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Leaving Against Medical Advice (AMA)

A patient with a serious infection requiring IV antibiotics is demanding to leave the hospital. Practice the AMA conversation.

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Mr. Jones in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

1. Learning: The AMA Conversation

Purpose of this Scenario

When a patient with decision-making capacity chooses to leave Against Medical Advice (AMA), it presents a significant ethical and medical challenge. Your goal is not to force the patient to stay, but to engage in a harm-reduction conversation. This involves ensuring the patient is truly capacitant, understands the risks of leaving, and has the safest possible plan for outpatient care.

Key communication strategies include:

  • Explore the "Why": Start with open-ended questions. "I understand you want to go home. Can you tell me more about what's driving that decision?" The reason is often a solvable problem (e.g., a pet at home, a job to get to).
  • Assess Capacity: Gently assess their understanding. "To make sure we're on the same page, can you tell me in your own words what you understand your medical problem to be?" and "Can you tell me what you understand might happen if you leave the hospital now?"
  • State Risks Clearly and Without Jargon: Clearly explain the potential negative consequences of leaving. "My primary concern is that without the IV antibiotics, the infection could get worse, spread to your bloodstream, and become life-threatening."
  • Negotiate a Harm-Reduction Plan: If the patient is adamant about leaving, try to create the safest possible bridge. "I cannot force you to stay. But if you are going to leave, can we agree on a plan? Can I give you a prescription for oral antibiotics and schedule you for a follow-up appointment tomorrow?"

2. Scenario Briefing

Your Objective

You are the hospital physician. Your patient, Mr. Jones, a 50-year-old man with cellulitis and a bloodstream infection, is demanding to leave the hospital. He is clinically improving but still requires IV antibiotics. Your objective is to have the AMA conversation: explore his reasoning, ensure he has capacity, explain the risks, and attempt to negotiate a safer plan.

Patient Background

Mr. Jones is a 50-year-old construction worker admitted two days ago with a severe cellulitis of his leg that has spread to his bloodstream (bacteremia). He is clinically stable and improving on IV antibiotics.

The Conflict: Mr. Jones is the sole proprietor of a small business and feels he "can't afford" to be in the hospital any longer. He is demanding to be discharged with oral antibiotics, which you feel is unsafe at this stage of his infection.

Key Medical Facts

  • Diagnosis: Cellulitis with Staph aureus bacteremia.
  • Current Treatment: IV Vancomycin. He has received 48 hours of treatment. Standard of care is a longer course of IV antibiotics.
  • The Risk of Leaving: Switching to oral antibiotics this early in a bloodstream infection creates a high risk of treatment failure, which could lead to a relapse of the bacteremia, sepsis, and metastatic infections like endocarditis or osteomyelitis.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Assess a patient's decision-making capacity in the context of a request to leave Against Medical Advice (AMA).
  • Articulate the specific risks of leaving with an untreated serious infection, the benefits of staying for IV antibiotic therapy, and potential alternatives (RBA).
  • Formulate a safe and practical harm-reduction plan for a patient who is determined to leave AMA.

What is the primary goal of an Against Medical Advice (AMA) conversation with a capacitant patient?

Which of the following is NOT a required element for determining a patient has decision-making capacity?

For a patient with a serious infection requiring IV antibiotics, what is the most critical risk to communicate if they choose to leave AMA?

When formulating a harm-reduction plan for a patient leaving AMA with a serious infection, which of the following is the MOST important component?