
J 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
Grace Farris MD @gracefarris
@JHospMedicine @alfandremd Thanks @alfandremd for articulating what we’ve all been thinking! #JHMchat
Ivy Melgarejo @ivym808
Thanks! @tony_breu Interesting and relevant topic for house staff. #jhmchat
J Hospital Medicine @JHospMedicine
@IvyM808 Glad to have you on-board, Ivy! Look forward to hearing your thoughts #jhmchat
Rebecca Jaffe @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
Madhu S. MD @thinkalot
@JHospMedicine @WrayCharles VA doc, hospitalist at Madison,WI #JHMChat
J Hospital Medicine @JHospMedicine
RT @gracefarris: @JHospMedicine @alfandremd Thanks @alfandremd for articulating what we’ve all been thinking! #JHMchat
J 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
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly @FutureDocs @WrayCharles ha! the husband's out of the country, I had hoped for early dinner time...and just got food out of the oven... #JHMchat #worklifebalance
Grace Farris MD @gracefarris
@RJmdphilly @FutureDocs @WrayCharles Two words: door monkey #JHMchat
J 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
J 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: 1) Decisions 2) Effects & 3) Strategies & Systems on AMA DCs #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
T1 #JHMchat I feel like the decision comes from patients far more than it comes from me...
Lakshman Swamy @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
J Hospital Medicine @JHospMedicine
@tony_breu Great point, Tony. Our jobs can be hard enough...#JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy #JHMchat MICU AMA discharges are unique--to be able to leave directly from critical care status!
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
Avital O'Glasser, MD FACP FHM @aoglasser
T1 #JHMchat as in the stat page to resident, "the patient is one foot out the door!"
Avital O'Glasser, MD FACP FHM @aoglasser
@andrew__parsons #JHMchat--i feel that with the "truest" AMA discharges, the pt refuses to sign the AMA paperwork
J 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
@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
J Hospital Medicine @JHospMedicine
RT @SHMLive: T1a is live! You can jump into #JHMChat at any time! https://t.co/IhcwFssFAh
J 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 @RJmdphilly
RT @JHospMedicine: Tonight’s questions will center on 3 major themes: 1) Decisions 2) Effects & 3) Strategies & Systems on AMA DCs #JHMChat
J Hospital Medicine @JHospMedicine
T1b: Have you ever received any formal education around these moments? Informal curriculum? #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
T1 #JHMchat will DC "AMA" when pt has violated part of a safety contract--ex. drug parapheenalia or active substance use discovered
Rebecca Jaffe @RJmdphilly
RT @FutureDocs: @RJmdphilly @WrayCharles flying solo here so #bedtime fail on all fronts #JHMchat
Lakshman Swamy @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 @RJmdphilly
Should rename this #bedtimechatforhospitalists https://t.co/VR7111MPvO
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly love it! #JHMchat
Nancy H Stewart DO, MS @nvhstewart
@JHospMedicine @laxswamy @JHospMedicine #jhmchat I’ve seen several of these, and most don’t “need” #icu status other than for immediate #safety @ presentation
J 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!
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @JHospMedicine I think this earns a "ditto"... #JHMchat
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
@tony_breu @JHospMedicine Just “go do many, and more” #JHMchat
Andrew Parsons @andrew__parsons
@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 @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
Avital O'Glasser, MD FACP FHM @aoglasser
@alfandremd @JHospMedicine #JHMchat seeing as student, there was definitely a HUGE negative connotation pointed towards pt
David Alfandre @alfandremd
@JHospMedicine Have been leaving out the #JHMChat hashtag. Sorry! Yes, great question
Avital O'Glasser, MD FACP FHM @aoglasser
@alfandremd @JHospMedicine #JHMchat as an attending, I view more as collective "failure" or lapse in the system working as smoothly as possible for pt...
