Table Of ContentMID ICAL-SQCIAL FACTORS EVIDENT IN A STUDY OF
SIX PATIENTS WHO TERMINATED HOSPITAL CARE
AGAINST MEDICAL ADVICE
A Thesis
Presented to
the Faculty of the School of Social Work
The U niversity of Southern C alifornia
In P a rtia l F ulfillm ent
of the Requirements fo r the Degree
M aster of S ocial Work
by
V irginia A lice Meek
June 1951
UMI Number: EP66398
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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
Cl%PfLO^A.
Dean
Thesis of Virginia Alice Meek
Faculty Committee
Chairman
TABLE OF CONTESTS
Page
LIST OF TABLES......................................................................................................
THE INTRODUCTION . . 1
Chapter
= I. THE PROBLEM AND STUDIES OF DISCHARGES AGAINST
; MEDICAL ADVICE....................................................................................2
S ta tis tic a l Facts of This Study and a Compari
son w ith V eterans A dm inistration
Problem Aspects of Irreg u lar Discharge
Meaning to p atien t of discharge w ithout
consent
Meaning from the h o sp ital standpoint
Meaning fo r the p a tie n t's fam ily and com
munity
Findings from Other Studies
Irreg u lar discharge among tuberculosis
p atien ts
Irreg u lar discharge among general m edical
and su rg ical p atien ts
II. SETTING AND METHOD OF STUDY...................................................21
S etting of the Study
Medical so c ia l service
Medical so cial casework services
Admissions service
Method of the Study
Sample of p atien ts used
Process of the case studies
III. THE CASE STUDIES. . . .........................................................3 3
Maggie Johnson
P atrick O'Leary
Evalena Jones
Luella Sinton
Richard May
Isaac Miske
-iv-
Chapter Page
I?. CONCLUSIONS........................................................ 5^
Smamary of Findings
Findings of Three Other Theses
C orrelation of Findings of Four Theses
V. THE IMPORT OF THE CONCLUSIONS FOR MEDICAL
SOCIAL WORK......................... ...........................................................66
BIBLIOGRAPHY.............................................. . . . . . 71
LIST OF TABLES
Percentage of Discharges w ithout Consent of
T otal D ischarges per Month from the Los Angeles
County General H ospital, October 1, 1950 -
March 31, 1951 . . . . * .........................................................
A nalysis of Discharges w ithout Consent, January 1,
through March 31 * 1951 by Sex, Age Range and
Length of Time in H ospital . ................................ • •
T abulation of Findings of Four Studies of Medi
cal-S o cial Factors in Irreg u lar D ischarges • . • •
THE INTRODUCTION
The primary objective of the service of the m edical
so c ial worker is to enhance the usefulness of m edieal
care to the p atien t and to help the h o sp ital to achieve
its . purpose in m edical treatm ent. . • •
In the la s t a n a ly sis, i t is the p a tie n t, him self,
who has to manage th is problem of illn e s s , and we are
I dependent upon what he w ith h is inner and outer
resources, is able to do w ith the help we extend. . . .
The "uncooperative patient*1 makes us aware of the
fa c t th a t he may not be able to engage him self in the
processes of m edical care. When he does not choose to
carry out the steps which are outlined fo r him, m edical
therapy is obstructed.
The so cial worker*s task is th a t of helping the
in d iv id u al to make the best use th a t he can of him self
and h is p o te n tia litie s w ithin the so cial world of which
he is a p a rt.1
The development of psychosomatic concepts in medi-
! I
cine has stim ulated m edical so cial workers to give in creas- j
ing consideration to the em otional facto rs which accompany 1
illn e s s and to re la te these concepts to casework service to
i l l persons. The inform ation about these facto rs has been
i augmented during the past fiv e years by studies of the prob-
j
lem of discharges against m edical advice, which are the
m anifestation of a negative a ttitu d e toward h o sp ita lisa tio n
and m edical care. This is the subject to be pursued in the
follow ing pages.
