By Dr. Katie E. Golden, MD
More than ever, people are participating in the decisions surrounding their medical care. And in turn, many doctors are making an effort to educate their patients about the risks and benefits of their treatment options.
This way the patient has the necessary information to make the best decision for themselves. These conversations between a patient and their doctor are referred to as ‘shared medical decision-making’ discussions. And most doctors agree they are an important part of delivering the best care possible.
But what happens when your choice goes against your doctor’s recommendation? If you have been in this position, you may have been asked to sign a form that states you are choosing to go ‘against medical advice (often abbreviated to ‘AMA’). In its best light, this form supports both the patient and the doctor. It ensures the patient understands the risks associated with declining a recommended course of action. And for the doctor, it documents their recommendation and the patient’s decision for the medical record. But all too often, the AMA form is portrayed in a negative light that highlights a patient-doctor disagreement and the need for legal protection.
But it doesn’t have to be this way. And the AMA form can be used as a tool for patient education and communication. So here, I would like to better explain the ‘against medical advice’ process. So patients understand what it means for their medical care when they sign this form. And more importantly, what it doesn’t have to mean for their care and their relationship with their doctor.
When is AMA used?
Anytime someone declines a recommendation from their provider, they may be asked to sign an AMA form. Common examples when this happens include when a patient chooses not to:
- Go to the ER for evaluation of a possible emergency. Like when their doctor tells them to go to the ER because they are having worrisome chest pain.
- Be admitted to the hospital for treatment. This is a common one because most people do not like staying in the hospital.
- Have a certain test performed, like a CT scan or an MRI.
- Consent to a procedure. This can be something minor like stitches or a bigger procedure like a pacemaker implant.
Of course, many patients will agree to their provider’s recommendations. But not always follow up or take their medications as recommended. For example, they may not show up for their scheduled MRI. Or they may miss a couple of days of their blood pressure medication. These are not scenarios where the AMA distinction is necessary.
What does AMA mean for me?
When the AMA process is initiated, all it requires from you is to sign a form verifying your decision. The main intent of this form is to document the discussion between you and your provider. It does not impact your care moving forward. In fact, it can be a helpful tool to encourage an honest risk and benefit discussion. And to ensure you have a clear understanding of the reasoning behind your provider’s recommendation, and any associated risk with your decision.
What does it NOT mean?
Perhaps more important than understanding what the AMA form means for you, it is helpful to know what it doesn’t mean. The AMA process is not intended to have any negative consequences on your care. It does not mean that:
- Your provider necessarily disagrees with your choice. For example, your provider may recommend you be admitted to the hospital. But they may also understand and agree with the reasons you decide to go home instead.
- You are making a bad decision. Again, every treatment should cater to the needs and priorities of the individual. And even if a decision is labeled with the AMA stamp, it can still be the best choice for you.
- You will be treated differently by your providers. Again, providers respect their patient’s autonomy and right to make the best decision for themselves.
- You can’t change your mind. If you choose to go against a formal recommendation, you can still change your mind at any time. The form does not hold you to your original decision.
- That your health insurance reimbursement will change. Patients are sometimes misinformed that their insurance coverage may be affected by their decision, but evidence shows this has never been the case.
While it can feel unnerving to sign a form warning you of the risks of your medical decision, try not to let it create a negative frame of mind. Instead, remember that it can be a helpful tool to encourage a frank risk-benefit discussion with your provider. And a way to ensure you have all the information you need to make a decision. If you feel uneasy about it, take the time to talk to your provider more about your options. At the end of the day, only you can know what is best for you.