Rebecca Jaffe @RJmdphilly
#JHMchat no (short and sweet) https://t.co/j1SDhGe9Yl
J 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
J 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? #JHM
Nancy H Stewart DO, MS @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
Tom Wagner @tom_wagner2
@JHospMedicine @WrayCharles Tom Wagner, medicine PGY2, University of Chicago #JHMChat
Rebecca Jaffe @RJmdphilly
#JHMchat brings up issue though - if the patient not asking to leave, it can't really be AMA right? https://t.co/AyHBD9p7sN
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly #jhmchat bingo
Andrew Parsons @andrew__parsons
@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
J Hospital Medicine @JHospMedicine
Glad to have you on-board, Jay! Please jump in #JHMchat https://t.co/MSJ2owdMN6
Grace Farris MD @gracefarris
@alfandremd @JHospMedicine As an intern— “just let them go” #JHMchat
Rebecca Jaffe @RJmdphilly
RT @JHospMedicine: .@alfandremd, Your thoughts on this? #jhmchat https://t.co/NVyXeKwTR1
J 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 per…
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 @andrew__parsons
@aoglasser @alfandremd @JHospMedicine #JHMChat agree 100%
Nancy H Stewart DO, MS @nvhstewart
Interesting. Isn’t this also a #patientsafety issue ? #jhmchat #ama https://t.co/0Zz4vkQUQe
J 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
Avital O'Glasser, MD FACP FHM @aoglasser
RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their a…
J Hospital Medicine @JHospMedicine
RT @alfandremd: @JHospMedicine Would humbly suggest that we as clinicians always have choices. #JHMChat
J 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 per…
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 @nvhstewart
@gracefarris @alfandremd @JHospMedicine Heard this one many times 😔 although not the best for #patientsafety #ama #jhmchat
Rebecca Jaffe @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
J 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 a…
Avital O'Glasser, MD FACP FHM @aoglasser
@nvhs0401 #jhmchat yup. may be safety issue for other pts on unit, unit staff, plus risk overdose
David Alfandre @alfandremd
Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMchat
Tom Wagner @tom_wagner2
@JHospMedicine T1a I will mention it to pt once trying to convince them to stay has begun to compromise the care of the other pts on service 1/2 #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @RJmdphilly: @IvyM808 #JHMchat I think this is one of the key issues. Have to know if informed consent is really possible. For AMA and…
Grace Farris MD @gracefarris
@alfandremd @JHospMedicine Things we can control, influence and improve and things we can’t #JHMchat but we can always try to optimize
Avital O'Glasser, MD FACP FHM @aoglasser
RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMch
J 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
@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. #JHMch
Nancy H Stewart DO, MS @nvhstewart
RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their a…
Society of Hospital Medicine @SocietyHospMed
Don't forget to claim #CME after tonight's #JHMChat! Fill the evaluation here: https://t.co/Ef1q4nNAaN
Andrew Parsons @andrew__parsons
@tony_breu @JHospMedicine @alfandremd @IvyM808 #JHMChat isn’t this a different issue though? Important one, no doubt
J Hospital Medicine @JHospMedicine
RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMch
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
Avital O'Glasser, MD FACP FHM @aoglasser
RT @tony_breu: @alfandremd Very important. It may be irrational for the patient to desire discharge. But, this doesn't equate to a…
Grace Farris MD @gracefarris
@RJmdphilly #JHMchat they call this an “administrative discharge” in NYC. But aren’t *all* discharges administrative?
Andrew Parsons @andrew__parsons
RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their a…
Nancy H Stewart DO, MS @nvhstewart
RT @laxswamy: @gracefarris @alfandremd @JHospMedicine The fact that AMA is enticing to interns -and it most definitely is- shows…
J Hospital Medicine @JHospMedicine
RT @laxswamy: @gracefarris @alfandremd @JHospMedicine The fact that AMA is enticing to interns -and it most definitely is- shows…
Joanna @steinglmd
RT @alfandremd: @IvyM808 I like to tell housestaff, the patient decides to leave, you decide to discharge them AMA. Remind them of their a…
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
Grace Farris MD @gracefarris
@tony_breu @JHospMedicine @alfandremd @IvyM808 Yet in other #Jhm study 80% had signed AMA form, only 20% w capacity evaluation documented #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@gracefarris @RJmdphilly #JHMchat how about when pt asks to leave (room to talk), v says "I'm leaving" (no room to talk), or elopes/leaves without telling anyone...
