Citation

Brzezinski M, Gregersen M, Schuch LG, Sawatzki R, Chen JW, Gauger G, Kukreja J, Cason B. Case Rep. Anesthesiol. 2017; 2017: e3045907.

Affiliation

Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue Room C-450, San Francisco, CA 94143-0648, USA.

Copyright

(Copyright © 2017, Hindawi Publishing)

DOI

10.1155/2017/3045907

PMID

28713596

PMCID

PMC5497649

Abstract

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.

Language: en