• Mayesha Khan, Ying Yu, Daniel Daly-Grafstein, Hiten Naik, Jason M Sutherland, Karen C Tran, Trudy Nasmith, Jennifer R Lyden, and John A Staples.
• Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
• J Gen Intern Med. 2024 Nov 1; 39 (14): 263826482638-2648.

BackgroundPatient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with "before medically advised" hospital discharge (BMA discharge; commonly known as discharge "against medical advice").ObjectiveTo evaluate whether patient-physician sex discordance is associated with BMA discharge.DesignRetrospective cohort study using 15 years (2002-2017) of linked population-based administrative health data for all non-elective, non-obstetrical acute care hospitalizations from British Columbia, Canada.ParticipantsAll individuals with eligible hospitalizations during study interval.Main MeasuresExposure: patient-physician sex discordance.OutcomesBMA discharge (primary), 30-day hospital readmission or death (secondary).ResultsWe identified 1,926,118 eligible index hospitalizations, 2.6% of which ended in BMA discharge. Among male patients, sex discordance was associated with BMA discharge (crude rate, 4.0% vs 2.9%; adjusted odds ratio [aOR] 1.08; 95%CI 1.03-1.14; p = 0.003). Among female patients, sex discordance was not associated with BMA discharge (crude rate, 2.0% vs 2.3%; aOR 1.02; 95%CI 0.96-1.08; p = 0.557). Compared to patient-physician sex discordance, younger patient age, prior substance use, and prior BMA discharge all had stronger associations with BMA discharge.ConclusionsPatient-physician sex discordance was associated with a small increase in BMA discharge among male patients. This finding may reflect communication gaps, differences in the care provided by male and female physicians, discriminatory attitudes among male patients, or residual confounding. Improved communication and better treatment of pain and opioid withdrawal may reduce BMA discharge.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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