Grace Farris MD @gracefarris
@alfandremd @IvyM808 A black pearl #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
J Hospital Medicine @JHospMedicine
Great discussion and insights on T1. Onto Theme/topic 2...the effects of AMA on patient care #JHMchat
Rebecca Jaffe @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
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: @tony_breu @JHospMedicine @alfandremd @IvyM808 Yet in other #Jhm study 80% had signed AMA form, only 20% w capacity…
J 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
Grace Farris MD @gracefarris
@FutureDocs I still hear this myth from residents even tho debunked #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @RJmdphilly: @andrew__parsons @tony_breu @JHospMedicine @alfandremd @IvyM808 #JHMchat I'd argue it is the first part of the AMA…
Ivy Melgarejo @ivym808
@JHospMedicine T2a: they will likely do the same thing on the next admission. #jhmchat
Andrew Parsons @andrew__parsons
@ericschul @JHospMedicine #JHMchat same here. But why ask to sign vs just click discharge? No reason for ama imo
Joanna @steinglmd
RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMch
Avital O'Glasser, MD FACP FHM @aoglasser
T2a #JHMchat incomplete therapy ex pt w bacteremia, ends up at different hospital days/weeks later with endocarditis with tons septic foci
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 @RJmdphilly
RT @alfandremd: Remember that capacity evaluation assesses not the decision but the process by which the patient makes the decision. #JHMch
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
Avital O'Glasser, MD FACP FHM @aoglasser
T2a #JHMchat also loss of chance to connect pt w PCP/SW/resources
Grace Farris MD @gracefarris
@tony_breu @JHospMedicine @alfandremd @IvyM808 By “presume” do u mean “hope”? #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
J Hospital Medicine @JHospMedicine
Would be incredibly interesting to see this example described in detail/research #JHMchat https://t.co/1A5oMCOd8p
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat my last AMA discharge w pt with > 80 ER visits this calendar year; & it was patient initiated, plus wouldn't stay for DC scripts
Lakshman Swamy @laxswamy
I have cared for employees fearing for their jobs if they leave AMA. #JHMchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2a: What effects have you seen on patients who were discharged AMA? #jhmchat
J Hospital Medicine @JHospMedicine
RT @FutureDocs: The crusade to address myths regarding @CostsofCare for AMA discharges continues #JHMchat https://t.co/woJRtlLSZL
Avital O'Glasser, MD FACP FHM @aoglasser
RT @alfandremd: @andrew__parsons @ericschul @JHospMedicine in general, we don't ask for patient's signature to decline a medical tr…
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: 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
Grace Farris MD @gracefarris
@alfandremd @JHospMedicine Saw this scene last week— how does this improve care? #JHMchat https://t.co/XEZ4aegPUq
J 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 edit…
Grace Farris MD @gracefarris
@tony_breu @JHospMedicine I still get a lot of “can we discharge AMA?” #JHMchat
J Hospital Medicine @JHospMedicine
RT @gracefarris: @alfandremd @JHospMedicine Saw this scene last week— how does this improve care? #JHMchat https://t.co/XEZ4aegPUq
Avital O'Glasser, MD FACP FHM @aoglasser
@JHospMedicine #JHMchat my 2nd to last "AMA" dc was pt with MSSA bacteremia, epidural abscess. disappeared from unit, answered phone at home 3 hrs later
David Alfandre @alfandremd
@JHospMedicine We know AMA discharges increases readmit,but interestingly, it also decreases readmit because patients report reluctance to return #JHMChat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @gracefarris: @alfandremd @JHospMedicine Saw this scene last week— how does this improve care? #JHMchat https://t.co/XEZ4aegPUq
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: @alfandremd @JHospMedicine Saw this scene last week— how does this improve care? #JHMchat https://t.co/XEZ4aegPUq
Lakshman Swamy @laxswamy
@aoglasser Yes- we can and should talk about shared decision making, but patients are people. They sometimes just make bad choices. #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @mahoneyr: T2 #JHMChat one of the biggest risks to patients who leave AMA is the (often false) beliefs of the providers who discharge th…
J 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 @nvhstewart
This is a sad reality for so many #patients leaving #AMA #jhmchat https://t.co/pNPAPlfjlx
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy love that sentiment #JHMChat
Grace Farris MD @gracefarris
@JHospMedicine Have seen this pt #JHMchat
Madhu S. MD @thinkalot
#jhmchat T2 AMA DC are a symptom of loss of trust between patient, clinician 1/x
Avital O'Glasser, MD FACP FHM @aoglasser
RT @laxswamy: @aoglasser Yes- we can and should talk about shared decision making, but patients are people. They sometimes just make bad ch…
