Medical-social factors indicated in a study of six patients who terminated hospital treatment against medical advice

96 Pages·05.387 MB·English

by  Arburua, Josephine Louise

MEDICAL-SOCIAL FACTORS INDICATED IN A STUDY OF
SIX PATIENTS WHO TERMINATED HOSPITAL TREATMENT
AGAINST MEDICAL ADVICE
A Thesis
Presented to
the Faculty of the School of Social Work
The University of Southern California
In Partial Fulfillment
of the Requirements for the degree
Master of Social Work
\
hy
Josephine Louise Arburua
June 1950
UMI Number: EP66319
All rights reserved
INFORMATION TO ALL USERS
The quality of this reproduction is dependent upon the quality of the copy submitted.
In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.
Dissertation Publishing
UMI EP66319
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
Microform Edition © ProQuest LLC.
All rights reserved. This work is protected against
unauthorized copying under Title 17, United States Code
ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, Ml 48106-1346
This thesis, written under the direction of the
candidate’s Faculty Committee and approved
by all its members, has been presented to and
accepted by the Faculty of the Graduate School
of Social Work in partial fulfilment of the re­
quirements for the degree of
MASTER OF SOCIAL WORK
Dean
Dd
Thesis of... JQSEM M ..LQUI.SE .M .B IM &
Faculty Committee
Chairvmri
....7.................
I
(Cf / *
TABLE OF CONTENTS
CHAPTER PAGE
I. THE PROBLEM AND STUDIES OF DISCHARGES AGAINST
MEDICAL ADVICE............... 1
The research problem....................... 1
Statement of the problem . ............... 1
Importance of the study. .............. 2
Problem aspects of irregular discharge ........ 6
For the patient. • • * • » . • • * • • • • • • 6
For the hospital . ............. 10
For the patlent*s family and community • • • • 11
Review of the literature 12
Irregular discharge among tuberculous patients 12
Irregular discharge among general medical
and surgical patients. .................. 19
II. SETTING AND METHOD OF THE STUDY................ . 21
Setting of the study......... . 21
History of Veterans Administration medical
care....................... 21
Locus of the study......... 22
Definition of discharge against medical advice 2?
Method of the study......... 27
Sample of the patients used.................27
Procedure of the case studies...............27
iii
iv
CHAPTER PAGE
III. PRESENTATION AND ANALYSIS OP THE CASE STUDIES . . . 31
Cornelia Waterford...............................32
Oscar Stein................• • • • . ...........35
Henry Parkington....................... • . . . . 4-0
John Gafferty......... 4-4-
Frank Markus................... . . . . . . . . . 4-7
Thomas Kitchens............. *50
IV. ANALYSIS OF FINDINGS FROM THE CASE STUDIES AND
CORRELATION WITH TWO OTHER THESES............... ?4-
Analysis of findings. . . . . .......... • • • • 54-
Concept of continuum........................ .5*+
Medical-social factors........... *59
The meaning of illness to the patient . . . . 60
The meaning of treatment to the patient . . • 61
The meaning of hospitalization to the patient 64-
Social and economic pressures involved in
the discharge
Summary of findings • • • • • • • • • • • • • . 6 7
Findings of two other theses............. ♦ • • • 6 8
Correlation of findings of three theses . . . . . 69
V. THE IMPLICATIONS OF THE FINDINGS FOR MEDICAL
SOCIAL WORK.....................................72
V
CHAPTER PAGE
Summary. . . . . . . . . . . . . . ........... 72
Implications for medical social work. . . . . . 7**
BIBLIOGRAPHY ................................... 85
LIST OF TABLES
TABLE PAGE
I* Percentage of Discharges Against Medical Advice
of Total Discharges per Month, from the Veterans
Administration General Medical and Surgical
Hospital, West Los Angeles, October, 19^9 -
March, 1950 • • * • • • • • • • • • • • • • • • • *+
II* Tabulation of Findings of Three Studies of Medical-
Social Factors in Irregular Discharges. • • « • • 70
vi
CHAPTER I
THE PRGBIiEM AND STUDIES OF DISCHARGES
AGAINST MEDICAL ADVICE
I. THE RESEARCH PROBLEM
Statement of the problem. Most patients who volun­
tarily seek admittance to and treatment in a medical and
surgical hospital do so with the intention of securing maxi­
mum hospital benefit. The few patients who terminate the
experience by leaving against medical advice indicate prob­
lems' for themselves, their families, and for the hospital.
The patient with such a discharge has not only seemed to
vitiate his purpose and that of the hospital, but evidenced
that factors were present in his situation which made secur­
ing full benefit of treatment impossible. These aspects of
such a situation are' the medical-social factors.
The research for this thesis has attempted to discover
the medical-social factors which contributed to the discharge
of six patients who left against medical advice from the
Veterans Administration General Medical and Surgical Hospital
in West Los Angeles, These patients* situations and reasons
for the action, learned In part in an interview after dis­
charge, were studied in detail* The constellation of factors
that precipitated the irregular discharge at the one particu­
lar point of the hospitalization were evaluated.
Becently, medical social work students in the School
of Social Work of The University of Southern California began
a number of related case studies of patients leaving hospi­
tals against medical advice* Of these, two have been com­
pleted, “Medical-Social Factors Involved in Termination of
Hospital Treatment Against Medical Advice,11 by Kathryn Brown
1
Joyce, and “The Social and Emotional Factors in Patients Who
Left the Hospital without Consent: Six Patients in the
2
Infected Obstetrics Ward,” by Jean Browne Sweeley$ and three
others, in addition to this study, are in process* In the
final part of this projeet an effort will be made to corre­
late the findings of the completed studies with this third
one*
Importance of the study. In order to appreciate some
of the numerical significance of the problem of discharge
against medical advice from a general medical and surgical
hospital, statistics were compiled for six months, October,
19^9 through March, 19$0* These are figures of those
Kathryn Brown Joyce, “Medical-Social Factors Involved
in Termination of Hospital Treatment Against Medical Advice,11
(unpublished Master's thesis. The University of Southern
California, Los Angeles, 19**o), 93 PP*
^ Jean Browne Sweeley, “The Social and Emotional
Factors in Patients Who Left the Hospital without Consent:
Six Patients in the Infected Obstetrics l&rd,“ (unpublished
Master's thesis, The University of Southern California,
Los Angeles, 19^9), 88 pp.
3
patients who signed themselves out or the Veterans Administra­
tion hospital in which the study was made* Tuberculous
patients were excluded here and not followed for the research
interviews because it was thought that the diagnosis involved
public health and hospitalization characteristics different
from general medical and surgical patients. These statistics,
presented in Table I on the following page, indicate that an
average of 9*7 patients left the hospital against medical
advice each month. An average total of 1,658 discharges per
month during the same period shows that less than one per
cent, specifically .59 per cent, were discharges against medi­
cal advice.
In the fiscal year 19^7 a little more than 7 per cent
of the general medical and surgical patients were irregularly
discharged from all Veterans Administration hospitals. In
that same period the contract hospitals in which Veterans
Administration beneficiaries were treated had an irregular
discharge rate of b per cent for those patients. Although
the source made no effort to account for this difference, it
would be interesting to know what variables were involved.
The percentage for Veterans Administration hospitals is almost
^ William B. Tollen, Irregular discharge: The Problem
of Hospitalization of the Tuberculous (Washington, D. C.:
United States Government Printing Office, 19^8), p. 5*