Discharge summaries

Issue: BCMJ, Vol. 59, No. 6, July, August 2017, page(s) 293 Editorials
David R. Richardson, MD

“This hundred-year-old female was admitted feeling poorly. We didn’t do much, but she felt a bit better after a few days and went home.”

It is possible that I once produced a discharge summary similar to the one above in a pathetic passive-aggressive protest over suddenly having to dictate all of my discharge summaries. I have adjusted to my current dictation reality, but my new complaint revolves around how incomplete records are handled in my health region (out of fairness I won’t name it). I realize that I sound like a bit of a whiner, but since I am the editor you have to put up with me.

My office colleagues and I now take turns doing weekly rounds at our hospital. Since there are four of us, my stint comes along roughly once a month. After just completing my week of rounds I received a letter by e-mail from my Health Authority Medical Advisory Committee (HAMAC) advising me that I had one or more incomplete records to dictate. I figured that I would deal with this during my next set of weekly rounds. However, 2 weeks later I received another e-mail missive from HAMAC, this time with a paragraph in red ink advising me that if I didn’t complete my outstanding chart(s) within 1 week my privileges would be suspended.

I signed on to the hospital EMR to discover that I had one incomplete discharge summary from a patient admitted by a specialist after a strongly positive exercise stress test who had then been immediately transferred to a tertiary centre. I must admit that I was a little miffed. Would my privileges really have been suspended for this one incomplete chart? If not, then threatening me in red ink seems a little heavy handed. 

I wrote a letter regarding this issue, with copies to everyone including my therapist, and received some interesting responses. I was contacted by the chair of the HAMAC, who wanted to discuss my letter, but after playing phone tag for a week I did what I usually do when faced with adversity and gave up. My site medical director sent me a letter outlining his frustration with the issue. He personally seeks out physicians who have a number of outstanding records and collegially reminds them of the need for completion, which is then ignored. He went on to ask for my help in solving this difficult problem. I replied that I really just wanted to complain because offering any tangible solutions seemed like a lot of work. In contrast, the medical director of the health region sent me a letter reminding me that discharge summaries are an important part of patient care and included a suggested physician contact in case I was having difficulties managing my health record completion.

Hospital retention of family practioners in Fraser Health (I changed my mind about identifying my region) is challenging at best, and the current process of dealing with incomplete hospital records isn’t going to help. I have spoken to a number of long-serving full-service GPs who have also received letters from the HAMAC, threatening to suspend their privileges. After decades of dedicated hospital service many of them are ready to throw up their arms and say, “Take ’em!”

I am already working on my next discharge summary: “Here for a good time, not a long time.”
—DRR

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