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 negati…
Guilherme Barcellos @brhospitalist
#JHMChat Interesting to see that you deal with the same myths them we in Brasil
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy sometimes we all made sub-par decisions, esp with life presents us with competing forces & demands #JHMChat
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
J Hospital Medicine @JHospMedicine
T2b: @alfandremd, what effects should clinicians be aware of? (tho you're beating me this question in prev responses :) #JHMchat
J Hospital Medicine @JHospMedicine
RT @thinkalot: #jhmchat T2 AMA DC are a symptom of loss of trust between patient, clinician 1/x
Avital O'Glasser, MD FACP FHM @aoglasser
RT @FutureDocs: High workloads such that patients become numbers and any discharge is a discharge #JHMchat https://t.co/puiLg2TDfL
Tony Breu @tony_breu
@JHospMedicine @alfandremd Associated with quick "bounceback" #JHMchat https://t.co/O914dHKpn0 https://t.co/0xvsWnPtOo
Rebecca Jaffe @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
J 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. #JHMC
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2b: @alfandremd, what effects should clinicians be aware of? (tho you're beating me this question in prev responses :)…
J Hospital Medicine @JHospMedicine
RT @alfandremd: @JHospMedicine There is limited qualitative data on patient's perspective on AMA discharges, but almost all of it is negati…
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
Grace Farris MD @gracefarris
@brhospitalist Oi Guilherme! Bem vindo!! #JHMchat
VGeslaniMD @vgeslanimd
Resonates with many. https://t.co/1C9MRfvrfE
Lakshman Swamy @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 @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
Avital O'Glasser, MD FACP FHM @aoglasser
RT @RJmdphilly: I hear this a lot. #JHMchat "patient w hx of frequent AMA." Another ex of implicit bias https://t.co/JwcmfZl754
Madhu S. 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
J 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 @RJmdphilly
@laxswamy @aoglasser =))) winning #JHMchat
Lakshman Swamy @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
Madhu S. 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
Grace Farris MD @gracefarris
@laxswamy @aoglasser But court dates, immigration ppwk, poor management of drug dependence inpt makes sense to me #JHMchat
J 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
J Hospital Medicine @JHospMedicine
RT @alfandremd: @JHospMedicine @WolfsonD Designating a discharge as AMA has never been shown to advance patient's care. We do have…
Rebecca Jaffe @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
Avital O'Glasser, MD FACP FHM @aoglasser
@gracefarris @laxswamy #JHMchat bingo
Lakshman Swamy @laxswamy
@gracefarris @aoglasser Definitely. But it doesn’t always have to make sense for it to be legitimate. #JHMchat
Grace Farris MD @gracefarris
@JHospMedicine @alfandremd @WolfsonD Yes. Let’s abandon it. Especially w it’s veneer of legal protection #JHMchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2c: Should we consider AMA DCs a Low-Value process? @alfandremd @WolfsonD #JHMchat
Nancy H Stewart DO, MS @nvhstewart
RT @alfandremd: @JHospMedicine Clinicians should be aware of how a prior AMA discharge may affect their decision making for a current admis…
Madhu S. 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: 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 @andrew__parsons
@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
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat T2c re low value care, very often we "thrust" paper Rx for po abx at pt leaving, ID will later say low efficicacy, risk resistance
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal proble…
Rebecca Jaffe @RJmdphilly
RT @alfandremd: @JHospMedicine There is limited qualitative data on patient's perspective on AMA discharges, but almost all of it is negati…
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
J Hospital Medicine @JHospMedicine
Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj
Avital O'Glasser, MD FACP FHM @aoglasser
RT @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/OvDXcp…
J 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…
Madhu S. 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
J Hospital Medicine @JHospMedicine
RT @andrew__parsons: @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system =…
Ivy Melgarejo @ivym808
RT @andrew__parsons: @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system =…
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 motivat…
Madhu S. MD @thinkalot
RT @JHospMedicine: Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj
J Hospital Medicine @JHospMedicine
T3a: What strategies do you utilize when DCing a patient AMA? #JHMchat
Madhu S. 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/OvDXcp…
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
Avital O'Glasser, MD FACP FHM @aoglasser
