Thursday, June 9, 2011

471. AMA (Against Medical Advice) Form

Vomiting and diarrhoea in a dog, several times a day and over 2 days.

1. Don't just give an injection and some antibiotics as this may be what the pet owner wants. The owner wants the pet to go home, but in such severe cases, it is best to hospitalise the dog, get IV fluids.

2. Check potassium levels. If it is low, the dog can get hypokalemic which can lead to life-threatening cardiac arrhythmias and death.

The owner insisted on antibiotic injection and oral antibiotics first. If the dog still has vomiting and diarrhoea, she would bring it back. But the dog could not stop vomiting and passed watery stools past midnight. The next day, the angry son came with the owner (the mother) and verbally abused me.

A written form of discharge stating that IV fluids and hospitalisation is advised but the dog owner wants the dog back AMA (Against Medical Advice) would be best. In this case, the mum was rather embarrassed at the son's wanting the money back. I request him to send the dog to another vet for treatment. When the trust is not there and oral allegations of negligence set in, it is best not to continue with the case.

The AMA form is used in human medicine and this may be adapted for use in veterinary medicine as family members who are not present during consultation may start to get litigious when the clinical outcome is not to their favour, due to restrictions imposed or AMA behaviour of the primary caregiver who is present during consultation.

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