Can we predict the patient who leaves against medical advice: the search for a method.

Previous attempts to determine a profile of the typical patient who leaves against medical advice (AMA) have been largely unsuccessful. The premature separation from the hospital arouses unresolved feelings in everyone involved, including the patient, and is expensive as well. The theory that a patient left AMA as a result of a malfunction in the contracting process on admission was not replicable in our institution. We found that the largest group of patients leaving AMA was the young male substance abuser, who is usually the most unpopular type of patient. We believe that staff, actively or passively, encourage patients that they do not like to leave AMA. This interpersonal process may be the one which most needs addressing.