T3a #JHMchat harm-reduction model
Andrew Auerbach @ADAuerbachMD
RT @alfandremd: @JHospMedicine @WolfsonD Designating a discharge as AMA has never been shown to advance patient's care. We do have…
Madhu S. MD @thinkalot
Indeed. #sdoh is huge in AMA DC https://t.co/tvmSvDedlY
Avital O'Glasser, MD FACP FHM @aoglasser
we've gone so far as to include the "if then" pending AMA discharge on night float sign out #JHMchat T3a
J 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
RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal proble…
Madhu S. 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
Avital O'Glasser, MD FACP FHM @aoglasser
T3a #JHMchat and may even have paper Rx ready at RN station so covering intern doesn't have to attempt the conversation in isolation
Madhu S. 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
Tom Wagner @tom_wagner2
RT @tony_breu: @VGeslaniMD Best article on the topic. Table has great questions to ask #JHMchat https://t.co/C5Ob3f29fL https://t.co/OvDXcp…
Rebecca Jaffe @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 @nvhstewart
RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine This is true. When people are admitted because of societal proble…
Madhu S. 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 @nvhstewart
RT @IrfanDhalla: There is a very interesting journal club going on right now at #JHMChat, on the topic of patients leaving hospital against…
Grace Farris MD @gracefarris
@alfandremd @JHospMedicine @WolfsonD I think form is misleading. There is no aspect of AMA discharge or form that absolves doc in medico-legal scenario #JHMchat
Guilherme Barcellos @brhospitalist
RT @JHospMedicine: Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj
Avital O'Glasser, MD FACP FHM @aoglasser
@tony_breu @JHospMedicine @laxswamy #JHMchat SW has been crucial w some AMA dc's, esp with active addiction involved. Give list resources, call pt afterwards
Grace Farris MD @gracefarris
@alfandremd @JHospMedicine @WolfsonD Better to spend time documenting capacity and risk benefit discussion #JHMchat
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 @nvhstewart
RT @andrew__parsons: @JHospMedicine @alfandremd @WolfsonD #JHMChat no proven benefit + emerging evidence of harm + obvious neg to system =…
J Hospital Medicine @JHospMedicine
In AMA DC, do you prescribe or provide DC meds? #JHMchat
Grace Farris MD @gracefarris
RT @JHospMedicine: Nice summary of how/why Against Medical Advice Discharges are Low Value care #JHMchat https://t.co/50tGjdxGcj
Lakshman Swamy @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, MD, PhD @ZackBergerMDPhD
RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #JHMchat
Grace Farris MD @gracefarris
@JHospMedicine 1. Capacity eval 2. Risk benefit discussion 3. Document 4. “You are always welcome to return—you know where we are!” #JHMchat
Madhu S. MD @thinkalot
Merits a conversation for sure. An opportunity to make things better https://t.co/d2vbz9cIyB
Avital O'Glasser, MD FACP FHM @aoglasser
@laxswamy @gracefarris @alfandremd @JHospMedicine #JHMchat my last 3 AMA dcs-the residents paged me stat the second things started brewing, was to talk to at least 1 pt. takes a village
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 @andrew__parsons
@gracefarris @alfandremd @JHospMedicine @WolfsonD #JHMChat great point!
Lakshman Swamy @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
J 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 dysfunc…
David Alfandre @alfandremd
@JHospMedicine Depends on what kinds of meds #JHMChat . but yes, should provide a treatment consistent with accepted standards.
Rebecca Jaffe @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
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
Nancy H Stewart DO, MS @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
Avital O'Glasser, MD FACP FHM @aoglasser
@ctiMD @ClaireSevovMD #JHMchat often the biggest issue for us is if the patient will wait for you to generate a script, not whether to give or not
J 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
Grace Farris MD @gracefarris
@ClaireSevovMD @aoglasser There is an ethics “best practices” on this. Making a safe dc plan w scripts and appts rev #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @alfandremd: @JHospMedicine Request to leave AMA is often an "opportunity" to discuss the patient's concerns about the treatment…
Tony Breu @tony_breu
@nvhs0401 @gracefarris @alfandremd @JHospMedicine @WolfsonD Thank you for saying this! #JHMchat
Guilherme Barcellos @brhospitalist
RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #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…
Nancy H Stewart DO, MS @nvhstewart
RT @laxswamy: @mahoneyr @gracefarris @alfandremd @JHospMedicine As an example of making the most of a hospitalization re societal…
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat yes this, all of this https://t.co/jAeRoiC6J8
J Hospital Medicine @JHospMedicine
