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Can ignoring medical advice hurt your wallet?

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Kai Ryssdal: Largely lost in all the talk about the health care law is that a lot of things haven’t really changed yet. Most of its provisions are going to phase in over time, which means millions of people still don’t have health insurance and health care costs continue to climb.

Commentator and physician John Schumann says conventional wisdom among his peers is sometimes responsible for those rising costs.

John Schumann: Nora, a third-year medical student, came to me in distress. Ms. DiFazio, one of the patients on her hospital rotation, was frightened to undergo an invasive and expensive medical procedure in which a catheter would be inserted into the heart to test whether she had heart disease.

At the bedside, the doctor Nora was shadowing demanded to know why Ms. DiFazio refused the procedure. When no reason beyond “I don’t want to” was offered, the doctor told Ms. DiFazio that there was no longer any reason for her to stay in the hospital.

But by declining the procedure, he informed her she would have to sign out ‘against medical advice’ or AMA. She would have to acknowledge that leaving AMA could result in serious harm or death. And that she would bear responsibility for all hospital charges not reimbursed by insurance because of her decision.

“The threat of a huge hospital bill got Ms. DiFazio to stay and take the test,” Nora told me. “It just seems so wrong to bludgeon a patient this way,” she said. “Can it possibly be true?” Ethically, the notion that patients must do our bidding or pay the price seemed dubious. Yet in a world of co-pays, deductibles, and “preexisting conditions,” the idea seemed plausible.

To find out for sure, I elicited the help of some colleagues and we sifted through nearly 10 years of discharges against medical advice from our teaching hospital. Out of the hundreds of cases we examined, not one resulted in an unpaid bill because of the AMA discharge.

I also went to source and talked with folks from some of the nation’s largest private insurance companies. Each of them told me that the idea of a patient leaving against medical advice and having to foot the bill is bunk: nothing more than a medical urban legend.

So patients beware: The next time you or your loved one has decided that it’s time to leave the hospital, don’t let us doctors coerce you into staying by threatening you with the bill. It simply isn’t true.

Ryssdal: Dr. John Schumann specializes in internal medicine at the University of Oklahoma School of Community Medicine in Tulsa.

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This commentary was originally an essay for Costs of Care, an organization that seeks to curb medical expenses by raising awareness among doctors and patients.

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