Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges
Discharge against medical advice (DAMA) can have detrimental effects on patient outcomes. Recently, the diagnosis of posttraumatic stress disorder (PTSD) has been linked with DAMA in the mental health setting. However, PTSD as a risk factor for DAMA in surgical patients has not received much conside...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Anesthesiology |
| Online Access: | http://dx.doi.org/10.1155/2017/3045907 |
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| author | Marek Brzezinski Maren Gregersen Luiz Gustavo Schuch Ricarda Sawatzki Joy W. Chen Grant Gauger Jasleen Kukreja Brian Cason |
| author_facet | Marek Brzezinski Maren Gregersen Luiz Gustavo Schuch Ricarda Sawatzki Joy W. Chen Grant Gauger Jasleen Kukreja Brian Cason |
| author_sort | Marek Brzezinski |
| collection | DOAJ |
| description | Discharge against medical advice (DAMA) can have detrimental effects on patient outcomes. Recently, the diagnosis of posttraumatic stress disorder (PTSD) has been linked with DAMA in the mental health setting. However, PTSD as a risk factor for DAMA in surgical patients has not received much consideration, although such patients may be at risk for triggering or amplification of PTSD symptoms perioperatively. We present the first case report series of three surgical patients with PTSD who left the hospital AMA. These cases differ markedly from DAMA in non-PTSD patients. In all three subjects, the stress of feeling misunderstood by clinicians and the distress of public detainment by hospital security in the setting of chronic PTSD led to aggressive and risky behavior. All three subjects represented a risk to themselves and to others at the time of DAMA. Finally, all three subjects were difficult to contact for follow-up or medical care and missed appointments. |
| format | Article |
| id | doaj-art-74eef5897a784df697da19841452dddb |
| institution | Kabale University |
| issn | 2090-6382 2090-6390 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Anesthesiology |
| spelling | doaj-art-74eef5897a784df697da19841452dddb2025-02-03T01:01:56ZengWileyCase Reports in Anesthesiology2090-63822090-63902017-01-01201710.1155/2017/30459073045907Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique ChallengesMarek Brzezinski0Maren Gregersen1Luiz Gustavo Schuch2Ricarda Sawatzki3Joy W. Chen4Grant Gauger5Jasleen Kukreja6Brian Cason7VA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Neurosurgery Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Surgery Services, 4150 Clement Street, San Francisco, CA 94121, USAVA Medical Center, Anesthesia Services, 4150 Clement Street, San Francisco, CA 94121, USADischarge against medical advice (DAMA) can have detrimental effects on patient outcomes. Recently, the diagnosis of posttraumatic stress disorder (PTSD) has been linked with DAMA in the mental health setting. However, PTSD as a risk factor for DAMA in surgical patients has not received much consideration, although such patients may be at risk for triggering or amplification of PTSD symptoms perioperatively. We present the first case report series of three surgical patients with PTSD who left the hospital AMA. These cases differ markedly from DAMA in non-PTSD patients. In all three subjects, the stress of feeling misunderstood by clinicians and the distress of public detainment by hospital security in the setting of chronic PTSD led to aggressive and risky behavior. All three subjects represented a risk to themselves and to others at the time of DAMA. Finally, all three subjects were difficult to contact for follow-up or medical care and missed appointments.http://dx.doi.org/10.1155/2017/3045907 |
| spellingShingle | Marek Brzezinski Maren Gregersen Luiz Gustavo Schuch Ricarda Sawatzki Joy W. Chen Grant Gauger Jasleen Kukreja Brian Cason Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges Case Reports in Anesthesiology |
| title | Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges |
| title_full | Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges |
| title_fullStr | Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges |
| title_full_unstemmed | Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges |
| title_short | Discharge against Medical Advice in Surgical Patients with Posttraumatic Stress Disorder: A Case Report Series Illustrating Unique Challenges |
| title_sort | discharge against medical advice in surgical patients with posttraumatic stress disorder a case report series illustrating unique challenges |
| url | http://dx.doi.org/10.1155/2017/3045907 |
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