The drivers of self-discharge

Anne Sutton Brown's experience does not invalidate the systematic observations made in methodologically rigorous studies such as that by Anis and associates¹ or in other work that I cited in drawing my conclusions.² Nonetheless, these studies are clearly not representative of all experiences. For example, the experiences of HIV-positive patients in Vancouver may not apply to patients undergoing gallbladder surgery in Montréal, and vice versa.

As I stated in my editorial,² “the most important void in the literature on discharges against medical advice is the lack of understanding of why … . Patients need to be interviewed to find out what motivates them to leave.” To fill this gap in the literature, data should be collected systematically, from diverse patient samples and in methodologically sound studies. Some — perhaps many — of the patients in those samples will confirm what Brown has reported. In the meantime, I see no reason to wait to act on the data already provided by high-quality research, which suggest that we should address addictions properly in patients who have them.

Richard Saitz Associate Professor of Medicine and Epidemiology Boston University Schools of Medicine and Public Health Boston, Mass.