More patients leave hosps against medical advice

Chennai: Early this month, standing outside the intensive care unit where her husband Ganesan R, battling a heart disease, lay, a teary-eyed Gayatri made a painful decision.

Against the advice of doctors, she signed the papers, booked an ambulance and took her 65-year-old husband home. He lived for just a couple of days after that but when his family was by his side he breathed his last. "It was painful but we held his hands and bade goodbye," recalls the 62-year-old home maker. The family estimates it would have saved at least 1 lakh it planned to borrow for his stay in hospital.

An increasing number of seriously ill people have been leaving hospital either because they can't afford treatment or because they want to be with their loved ones at the end.

A study by doctors at Apollo Hospitals showed that at least 15% of severely-ill patients leave ICU against medical advice. A team led by critical care expert N Ramakrishnan found that 100 of 600 patients leave the critical care unit of a corporate hospital. A month later, the doctors confirmed that 53% of the patients died and the status of 21% was unknown. "Nearly one-fourth of the patients were alive after one month although we don't know the quality of their lives. Understanding the outcomes of these patients will help refine care at CCUs," said Dr Ramakrishnan.Doctors say the bigger the hospital, the greater the discharge rate. "Tertiary care is expensive and ICU rent alone can go up to 15,000. This is besides the medicines, consultation and procedure fee. There are patients who have spent lakhs of money to see their kin die," said geriatrician Dr VS Natarajan.



But discharge against medical advice isn't always easy. As happened when Suchiammal V, 70, was discharged on request from her family. "It got messy. She was breathless all the time. It was tough to watch a loved one suffer for nearly three weeks. When she left, we were drenched in guilt," said A Victor, her son, who works in an automobile factory.


More importantly, it becomes difficult to get a death certificate from a doctor if the end comes at home. While the Ganeshans were lucky to have a doctor as a neighbour, businessman S Rathinavelu of Valasaravakkam said it took nearly five hours to get death certificate for his 70-year-old mother, who died at home of stomach cancer. "We paid nearly 1,000 to get a certificate. We picked up the doctor from his clinic in Porur and dropped him back," said Rathinavelu.



Although the overall numbers represent only a fraction of hospital patients, most doctors feel the increase in early discharges is more likely an indicator of the intense pressures, including economic and social, patients may face.