1. matthew links

    November 5, 2017 at 8:53 pm

    Nice article! but there are some things from previous literature that are worth mentioning. The main one is information and psychosocial concers. Using oncology as an example: patient doesn’t know they have cancer, carers stressed , patient understanding is poor, patient told life expectancy is less than three months – these are critical issues that never make it into discharge summaries and the principle applies in other specialties. Tattersall MHN, Butow PN, Brown JE, Thompson JF. Improving doctors’ letters. The Medical Journal
    of Australia. 2002 Nov 4;177(9):516–20.

  2. Elie Matar

    November 10, 2017 at 6:07 pm

    Hi Matthew, thanks for your comment. I completely agree with you that psychosocial issues are significant (sometimes the most significant) aspects of a patient’s hospital admission and this should be reflected in discharge letters for those patients. Such examples are not limited necessarily to discussions around diagnosis and prognosis but also to end of life discussions, family meetings, grief/anxiety reactions or other significant concerns raised by patients. As you mentioned these are not only relevant to oncology but are common across all specialties and certainly more relevant to general practitioners and patients than the transient hypokalaemia fixed with a few tablets of Slow K that seems to always make the ‘issues’ list. As an aside, I think this latter point speaks to the tendency of junior doctors (and some senior doctors) to gravitate towards the more comfortable ‘biological’ aspects of patient care which are emphasized in medical school and reinforced by the perverse bias of health-care funding allocation towards procedure- and pharmacological-based care. Perhaps by encouraging junior doctors to be cognizant of reporting the psychosocial issues in discharge letters it will not only translate to better continuity of care but may subconsciously prime them to be mindful of these issues more generally as they progress to senior positions and go on to deliver care in outpatient settings.

  3. Jannine Rigby

    September 5, 2018 at 12:50 pm

    Hi Elie, we are a regional hospital in Victoria and would if possible like to get a copy of the survey tool you developed or utilised. Would you be able to provide this to us? Thanks Jannine


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