Discharge Against Medical Advice (DAMA):Day 1(A Three days series)

13 April, 2018


Every year, thousands of patients leave the hospital before the treating doctors recommend their discharge and this poses serious clinical, ethical, and legal challenge to the individual doctor as well as the hospital.
Patients who leave the hospital before clinician certification of fitness are referred to as discharge against medical advice (DAMA). This phenomenon of discharges against medical advice is an undesirable but relatively common occurrence worldwide.


Discharge against Medical Advice (DAMA) is a critical problem in hospitalization of patient in which a patient despite medical advice leaves the hospital earlier than due time. This has emerged as a pervasive problem in general hospitals as such incidents lead to frustration and resentment on the part of clinicians and poor outcomes and worsening health of patients and also increases the risk of severity of the illness and readmission.
Since a significant number of these patients have underlying serious diseases and their treatment remains incomplete due to such choice, the risk of complications and problems will be high for them. Hence, when patients check themselves out of the hospital against the advice of the doctors, this should be considered because of a process that has not succeeded, for various reasons, in convincing the patients to continue treatment.


Despite all efforts, some patients/ families refuse treatment or leave the hospital against medical advice. This usually occurs when the patient is angry, afraid, or disoriented or has certain religious beliefs. The other causes for DAMA includes the following:

  • Dissatisfaction with hospital services
  • Higher morbidity and mortality
  • High medical cost, affordability issue
  • Financial constraints or family concerns  
  • lack of significant improvement in medical conditions
  • believe in traditional medicine or cheaper medication
  • long stay at hospital
  • Lack of transparency in hospital billing
  • Lack of communication from Doctors on line of treatment & health improvement
  • Contrary opinion from other Doctors/hospitals on treatment being provided
  • Not happy with treatment or facilities or staff behaviour or line of treatment
When a patient or family leaves the hospital without a full evaluation and complete treatment, everyone involved may suffer as:
  • It leads to deterioration of the patient’s situation or the entailing side effects which can lead to medical complications & death’s
  • It leads to a sense of frustration for the doctors when the advice and recommendations are not heeded by the patient/family
  • The hospital and doctors may be subjected to a lawsuit if the patient later suffers serious morbidity or dies, even if the family left voluntarily or signed out DAMA


  • Providing incomplete information to the patients concerning their conditions
  • Not informing the consequences of an incomplete treatment process or the risks associated with the disease to the patient
  • Inappropriate treatment or improper behaviour by the medical staff or doctors
  • lack of medical specialists who fails to understand their disease
  • Better quality treatment services and creating a suitable environment for patients
  • equipping the emergency department with the facilities needed by patients
  • Keep the patient/family informed on line of treatment & precautions to be taken
  • providing full medical assistance to patient as and when required
  • To raise awareness of the patients regarding the dangers and consequences of leaving the hospital, effective communication should be established and strengthened between patients, doctors and medical staff

DAY 1 (Series DAMA) - Reasons, Outcomes, Do’s & Don'ts
DAY 2 (Series on DAMA) - Strategies for preventing DAMA Discharges
DAY 3 (Series on DAMA) - Case Law & Things to Remember

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