Background. Ideally, medical consultation should be an opportunity for shared decision-making. In some instances, agreement between the doctor and patient may not be reached, and the consultation or admission could conclude with a refusal of hospital treatment (RHT). At Odi District Hospital in Gauteng Province, South Africa, patients refuse hospital admission either at the accident and emergency department or at the ward. Objectives. To determine the reasons for and factors associated with RHT. Methods. This was a retrospective review of patients’ files. Results. The institutional prevalence of RHT was 1.16%. Of 223 reviewed patient files, the majority were males (n=139; 86.05%), single (n=152; 68.16%) and unemployed (n=163; 42.13%). The mean (standard deviation) age was 31.036 (17.297) years. A correlation between time of day and number of RHTs was noted (p=0.0413). RHTs took place mainly at the emergency department (59.5%). Familial reasons were recorded in 31.84% of cases. There was an association between age and previous admission (p<0.0001, 95% confidence interval (CI) 0.1071-0.2451) and with comorbidities (p=0.0072, CI 0.4222-0.8647). Surgical RHT was associated with ward stay (p<0.0001, CI 3.238-11.051), and first-time consultation (p=0.0033, 95% CI 0.4592-0.6880). Medical RHT showed an association with age (p<0.0001, CI 0.08014-0.2753), stay in the ward (p=0.0003, CI 1.382-3.275) and comorbidities (p<0.0001, 95% CI 2.2015-4.486). Conclusion. Since RHT is the patient’s protected right, the challenge is for the healthcare worker to inform the patient adequately to enable him or her to exercise it safely. More needs to be done to improve healthcare worker-doctor communication for collaboration regarding RHT.