RT @alfandremd: @JHospMedicine Depends on what kinds of meds #JHMChat . but yes, should provide a treatment consistent with accepted stan…
Avital O'Glasser, MD FACP FHM @aoglasser
RT @tony_breu: @gracefarris @alfandremd @JHospMedicine @WolfsonD True. Spent time on a well written note outlining discussion with…
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
Avital O'Glasser, MD FACP FHM @aoglasser
RT @nvhs0401: @tony_breu @gracefarris @alfandremd @JHospMedicine @WolfsonD We should make sure to try to spend just as much time…
Robert J. Mahoney, MD @mahoneyr
@RJmdphilly But repeated AMA discharges (often involving multiple teams) suggest more than team dynamics. #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
RT @gracefarris: @JHospMedicine 1. Capacity eval 2. Risk benefit discussion 3. Document 4. “You are always welcome to return—you know where…
J Hospital Medicine @JHospMedicine
@nvhs0401 @tony_breu @gracefarris @alfandremd @WolfsonD Some would argue that you need to spend more (w/patient) #JHMchat
Lakshman Swamy @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
Grace Farris MD @gracefarris
RT @JHospMedicine: In AMA DC, do you prescribe or provide DC meds? #JHMchat
Andrew Parsons @andrew__parsons
@RJmdphilly @alfandremd @JHospMedicine @WolfsonD #JHMChat document document document
Rebecca Jaffe @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
J Hospital Medicine @JHospMedicine
T3b: Does your hospital have any systems or procedures in place for AMA DC? #JHMchat
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat yes this, all of this https://t.co/jAeRoiC6J8
Vinny Arora MD MAPP @FutureDocs
@alfandremd @gracefarris @JHospMedicine @WolfsonD legal implications AMA Dc seem like an area poorly understood #JHMchat
Grace Farris MD @gracefarris
RT @tony_breu: @JHospMedicine Yes. Otherwise we are abandoning or leading to coerced continued hospitalization ("I won't give meds…
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
Madhu S. MD @thinkalot
Sometimes folks just hate each others guts. Especially with sleep disruption disagreements balloon out of proportion https://t.co/7XE0EaVmQw
Avital O'Glasser, MD FACP FHM @aoglasser
@IvyM808 @JHospMedicine #JHMchat antibiotics, antiHTNives, prior home meds, inhalers--almost certainly yes centrally acting/controlled substances--almost 100% no
Nancy H Stewart DO, MS @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
@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
J 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.c…
Avital O'Glasser, MD FACP FHM @aoglasser
@gracefarris @ClaireSevovMD #JHMchat even w non AMA dcs, there's a "transitions of care", doesn't end second pt leaves hospital inpatient census 1/2
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: 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
Avital O'Glasser, MD FACP FHM @aoglasser
@gracefarris @ClaireSevovMD #JHMchat even a "good" DC needs call to PCP, f/u plan for pt, perhaps other follow-through. Same could apply for AMA discharges 2/2
Rebecca Jaffe @RJmdphilly
RT @tony_breu: @VGeslaniMD Best article on the topic. Table has great questions to ask #JHMchat https://t.co/C5Ob3f29fL https://t.co/OvDXcp…
Madhu S. MD @thinkalot
RT @JHospMedicine: excellent point. Not all meds are created equal #JHMchat https://t.co/Es7CcqffGQ
Grace Farris MD @gracefarris
RT @alfandremd: @ctiMD @ClaireSevovMD @aoglasser Some may feel they are complicit with the patient's inadvisable medical decision.…
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/…
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 @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
Shannon McNamara, MD @ShannonOMac
@gracefarris @FutureDocs @alfandremd @JHospMedicine "You are in charge of when you leave. I'm concerned because... I will be discharging you AMA bc of concern." + DC plan & meds. #jhmchat
J Hospital Medicine @JHospMedicine
RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine Interns hope for many things. Much of the attending's job is to s…
Lakshman Swamy @laxswamy
RT @mahoneyr: @laxswamy @gracefarris @alfandremd @JHospMedicine Interns hope for many things. Much of the attending's job is to s…
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
J Hospital Medicine @JHospMedicine
And therein lies the rub... #JHMchat https://t.co/Io5NHSenki
Rebecca Jaffe @RJmdphilly
and find out as much as possible about why they are leaving. #JHMchat https://t.co/121oM9Gd2n
Avital O'Glasser, MD FACP FHM @aoglasser
RT @RJmdphilly: and find out as much as possible about why they are leaving. #JHMchat https://t.co/121oM9Gd2n
Avital O'Glasser, MD FACP FHM @aoglasser
RT @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…
lauren meade @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
@tony_breu @FutureDocs Not easily done, to reschedule scans, consults, procedures... But often it is possible. But. It. Is. Just. So. Hard. #JHMchat
Grace Farris MD @gracefarris
@alfandremd @ctiMD @ClaireSevovMD @aoglasser Harm reduction mentality is key. Didn’t learn abt this in med school #JHMchat https://t.co/tDvifMkIZ8
