1. Matt

    February 4, 2018 at 10:33 am

    Thanks for the article. Part of my concern is that discharge summaries are sent to the patient as well and it can be difficult to frankly reveal fairly personal information in a formal document like that. Are there any suggestions to best approach it when patients have clearly lied in the past (e.g. around alcohol consumption, smoking, compliance with meds etc…) or psychosocial concerns are at play? I guess more serious issues deserve a phone call directly but that’s not always practical.

    • Matthew links

      February 4, 2018 at 11:22 am

      Good point and difficult issue. There is a “open notes movement” that says we should always involve patients in checking notes. Ultimately you need to say “this is what I am saying about your alcohol” or negotiate a wording about a difficult family with the patient. Difficult family might not fly, but “very concerned family having difficulty with balancing patient autonomy and multiple family viewpoints” – should be acceptable. “In complete denial” won’t go down well – but “patient remains very optimistic, hoping for cure despite being told condition is terminal” is a factual but non judgemental option . The gp will get the message – but you are right you should assume the patient will read it.

  2. Christine Sanderson

    February 5, 2018 at 10:23 am

    Brilliant article – thanks so much Matthew!

    Its important to acknowledge how hideously busy junior doctors’ jobs are and how much easier the cut and paste hyper-clinical summary is – the expectation is speed of turnaround, and you are seen as very efficient when you produce it fast.

    The complexity of the discharge summary really is about “who is the audience?” Is it the GP, the patient and their family as alluded to above (and there is a lot to be said for letters that are directly written to patients and cc-ed to their doctors) or is it a communication tool between hospital clinicians? Those are often very different letters, and the latter is probably the easiest to write when you are a junior hospital clinician immersed in those processes yourself.

    So Matt’s suggestion is important. Picking up the phone and calling GPs is a really really valuable thing to do, usually doesnt take very long, and may help to clarify complex issues – in both directions. And its often good to do at admission as well as at discharge.

    Oh and yes – let’s just BAN the phrase “non-compliant” while we’re at it!


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