A few years ago, I cared for an unfortunate homeless patient who seemed incapable of managing his own affairs and was probably illiterate. When he left the hospital, I gave him a copy of his discharge summary and stressed that he should carry it around and always show it to anyone taking care of him. A lot went on in the hospital, and I worried he wouldn’t follow through with the subsequent care I had arranged and would instead wind up in another emergency department (ED) the next time he had a problem.
A few weeks later I got a call from another ED in the area and learned that the patient hadn’t been able to provide any meaningful details of his health history or where he had received care previously. But he did pull a wrinkled copy of the discharge summary from his pocket to show the staff. In our phone conversation, the ED doctor remarked how helpful it had been to have this information that he probably would have never found otherwise. It saved the need to pursue workup for things that I had already investigated.
I tell this story because I think it would be great for hospitalists to ensure that all, or nearly all, of their patients receive a copy of their discharge summary as they leave the hospital—or soon thereafter. In fact, I suspect that if this became common for hospitalists, the idea might become de rigueur for all patients in the hospital.
I’ve been providing a copy for many of my patients for several years. I first started doing this for patients I cared for who lived out of my area (e.g., a different state) and I couldn’t rely on the hospital getting a copy of the summary to the patient’s primary care physician (PCP) at home. That experience convinced me it could be a good idea to give it to nearly all patients.
Giving each patient a copy of selected parts of the medical record and, when requested by patients, all of the medical record, is not a new idea. I think it is great that a number of clinics and other providers mail test results to patients, and neater still are the organizations that encourage patients to “visit our Web site to review your test results” and other such information. However routinely encouraging them to review all of the test results and other records generated during a hospital stay may be an idea that isn’t yet ready for prime time. Instead, I think it is useful to give the patient a copy of the discharge summary, which highlights relevant test results with accompanying explanation and analysis.
There are many reasons this can be a good idea. Of course, a discharge summary can’t replace or reduce the need for the doctor to discuss diagnoses, treatment, and follow-up plans with the patient. Still, it is a great summary of the diagnoses, medications, and discharge instructions that the patient can review later. Research shows that many patients forget most of what they have been told by the time they get home, and my hope is that the discharge summary will serve as a reminder.