Diagnostic correlates of discharge against medical advice

The clinical histories of patients discharged against medical advice from a general hospital were studied to discern important diagnostic correlates of this event. Drug addiction occurred in 22% of the 73 test subjects and in none of 175 random controls. Chronic alcoholism was diagnosed in 42% of patients discharged prematurely vs 15% of controls (P less than .01). Discharge against advice should be considered a clue to the presence of one of these conditions if not previously appreciated. Since both are identifiable chronic disorders, early counseling is recommended to prevent such noncompliant behavior and its consequences for effective hospital care.