Discharge Against Medical Advice (DAMA) 🏃♂️
Clinical guide for managing discharge against medical advice (DAMA). Documentation, consent, risk assessment, and legal considerations for on-call doctors.
🧠 Definition
- DAMA occurs when a patient chooses to leave hospital before medical staff recommend discharge.
- It may be due to frustration, misunderstanding, personal reasons, or distrust.
📞 What to Ask / Orders to Make
- Why does the patient want to leave? Explore concerns or triggers.
- Is the patient cognitively intact and medically stable?
- Has there been appropriate communication with the team?
- Contact the Registrar and nursing staff to escalate early.
🧾 History
- Establish patient’s reasoning clearly.
- Any history of previous DAMA or similar behaviour?
- Check for misunderstandings, fear, or dissatisfaction with care.
🩺 Examination
- Assess capacity: alert, oriented, understands situation and consequences.
- Check for signs of acute illness, intoxication, or psychiatric distress.
- Ensure vitals are stable.
🔍 Investigations
- Ensure all relevant investigations are up to date if possible.
- Document any pending results that the patient should be made aware of.
💬 Management
- Discuss with patient: risks of leaving, benefits of staying, alternatives.
- Involve senior clinician and, if appropriate, next of kin.
- Offer compromise: outpatient review, temporary leave, or review by social work.
- If patient has capacity and insists on leaving, proceed to DAMA process.
📝 Documentation & Process
- Clearly document that the patient understands the risks and has decision-making capacity.
- Write a note: circumstances, discussions, risks explained, senior input.
- Have the patient sign a DAMA form if willing. If they refuse, document this.
- Inform GP or relevant outpatient service if appropriate.
- Ensure the patient leaves with medications, follow-up advice, or discharge summary if possible.
Note Template
Ready-to-use clinical note structure
🕒 26 / 05 / 2026 — 17:09 ATRP re: Discharge Against Medical Advice (DAMA) Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [relevant comorbidities] 🧾 Hx: • Reason for DAMA • Understanding of risks and consequences • Previous DAMA episodes • Family or social support 🩺 Exam: • Vitals: HR __ BP __ Temp __ RR __ SpO₂ __ • Mental status and capacity assessment 📋 Impression: Patient choosing to leave against advice 📌 Plan: • Discuss risks and document counselling • Attempt to address concerns/barriers • Provide information on follow-up and warning signs • Notify relevant teams and document thoroughly • Arrange safe discharge if possible 👤 [Your Name], [Role] IMC: _______