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 @RJmdphilly
because really its all about #handoffs #JHMchat https://t.co/ZtQWWwyuLo
lauren meade @laurenbmeade
RT @gracefarris: @JHospMedicine 1. Capacity eval 2. Risk benefit discussion 3. Document 4. “You are always welcome to return—you know where…
J 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
Grace Farris MD @gracefarris
@RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD In #jhm Oakland study most pts told someone they were planning to leave in advance #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
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat final thought-recent dc I refused to label AMA-pt left days before ideal, but gave us 24hr notice that he was leaving next day
J Hospital Medicine @JHospMedicine
RT @RJmdphilly: because really its all about #handoffs #JHMchat https://t.co/ZtQWWwyuLo
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat we had anticipated something like that, had time to fill Rx's and make f/u appt with specialists
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 advers…
Andrew Parsons @andrew__parsons
@dr_jaybrenner @WolfsonD #JHMChat take home point
Rebecca Jaffe @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
Avital O'Glasser, MD FACP FHM @aoglasser
#JHMchat someone asked me why we "didn't make him sign out AMA"--but there was communication & shared decision making
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
Madhu S. MD @thinkalot
I try my best to work out an amicable plan which works for patient https://t.co/YVewVB8Xv5
Lakshman Swamy @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
J Hospital Medicine @JHospMedicine
RT @aoglasser: #JHMchat final thought-recent dc I refused to label AMA-pt left days before ideal, but gave us 24hr notice that he was leavi…
J Hospital Medicine @JHospMedicine
RT @tony_breu: @gracefarris @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD We get "warning shots" and tend to ignore t…
J Hospital Medicine @JHospMedicine
RT @alfandremd: Also, establishing expectations on day of admission. That can help patient appreciate LOS. #JHMchat
Nancy H Stewart DO, MS @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
Avital O'Glasser, MD FACP FHM @aoglasser
@mahoneyr @laxswamy @VGeslaniMD #JHMchat one of my favorite articles EVER, give it out everytime I attend inpatient https://t.co/VQhIczwDIh
Rebecca Jaffe @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
Grace Farris MD @gracefarris
T3 #JHMChat https://t.co/ysviPStcu5
Nancy H Stewart DO, MS @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 leav…
Avital O'Glasser, MD FACP FHM @aoglasser
RT @alfandremd: Also, get help with your patients suffering from substance use disorders. Biggest barrier to remaining hospitalized. #JH
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
Avital O'Glasser, MD FACP FHM @aoglasser
@alfandremd #JHMchat yes! we have inpatient addiction medicine team now! starting #MAT inpatient @honoraenglander
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
Avital O'Glasser, MD FACP FHM @aoglasser
RT @nvhs0401: Yes! And would add, be cautious w label “difficult pt” if simply bc of #AMA . Let documentation speak. #jhmchat
J Hospital Medicine @JHospMedicine
Very lively and insightful conversation tonight! So much to take in. Big thanks to @alfandremd for joining us! #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: T3 #JHMChat https://t.co/ysviPStcu5
Nancy H Stewart DO, MS @nvhstewart
RT @aoglasser: @mahoneyr @laxswamy @VGeslaniMD #JHMchat one of my favorite articles EVER, give it out everytime I attend inpatient https://…
Grace Farris MD @gracefarris
@FutureDocs @alfandremd @JHospMedicine @WolfsonD Agree. AMA form seems more likely to make doctor appear adversarial #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!
J Hospital Medicine @JHospMedicine
Here it is, ladies & gentlemen! #JHMchat https://t.co/usWR8XfhPV
J Hospital Medicine @JHospMedicine
RT @SHMLive: Thanks to our partners @ABIMFoundation @CostsofCare for your support! #JHMChat
J 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
@aoglasser @mahoneyr @VGeslaniMD It starts with an AMA story. Perfect ! #jhmchat
Rebecca Jaffe @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
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs #JHMchat not just pets. Rent coming due, picking up checks... life happens, and then you get sick!
J 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 @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 Purp…
Tony Breu @tony_breu
@JHospMedicine @jeannemfarnan @oliver_hulland Will this bleed into noon conference? #JHMchat
Grace Farris MD @gracefarris
@tony_breu @RJmdphilly @mahoneyr @JHospMedicine @alfandremd @WolfsonD In the other #jhm study 70% left during normal hrs (daytime) #JHMchat
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @FutureDocs #JHMchat not just pets. Rent coming due, picking up checks... life happens, and then you get sick!
