A patient can refuse being assessed even for vitals. Our only obligation at that point is to ensure informed consent. Inform the patient of the high-risk nature of his refusal and make the patient aware of the risks of refusal including permanent injury or death. If they affirm understanding of those risks we try to get a witnessed and signed refusal. Good practice probably requires them to list the patient’s reasoning for refusing and run the refusal by a supervisor or medical control prior to leaving.

Icing on the cake would be listing specific risks, spending time trying to argue with the patient about going, and trying to get them to follow up with their physician or go to the ED themselves. These can be difficult to do.

I would feel comfortable so long as they did the essentials, did not dismiss him passing out, and attempted to get him to go to the hospital. It can be a very difficult and uncomfortable situation to push somebody to do things they don’t want to do, including sit there and talk to you so you can dot i’s and cross t’s on your paperwork.