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Discharging their responsibilities


According to a senior coroner commenting on a tragic and dysfunctional Liverpudlian death, medical care would be enhanced by sending a copy of the patient’s discharge letter to all primary, secondary and tertiary parties involved.

Well, simply sending one to the GP would be a start. As for scatter-gunning discharge letters to all-comers? Hmmmm, good idea. Probably. Possibly. Possibly not. In fact, no, don’t.

Though well-intentioned, this suggestion makes the common mistake of assuming that more communication equals better communication. It doesn’t.

Just check out the state of primary care records these days: they’ve become a data-dumping ground for anyone who has access (which is everyone), with the result being that they’re now a grotesquely bloated and utterly impenetrable parody of their former selves.

Whether through iatrogenesis or neglect, the outcome remains the same

And the more noise there is to signal, the more likely you’ll overlook something significant – that is, until you receive an invitation from the coroner to explain, say, why you prescribed Augmentin to a patient with a history of penicillin-induced anaphylaxis, which is news to you because, of course, you haven’t received a discharge letter. Or, in this case, the death notification.

As for those discharge letters themselves, the current trend is to churn out four-page monsters with the cut and paste ‘Investigations’ section trumped in length only by the ‘GP to do’ list.

And somewhere, buried in this disordered, unedited and thoughtless mess, is the odd unhighlighted and unmanaged shocker, such as, to give you a recent example, ‘…likely pancreatic cancer with bony mets…’

So, sure, send this out to everyone involved. Trouble is, until the message is improved rather than multiplied, you just end up with more recipients scratching their heads.

And action? At best it’ll be triplicated. At worst it’ll be ignored, as each waits for the other to act. And, whether through iatrogenesis or neglect, the outcome remains the same. Which brings us neatly back to the coroner.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (7)

  • My idea? Ban anything on the discharge letter that hasn't been dictated by a doctor or ANP. No proformas, just a written letter. Just tell us what happened, and what needs doing.
    One of my consultants as a junior insisted that we did a discharge letter on the day of discharge that he checked and faxed immediately to the GP. His rationale was that his care for the patient included a good handover. One of the good guys....

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  • How often do you get outpatient review letters arriving before the discharge letter for the original admission? Sometimes the discharge never comes and the important diagnosis may not be coded because the doctor reading the outpatient follow up letter wrongly assumes that it has already been coded. Having been burnt once I now always check and about half the time the discharge letter hasn't yet (if ever!) arrived.

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  • doctordog.

    It’s often much worse than that.
    How often are we expected to chase up results on tests performed by consultants without them even telling us?

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  • our local private hospital (Gatwick Spire) has a 4 page proforma letter with the diagnosis or operation as a single line in the middle of page 3. repeated efforts to get them to make this safe have yielded no progress.
    Where has common sense gone?

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  • Discharge letters can be gaxed or sent electronically before the patient leaves the hospital. They are often several weeks or months late, sometimes never.
    Information on them is usualy rubbish, sometimes wrong and misleading.
    Needs good doctor input, not ANPs or pharmacists (though the latter are more likely to get drugs list nearly right)

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  • |jonathan heatley | GP Partner/Principal|28 Sep 2019 10:21am

    Common sense left when the lawyers came in :)

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  • I have a new skeptical proposal. How about the consultant sorting out the patient for good without informing us and we sort out GP stuff without informing them and the patient keep their own notes with themselves for some personal responsibility....hang on we are already doing our work but why are we doing their's.

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