February 19, 2024
4 min read
People struggling with addiction cite untreated withdrawal, pain, discrimination and stringent policies as reasons for leaving hospitals against medical advice. We need to take their complaints seriously
At 3 A.M., a high-pitched beep rang on my pager from a patient’s nurse. The page read: “Please come to bedside ASAP. Patient agitated and threatening to leave AMA. Security on their way.”
Like many medical trainees, I have received countless pages like this one. Fred (not his real name), a patient in his 60s with a history of opioid use disorder, was trying to leave “against medical advice,” or AMA. He was admitted to the hospital for opioid withdrawal and to treat pneumonia, which required IV antibiotics.
I ran up three flights of stairs. I hadn’t written down Fred’s room number, but I could immediately tell which room was his: three suited security guards, two nurses and the crackling of walkie talkies were giveaways.
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The next thing I knew security guards were strip searching Fred, going through his belongings and throwing them into plastic bags that brandished the hospital’s logo. His nurse demanded he take off his socks and shirt, and empty his wallet. He grew angry, and as he emptied his wallet, dollar bills fell from his hospital bed to the floor. He threw his socks across the room.
“I found him secretly using a vape pen,” the nurse said. “We needed to search his belongings for any other contraband. It’s a safety concern.”
A vape pen? Not exactly contraband.
The security guards and I tried to deescalate, but Fred could no longer withstand being punished. So he decided to leave. The response to his vaping—a minor infraction that…
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