Theme | Quote |
Drug-seeking patients7 | PT: ‘The time I left before, I was in active addiction, and somebody … left me some money, and I went to go grab that money and to go get high, so I left the hospital.’ |
MD: ‘Sometimes they’ll say “morphine's not working, I need to go get a hit.” Some of them are honest about it.' | |
RN/SW: ‘We have had some patients also that want to leave that are having withdrawal symptoms from drugs or alcohol and they feel they need to leave so that they can go out and get something that helps them because (we are not managing their pain symptoms).’ | |
Pain management | PT: ‘I feel like [the teaching hospital] is very prejudice against drug addicts…whether you White or Black…if you tell them that drugs is in your story, it just doesn't matter, they just tend to treat you differently and I'm trying to explain to them, my pain, the level of pain that I'm experience, and none of that really was important to them, so I left.’ |
MD: ‘…we kind of have certain things we think about in terms of a patient feeling well enough to go out. For them, it might be well enough to go use drugs, as opposed to well enough to let's say, have some chronic condition…more adequately managed.’ | |
RN/SW: ‘Not getting adequate pain control (is a reason why patients leave against medical advice)’ | |
Other obligations5 | PT: ‘I also left because I got a 5-year-old daughter that I got sole custody of, and sometimes things don't work with babysitters, they give me a call and I gotta turn around and leave and go get my daughter.’ |
MD: ‘…they have something important they need to do, which is a common reason they cite. Whether it's actually something important like paying rent, making sure someone's out doing their stuff, having to go to a court date, OR they need to get out and get a drink of alcohol or shoot heroin, and that's something that they can't tell you, but it's the important thing they need to do.’ | |
RN/SW: ‘I have been presented with patients who really had situations outside of the hospital as reasons why they want to go. With their housing, with their income, and these are things that are very important to them even though we are looking at it from the medical standpoint …’ | |
Wait time16 | PT: ‘…they left me in the room for over three hours and no one came to talk to me after that, right. And I got very agitated about that right there …I'm here and this is the way ya'll treating me? It automatically makes you want to get up and leave.’ |
MD: ‘Unfortunately, we're at a loss too because we don't know exactly when the procedure is going to happen either. So often we're going into the patient's room saying, “Once we find out we'll tell you.” But hours have passed, and I don't underestimate the frustration of hunger. For some patients, you know, it's enough to make them want to jump out of a window. …And so um it's tough because we'd like to be able to tell them um a quick answer, but sometimes we're actually the last to know.’ | |
RN/SW: ‘Also, I have seen… a delay in procedures and somebody is kept NPO, … with nothing by mouth the night before. “You're gonna have your biopsy tomorrow and after that you can leave,” and then for whatever reason the biopsy doesn't happen the next day …, somebody bumps them, an emergency or whatever, and it happens like day after day after day and they're like, I cannot stay here anymore.’ | |
Doctor's bedside manner16 | PT: ‘…He [the doctor] telling me that since the medicine ain't working it's because I'm outside getting high. So if a doctor…telling you that you get high, and you know you don't get high, that kind of hurts your feelings…I left!’ |
MD: ‘An interesting experience I had was a patient who cited that they had things to do, and they left. And I actually ran into them in a store, just later on, they didn't know that I was the physician in the group. And I said, “Hey, what happened?” And they said to me that, um, one of the medical students made a very derogatory comment towards them, and because it was a teaching hospital, they didn't really think they had the recourse to say anything to anyone, so they left, to seek care elsewhere.’ | |
RN/SW: ‘…I hear some of the addicts and such, say “we've got substance abuse issues” and then they wait for their consult and the doctors come in and talk to them like dirt. And [they say] “I cannot believe how they just talked to me, I want to go, I will not stay here.” They have the ability to know when someone is being disrespectful at least. So the intimidation comes from the doctors, I mean, most of the time. I mean sometimes, er, nurses kind of, y'know they don't want to give them pain medication and stuff like that because [we] know they are abusers but the doctors sometimes belittle people.’ | |
Teaching hospital setting | PT: ‘I'm hurting in pain, and I have to be explored by a bunch of students first, before I actually get medical treatment… I can understand that's a teaching programme, but do that somewhere else…don't prolong that patient's pain and agony…that patient is paying good money to come in there and get help, but instead… they paying for that student's training programme… and that's not right!’ |
MD: ‘Unfortunately, in a teaching institution, uh, many levels of education are speaking to the patient and giving them different [opinions]…one person says, “this is bad,” and one is saying ‘this is not really that important’.’ | |
RN/SW: ‘Sub-I's… can't write orders, they can't really make decisions for the patient so they will have to get, or I'll have to bring somebody else. So sometimes the patients don't like that, having the med students, sub-Is.’ | |
Communication16 | PT: ‘I mean you're told one thing by one person, and then next thing you know, you got half a dozen other people coming in telling you something different. You know, what are you supposed to believe, …and how are you supposed to have confidence in somebody that's supposed to be trying to help your health to get better if you're being contradicted all the way up and down the line.’ |
MD: ‘some patients say that as the reason why they are going to leave. They say, “Ahh, you guys don't communicate with each other, I've seen fifty people in my room.”’ | |
RN/SW: ‘…sometimes some providers don't communicate with each other so you might have multiple providers going in to see the patient and they are telling different stories, and then the patients get confused and frustrated. I have seen patients get y'know to the point that they just want to leave because they don't think that they are getting adequate care because “… one hand doesn't know what the other hand is doing, am I able to have faith in this place?”’ | |
Other | PT: ‘If they indicate there's no more that I can do, then I understand it's time to go and get some second opinion elsewhere.’ |
PT: ‘I was feeling a little better, and I was suffering from the disease of addiction, and the disease of addiction said it was time to go… That's why I left.’ | |
PT: ‘…the main reasons that I would leave the hospital was I had no medical insurance… I would go to the hospital to get treatment…and once I had all my medication, I would leave because I knew they wanted to keep me for at least 3 or 4 days.’ | |
PT: ‘It was enough to make me leave. You know, because anytime … the sanitation of that area be as bad as it was, that's letting you know something about what they goin' to do with you.’ |
MD, physician; NPO, nil per os; PT, patient; RN, nurse; SW, social worker.