Summary

Discharge against medical advice (DAMA) remains a persistent problem in healthcare where a patient decides to leave the hospital before the treating physician recommends discharge. Irregular discharges are high-risk events with such patients having a higher adjusted risk of readmission and mortality. Existing research in this area has focused heavily on describing patient characteristics associated with DAMA. This has unfortunately served to perpetuate the current notion that leaving against medical advice is deviant behaviour observed in certain groups of predisposed patients, that is, young, male, socially isolated and economically disadvantaged individuals often with concurrent stigmatising medical comorbidities like substance use and/or mental health disorders. This article challenges the reader to instead view DAMA as a failure of the healthcare system to help the patient achieve his or her medical goals. We examine DAMA from a quality lens and describe how it represents a more systemic issue with current healthcare delivery models leading to significant quality gaps in all six dimensions of quality. DAMA could be seen as a product of ineffective and non–patient-centred care that disproportionately impacts vulnerable groups and itself leads to inefficient, untimely, inequitable and unsafe care. We conclude by advocating for a shared patient–healthcare system responsibility model where we replace the term DAMA with ‘premature discharge’ and critically analyse each event to help allow our healthcare systems to better serve our patients.