What Does It Mean to Leave “AMA” (Against Medical Advice)?

Leaving an emergency room (ER) or hospital against medical advice (AMA) is common. Studies show that as many as 2% of all hospital admissions end because someone decides to leave AMA. Still, it is a complex issue that affects patients and healthcare providers.

There are many reasons people might want to leave the ER or hospital early. But it’s important to understand how it can put you at risk to leave before you complete testing or treatment. 

You always have the final word on your care if you have decision-making capacity. But we will walk through exactly what AMA means (and doesn’t mean) to help you make sure you’re making the best decision. 

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Prescription Savings Are Just the Beginning

See what other benefits you qualify for—from cashback cards to cheaper insurance.

Unlock Savings

Why do people leave ‘against medical advice’?

AMA is a tricky topic to study, since it is hard for researchers to know the whole picture about why people leave the hospital. But when researchers look at some of the reasons people leave AMA, a few factors show up more than others:

• Personal obligations: You might have other people who depend on you, such as a child or an older adult who lives in your home. 

• Work: Time away from work can be stressful. Job security could be a worry, and time off work might also mean lost income. 

• Disagreement with providers: You may have concerns that your treatment plan isn’t working. You may also want to hear second opinions about the best plan for you. 

• Cost: Many people worry about the cost of medical care, regardless of insurance status. 

• Substance dependence: Studies have shown that people with substance or alcohol use are more likely to leave AMA. 

• Too long of a wait: Providers work as fast as possible to see everyone in need of care. Still, there may be a long wait, particularly in the ER. You might also become restless in the hospital and be eager to get home. 

• Feeling better: If the symptoms that brought you to the hospital improve, you might think you no longer have a reason to be there. 

What does the AMA process look like? 

The process of leaving AMA might not be as smooth as a typical hospital discharge. This is partly because it does not leave your healthcare team the time to plan your departure the way they normally would. But you should do a few things before you leave.

First, you should notify the team of your plans. Your nurse might be the first person you talk to, and they can answer some of your questions. But make sure you get the chance to speak with your primary provider too. 

Second, you should discuss your decision and current medical condition with your healthcare provider. During this discussion, it is important for your provider to explain your treatment plan and why it requires you to remain in the hospital. They should also clearly explain the risks of leaving the hospital early. We provide some tips later on so you know what questions to ask during this discussion.

Also, tell your provider why you want to leave the hospital. There might be resources to help with some of the factors that make it hard for you to stay. Or they may be able to modify your treatment plan in a way that works better for you. 

Read more like this

Explore these related articles, suggested for readers like you.

Do I Really Need a Primary Care Provider? Yes, and Here's Why

What Is Medicare Part A, and What Does It Cover?

ALS Treatment: All Your Options Explained

What You Need to Know About Qalsody

View more

If you ultimately decide to leave, your providers will work quickly to ensure that you have medications for home and outpatient follow-up in place. And finally, you might be asked to sign a paper that explains the risks of leaving the hospital. 

Can someone be kept in the hospital against their will?

In most cases, the hospital cannot force you to stay for treatment. But it is their responsibility to ensure that you have the mental capacity to make medical decisions for yourself. This requires that you can fully understand the risks of leaving the hospital. 

Some examples of conditions that may interfere with someone’s mental capacity are: 

• Severe illness: When someone is very sick, it can impair their ability to think clearly. They might be confused, disoriented, or unaware of their surroundings or circumstances.

• Delirium: Even in the absence of severe illness, people can be temporarily confused and unaware of the implications of their actions. This can occur as a symptom of certain conditions or a side effect of medications.

• Dementia: Not everyone with dementia lacks mental capacity. But advanced dementia can make it hard for someone to make complicated decisions about their medical care. In these cases, a family member is usually given the responsibility of making decisions for them.  