J Hospital Medicine @JHospMedicine
RT @alfandremd: Thanks everyone for your thoughtful comments. I learned lots. Let's keep the conversation and the research going! #JHMch
Jay Miller Brenner @dr_jaybrenner
@andrew_parsons was describing a pt leaving without being discharged (LWBD). This is a different situation from AMA. #jhmchat
Grace Farris MD @gracefarris
RT @alfandremd: @gracefarris @ctiMD @ClaireSevovMD @aoglasser My experience is that many find the idea of harm reduction philosophi…
Vinny Arora MD MAPP @FutureDocs
Why people need insurance ! but that could be a whole other #JHMchat https://t.co/Fv3SZOJXKC
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
Rebecca Jaffe @RJmdphilly
Take homes: twitter chat on desktop much harder to keep up! #jhmchat
Grace Farris MD @gracefarris
@alfandremd @ctiMD @ClaireSevovMD @aoglasser That’s a nonjudgmental way to put it! #JHMchat
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly use tweetdeck! makes it SO much easier :) #JHMchat
David Alfandre @alfandremd
@WolfsonD To consider AMA as a patient problem only is short sighted.Physician components, hospital components,environmental components, etc.#JHMChat
Grace Farris MD @gracefarris
#JHMChat https://t.co/rowOGEIskh
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! #JHMch
Madhu S. MD @thinkalot
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
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
J Hospital Medicine @JHospMedicine
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
Rebecca Jaffe @RJmdphilly
sounds like a fishbone to me. #QI #CauseAnalysis @JeffIMchiefs https://t.co/JneFWpj9Gu
Nancy H Stewart DO, MS @nvhstewart
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
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
Dave Tran, MD @rollkicksoul
RT @FutureDocs: High workloads such that patients become numbers and any discharge is a discharge #JHMchat https://t.co/puiLg2TDfL
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 @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
Vinny Arora MD MAPP @FutureDocs
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
Andrew Auerbach @ADAuerbachMD
RT @JHospMedicine: Mark ur calendars -- #JHMChat will be back 11/27 at 9PM - Discussing @jeannemfarnan & @oliver_hulland's "What's the Purp…
J Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat evaluation is now open: https://t.co/hnvGkelfza
Avital O'Glasser, MD FACP FHM @aoglasser
@RJmdphilly though much harder to do emojis and gifs in tweetdeck... #JHMchat
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 @RJmdphilly
@gretchendiemer @JeffIMchiefs @estewart2099 I know you guys have opinions on this one https://t.co/3EKtwAWvw4
J Hospital Medicine @JHospMedicine
RT @ADAuerbachMD: RT @JHospMedicine: Very lively and insightful conversation tonight! So much to take in. Big thanks to @alfandremd for joi…
Rebecca Berger @RebeccaEBerger
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
Rebecca Jaffe @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
Rebecca Jaffe @RJmdphilly
RT @gracefarris: T3 #JHMChat https://t.co/ysviPStcu5
Lakshman Swamy @laxswamy
#JHMchat totally missed my chance to leave 5 min early against moderator advice.
Emeka C. Anyanwu, MD @emekaanyanwu
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
Vinny Arora MD MAPP @FutureDocs
@laxswamy I left early for bedtime but got readmitted #JHMchat
Grace Farris MD @gracefarris
RT @FutureDocs: Cannot wait #JHMchat post #thanksgiving with the crew https://t.co/9dAlDIHwqT
Rebecca Jaffe @RJmdphilly
@JeffIMchiefs @TJUHospital @RichWebsterTJUH Not an uncommon approach We need this https://t.co/VbqSKkcywQ
Grace Farris MD @gracefarris
RT @ADAuerbachMD: RT @tony_breu: @JHospMedicine @alfandremd Great to have #JHMchat back. Thank you @WrayCharles and @alfandremd for a great…
Vinny Arora MD MAPP @FutureDocs
RT @aoglasser: @alfandremd #JHMchat yes! we have inpatient addiction medicine team now! starting #MAT inpatient @honoraenglander
Tom Wagner @tom_wagner2
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
Avital O'Glasser, MD FACP FHM @aoglasser
@FutureDocs @laxswamy I think my kids just had a semi-intentional supratherapeutic dose of screentime on a school night... #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: #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
Matthew Noe @NoetheMatt
RT @gracefarris: #JHMChat https://t.co/rowOGEIskh
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.