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January 2013, Volume 43 Number 1 , p 10 - 11



A patient came to the ED where I work complaining of severe abdominal pain. Upon admission, his abdomen was distended and he had a fever. Initial test results indicated acute pancreatitis. The ED physician wanted the patient to undergo imaging studies but the patient suddenly became uncooperative and demanded that we let him go. Ultimately, after he was informed about the risks of refusing treatment, he signed an "against medical advice" form according to policy and procedure, and left. Given his potentially serious condition, should we have done more to keep him for additional testing and treatment?-T.A., N.Y.If the patient was a competent adult at the time of discharge, you did the right thing. Although the hospital and clinicians have an obligation to keep patients safe, competent patients can't be held against their will. But the question of competency, especially with at-risk populations, can sometimes be a gray area.Patients who may not be competent (for example, because of delirium

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