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Discharge summaries have become my pet peeve recently.
It’s not uncommon for a patient to be referred to me for outpatient follow-up, or for one of my own patients to be treated where I’m not on staff and then sent back to me afterward. When that occurs, I used to get a copy of the discharge summary to get an idea of what happened. (Note the "used to.") I certainly wouldn’t rely on it entirely, but it was helpful. Not anymore.
The modern discharge summary is worthless and sometimes downright dangerous. It’s often nonspecific and typically full of errors. Not minor errors, either, but big ones. I commonly see patients listed as having had procedures they didn’t undergo, test results that were someone else’s, and diagnoses and medications that aren’t even close.
Here’s a recent example (I’ve removed some information, but this is the basic idea): "The patient was admitted for dizziness. She was seen by neurology and had a brain MRI and labs. Discharge diagnosis is dizziness. Her medications were not changed."
That was it – a few sentences in one paragraph.
How much valuable information did you get from that? Absolutely none. All I see is that I need to get the MRI report and/or films, and possibly the other neurologist’s notes.
In years past, the summary was done by the patient’s own physician, who knew he or she would be referring to it in a few weeks when the patient came in for follow-up. So there was a vested interest in it being thorough and useful.
But today the reports are typically dictated by hospitalists. They may provide good care, but it’s often the case that they just picked up the patient for the first time. They likely have 18 other people to see, five admissions, and three discharge summaries to do and don’t have the time to do more than glance through the H&P and last few scribbled notes. As the day goes on, patients also tend to blur together, causing more errors.
The hospitalists simply don’t know patients as well as do the outpatient physicians who have been seeing them for years, and so fewer errors will be caught. I admit I’m guilty of turning some of my own patients over to inpatient physicians. All of us are busy. And I’m not knocking hospitalists, who do an often difficult part of medicine. But the loss of communication between these two branches of medicine is a sad loss for all of us – especially for our patients.
Perhaps the most irritating part is the generic statement I see at the bottom of many summaries: "This discharge summary may contain errors and omissions. Please refer to the full chart for complete information." This, sadly, is an admission that the document is worthless (which I doubt will stand up in court). I don’t often have access to the full chart, or time to comb through it in detail, when the patient comes in. Although I wouldn’t put all my faith in the summary, it’s nice when it give me a general idea of what I’m dealing with.
Once, a discharge summary was something useful – a succinct statement of events for the next doctor to use for guidance. Today, it’s become the kitchen mess piled up after a party. No one wants to do it, so a hurried, sloppy job is done, making more work for everyone else later.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Discharge summaries have become my pet peeve recently.
It’s not uncommon for a patient to be referred to me for outpatient follow-up, or for one of my own patients to be treated where I’m not on staff and then sent back to me afterward. When that occurs, I used to get a copy of the discharge summary to get an idea of what happened. (Note the "used to.") I certainly wouldn’t rely on it entirely, but it was helpful. Not anymore.
The modern discharge summary is worthless and sometimes downright dangerous. It’s often nonspecific and typically full of errors. Not minor errors, either, but big ones. I commonly see patients listed as having had procedures they didn’t undergo, test results that were someone else’s, and diagnoses and medications that aren’t even close.
Here’s a recent example (I’ve removed some information, but this is the basic idea): "The patient was admitted for dizziness. She was seen by neurology and had a brain MRI and labs. Discharge diagnosis is dizziness. Her medications were not changed."
That was it – a few sentences in one paragraph.
How much valuable information did you get from that? Absolutely none. All I see is that I need to get the MRI report and/or films, and possibly the other neurologist’s notes.
In years past, the summary was done by the patient’s own physician, who knew he or she would be referring to it in a few weeks when the patient came in for follow-up. So there was a vested interest in it being thorough and useful.
But today the reports are typically dictated by hospitalists. They may provide good care, but it’s often the case that they just picked up the patient for the first time. They likely have 18 other people to see, five admissions, and three discharge summaries to do and don’t have the time to do more than glance through the H&P and last few scribbled notes. As the day goes on, patients also tend to blur together, causing more errors.
The hospitalists simply don’t know patients as well as do the outpatient physicians who have been seeing them for years, and so fewer errors will be caught. I admit I’m guilty of turning some of my own patients over to inpatient physicians. All of us are busy. And I’m not knocking hospitalists, who do an often difficult part of medicine. But the loss of communication between these two branches of medicine is a sad loss for all of us – especially for our patients.
Perhaps the most irritating part is the generic statement I see at the bottom of many summaries: "This discharge summary may contain errors and omissions. Please refer to the full chart for complete information." This, sadly, is an admission that the document is worthless (which I doubt will stand up in court). I don’t often have access to the full chart, or time to comb through it in detail, when the patient comes in. Although I wouldn’t put all my faith in the summary, it’s nice when it give me a general idea of what I’m dealing with.
Once, a discharge summary was something useful – a succinct statement of events for the next doctor to use for guidance. Today, it’s become the kitchen mess piled up after a party. No one wants to do it, so a hurried, sloppy job is done, making more work for everyone else later.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Discharge summaries have become my pet peeve recently.
It’s not uncommon for a patient to be referred to me for outpatient follow-up, or for one of my own patients to be treated where I’m not on staff and then sent back to me afterward. When that occurs, I used to get a copy of the discharge summary to get an idea of what happened. (Note the "used to.") I certainly wouldn’t rely on it entirely, but it was helpful. Not anymore.
The modern discharge summary is worthless and sometimes downright dangerous. It’s often nonspecific and typically full of errors. Not minor errors, either, but big ones. I commonly see patients listed as having had procedures they didn’t undergo, test results that were someone else’s, and diagnoses and medications that aren’t even close.
Here’s a recent example (I’ve removed some information, but this is the basic idea): "The patient was admitted for dizziness. She was seen by neurology and had a brain MRI and labs. Discharge diagnosis is dizziness. Her medications were not changed."
That was it – a few sentences in one paragraph.
How much valuable information did you get from that? Absolutely none. All I see is that I need to get the MRI report and/or films, and possibly the other neurologist’s notes.
In years past, the summary was done by the patient’s own physician, who knew he or she would be referring to it in a few weeks when the patient came in for follow-up. So there was a vested interest in it being thorough and useful.
But today the reports are typically dictated by hospitalists. They may provide good care, but it’s often the case that they just picked up the patient for the first time. They likely have 18 other people to see, five admissions, and three discharge summaries to do and don’t have the time to do more than glance through the H&P and last few scribbled notes. As the day goes on, patients also tend to blur together, causing more errors.
The hospitalists simply don’t know patients as well as do the outpatient physicians who have been seeing them for years, and so fewer errors will be caught. I admit I’m guilty of turning some of my own patients over to inpatient physicians. All of us are busy. And I’m not knocking hospitalists, who do an often difficult part of medicine. But the loss of communication between these two branches of medicine is a sad loss for all of us – especially for our patients.
Perhaps the most irritating part is the generic statement I see at the bottom of many summaries: "This discharge summary may contain errors and omissions. Please refer to the full chart for complete information." This, sadly, is an admission that the document is worthless (which I doubt will stand up in court). I don’t often have access to the full chart, or time to comb through it in detail, when the patient comes in. Although I wouldn’t put all my faith in the summary, it’s nice when it give me a general idea of what I’m dealing with.
Once, a discharge summary was something useful – a succinct statement of events for the next doctor to use for guidance. Today, it’s become the kitchen mess piled up after a party. No one wants to do it, so a hurried, sloppy job is done, making more work for everyone else later.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