E lea n o r Cocker ill* "The Use of the Psychosomatic
Concept in S ocial Case Work," B u lletin of the Johns Hopkins
H o sp ital. LXXX (January 19^7), 86-97.
CHAPTER I
THE RESEARCH PROBLEM AND STUDIES OF
DISCHARGES AGAINST MEDICAL ADVICE
Most individuals who are adm itted to general m edical
and su rg ical h o sp itals do so on recommendation of a physi
cian and they enter v o lu n tarily w ith the d esire to secure
the maximum improvement and benefit from h o sp italizatio n .
A sm all number of i l l or injured persons accompanied by the
police or others are adm itted when the individual needs
emergency care but is not consciously seeking the serv ice.
i i
The m ajority of a ll these p atien ts rem ain in the h o sp ital
u n til th e ir treatm ent has been m edically decided to be ade- ;
I i
quate. There is a m inority of the to ta l who fo r various j
t |
reasons term inate th e ir h o sp ital experience by leaving >
i i
jbefore the treatm ent has been com pleted, or w ithout consent
of th e ir physician.
i
| The m inority group of p atien ts who f a il to complete
the prescribed exam ination and treatm ent and who leave w ith
out consent or against m edical advice give evidence th at
there were facto rs connected w ith the h o sp ital experience
which made i t im possible fo r the indiv idu al to accomplish
the f u ll b en efit of th e treatm ent. The p atien ts who take a j
discharge w ithout consent negate th e ir reasons fo r being
there and cause the purpose of the h o sp ital to be in effec
tiv e . Such a discharge is an attem pt to find a more s a tis
facto ry so lu tio n to th e ir problem s, and the reasons fo r
taking such actio n are always in d iv id u al. There are sim ilar
featu res and these aspects comprise the m edical so cial fac
to rs in the situ a tio n . This study has endeavored to ascer
ta in the m edical so cial facto rs which contributed to the
discharge of six p atien ts who le f t w ithout consent from the
Los Angeles County General H ospital. The situ atio n s of
these p atien ts and the reason fo r th is actio n , obtained
p artly by an interview a fte r the discharge, were studied and
* i
the various facto rs which p recip itated the irre g u lar d is- j
! I
^charge a t the p a rtic u la r tim e during the h o sp italizatio n ,
jwere evaluated. j
< I
| C areful search has revealed very l i t t l e research has
been done in the fie ld of irre g u lar discharge among p atien ts
other than the tuberculous. M edical j ournals rarely discuss
th is problem except as i t re la te s to the tuberculous which
is no doubt due to the in te re st which has prevailed in the
improvement of the public h ealth through the study and con
tro l of in fectio u s and contagious d iseases. The problem of
irre g u la r discharge of the non-tuberculous p atien t or those
in general m edical and su rg ical h o sp itals is n eith er new nor
unusual, though i t is sm all and sometimes an irrita tin g o n e,,
i
i
There is a general tendency among h o sp ital personnel to be j
im patient w ith individuals who leave a h o sp ital against '
m edical advice. The e ffo rts of m edical so cial workers in
the past have been directed more toward helping p atien ts
w ith discharge planning than in aiding them to rem ain in the
h o sp ital,
A study of the m edical so cial facto rs re la te d to the
re je c tio n of treatm ent and professional s k ills is relevant
since the m edical so cial work profession aims to help the
p atien t to an improved use of m edical and other professional
s k ills and of the h o sp ital f a c ilitie s . This kind of study
provides an opportunity fo r the so cial worker to in te rp re t 1
more e ffectiv ely to the h o sp ital adm inistration and s ta ff
jthe ways in which the m edical so cial workers* services may
be u tiliz e d su itab ly in the m edical se ttin g , i
S ta tis tic a l Pacts of This Study and a Comparison
w ith V eterans A dm inistration
In order to evaluate the num erical sig nifican ce of
;the problem of discharge w ithout consent from a general i
; i
m edical service a t the Los Angeles County General H ospital, j
s ta tis tic s were collected from the six treatm ent wards on
the six th flo o r general m edical serv ice. This represents
about h a lf of the general m edical service of the Acute Unit
