Abstract
Past studies have found that up to 1.5 per cent of patients decide not to follow health professionals’ advice and were known to have discharged themselves from hospital [1, 2] This is significant when almost 15 million patients were admitted in the UK between 2009 and 2010 [3]. The reasons given for self-discharge include long waiting time, poor bedside manner, and failure of communication amongst hospital staff [4]. As a result, self-discharge has been framed in negative terms particularly as these patients have higher readmission and in-hospital mortality rates [5]. Yet, self-discharge could be perceived as an expression of patients’ rights. If patients are perceived as duty-bound to follow medical advice, self-discharge could offer a way of ‘equalling’ the balance of power between the two. So, how do self-dischargers and health professionals understand and make sense of the concepts ‘self-discharge’, and ‘self-dischargers’. Findings from an interdisciplinary two year pilot project will be reported. The findings are based on 32 qualitative interviews with self-dischargers and their carers (15) and health professionals (17) at two Northern Hospitals. The interview transcripts have been analysed for emerging themes and theoretical literature surrounding the doctor-patient relationship have been drawn upon to offer insight into the perceived position of the hospital patient, and the perceived role of health professionals within the hospital and community settings.
[1] Henson, V.L. & Vickery, D.S. (2005). Patient self discharge from the emergency department: who is at risk? Emergency Medicine Journal, 22, 499-501.
[2] Ibrahim, S.A., Kwoh, C.K. & Krishnan, E. (2007). Factors Associated With Patients Who Leave Acute-Care Hospitals Against Medical Advice. Am J Public Health, 97, 2204-2208.
[3] National Health Service. Hospital Episode Statistics (admitted patient care) England 2010-11.
[4] Onukwugha, E., Saunders, E., Mullins, C.D., Pradel, F.G., Zuckerman, M. & Weir, M.R. (2010). Reasons for discharges against medical advice: a qualitative study. Quality & Safety in Health Care, 19, 420-424.
[5] Choi, M., Kim, H., Qian, H. & Palepu, A. (2011). Readmission Rates of Patients Discharged against Medical Advice: A Matched Cohort Study. PLoS One, 6, e24459.
Biography
Broadly, my research interests rest within the social and ethical aspects of medicine. I have a particular interest in matters related to the donation of body parts, blood and tissue, the notion of dignity in practice, and research ethics. Throughout my research activities, I adopt an applied approach, whereby I consider the policy and practice implications of the topic under study. My research has tended to be interdisciplinary in nature, drawing on a wide range of literature from medical sociology and ethics, and focused upon accessing hidden populations and interviewing on sensitive subjects.
_
Return to speakers home page
RT