• Mental health conditions: If someone is in the hospital because a mental health condition puts them at risk of hurting themselves or someone else, a healthcare provider can put a temporary hold on their discharge. This is usually followed by a thorough evaluation from a mental health specialist to determine if they are safe to leave. 

Is leaving AMA always a bad idea? 

Personal decisions about healthcare involve a lot more than just treatment plans. Providers understand that each person has individual factors that play into the risks and benefits of their unique situation. So, as you are deciding what’s best for you, it may help to have a full understanding of the potential outcomes and consequences of your options.  

What are the risks of going AMA?

Some of the risks to consider when leaving AMA include:

• Higher readmission rates: Studies have shown that people who leave AMA are about twice as likely to need to come back to the hospital compared to people with a planned discharge. Leaving AMA results in higher readmission rates up to 3 months after discharge. 

• Longer length of stay-on readmission: When people come back to the hospital after leaving AMA, they also tend to stay longer than expected after a planned discharge. In other words, by leaving early, they end up staying in the hospital for a longer period of time in the long run.

• Risk of death: The most serious risk of leaving AMA is a higher risk of death, usually due to the untreated medical condition. Studies show that people who leave AMA are twice as likely to die within a month after leaving compared to those with a planned discharge. 

How does leaving against medical advice affect insurance payments and service costs? 

There is no evidence that insurance companies will not pay for your visit if you leave the hospital AMA. One study confirmed that insurance companies did not deny people’s claims if they left AMA. 

Studies do show that people who leave AMA are more likely to return to the hospital. And when they return, their stays tend to be longer. It isn’t easy to quantify the economic impact of leaving AMA. Still, it may lead to higher costs in the long run that result from delayed care.  

Can you return to the hospital if you change your mind about not following medical advice?

Leaving AMA does not mean that you cannot return to the hospital for care. But if you leave against medical advice and need readmission to the hospital, you will need to go back to the ER before readmission. 

The emergency room is always available. The ​​Emergency Medical Treatment and Labor Act (EMTALA) ensures that anyone who needs it gets medical care in the emergency room.

How to make sure you have all the information before deciding to sign out AMA

When you talk to your provider about your decision to leave AMA, it is important to get all of the information you need to make the best decision for you. This will also decrease the risk of a bad outcome.

Here are some tips that may help:

• If English is not your first language, always ask for a translator. Even if you speak English well, medical terms are confusing. A translator can be a great patient advocate and ensure that you understand all the details of your care. 

• Ask your provider to clarify the goals of your treatment and when they expect to reach those goals. 

• Tell your provider about your concerns regarding personal obligations, work, or finances. Your provider can keep these priorities in mind when developing a care plan. Patient advocates and social workers can also help address and alleviate some of these responsibilities, from arranging care for a dependent to cost-saving strategies.

• Be open with your provider about substance use, including tobacco products, alcohol, or other drugs. Your team can give you medications to treat withdrawal symptoms and make you more comfortable. 

• Ask about options for home care if possible. While the medical system is not set up to provide sporadic hospital care, assisted home care or long-term facilities might be good alternatives to the hospital in some cases. 

Here are some specific questions you can ask when talking to your provider about leaving AMA:

• What are the conditions that you are still treating?

• Can any of these conditions be addressed at home? Why or why not?

• Do you expect any changes to my care or management in the hospital?

• What are some markers you’re looking for to tell you I’m ready to go home?

• Are there medications I’m taking in the hospital that I could take at home?

• What kind of follow-up will I need when I leave the hospital?

• What are the risks of going home?

These are not easy discussions. But remember that your provider’s goal is to help you get healthy. Honesty from both sides is the best way to help you and your provider work together to keep you as safe and healthy as possible. 

Why trust our experts?

Written by:

Sarah Studyvin, DO, MPH

Sarah Studyvin, DO, MPH, is training to be an adult congenital heart disease cardiologist. She is a board-certified doctor in internal medicine and pediatrics.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Our editorial standards

Meet our experts