MEDICAL ANECDOTAL REPORT
Indexing Title: JDCANLAS’ MAR [15-10]
MAR Title: Importance of Discharge Instruction
Date of Medical Observation: September 2015
Tag: Doctors must make sure that their patients understand their discharge instructions
Category: Professional/Ethical – Reinforcement
It was a usual day at our Out-Patient Department (OPD) when one of my post-operative patients followed up. He is a three-year-old boy who underwent herniotomy (an operation for the repair of hernia) a week before. Post-operative care and instructions were taught to the father. On follow-up, the patient was still complaining of pain on the operative site. I asked the mother if the post-operative pain medication (Paracetamol) was given. The guardian replied that she did not give the medication, since, for her, paracetamol is only given to febrile patients. Furthermore, upon inspection of the post-operative site, it was noted that the site was not dressed properly; according to the mother, she knew that post-operative sites should not be wet and washed. I asked her if the instructions given to the father was relayed to her, but she said that her husband did not say anything. I reinforced that paracetamol is not only for fever, but for pain management as well; also, I told her that body hygiene is crucial for proper wound healing. I asked her if there were still questions that need to be answered and clarified, she replied none. She thanked me for the instruction. I came to realize that post-operative care and instructions should be given not only to the immediate guardian, but to other caregivers as well. Doctors must make sure that their patients and their relatives understand their discharge instructions.
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
Discharge instructions provide critical information for patients to manage their own care. However, many patients do not fully understand or recall the instructions they receive. Indeed, understanding and memorizing the hospital discharge instructions can be very challenging. At the time of discharge, patients or family members may be experiencing physical and emotional discomfort. They may be eager to leave, and thus, less interested in the instructions. Moreover, significant number of our patients in this hospital has low literacy and/or health literacy levels. In addition, the busy hospital setting may distract the patient’s attention from such instruction. Thus, it is important that we make sure that patient’s fully understand the instruction.
Under ideal conditions, the doctor explain his discharge instructions to the patient and family then have the nurse explain them again and give them a written copy to take with them after their discharge clearance. However, here at the Ospital ng Maynila Medical Center, very often the ideal giving of discharge instruction to patients by the nurses is not being followed. This is probably due to lack of nurse staff. How can we deal with this unfavorable situation? First, written instructions are important to deal with the memory issue. Almost no one can remember all of what is being said in a complicated interchange of this sort. Avoid using medical jargon to make sure that we get our message across. It would be great for the patients to make notes on the discharge documents. I have seldom seen a patient or relative do this so doctors must encourage their patients or relatives to take notes. Second, it helps to have another set of ears in the room. Additional family member who is not the direct object of the instructions is often better equipped to hear and interpret the doctor’s instructions. Patients often hear only what they want to or are prepared to hear. Finally, encourage patients and relatives to ask questions. On the occasions when I have stopped at the end of my discharge explanation and asked the patient or relative to repeat it to me, I have rarely received the same information back. It is never a bad idea to encourage patients and their relatives to ask questions about anything they don’t fully understand. Good discharge instruction and an understanding of the patient of this instruction can contribute to improved outcomes.
ROJoson’s Notes (17jan12):
Paracetamol is not only for the fever but also for pain.
Wounds can be wet without fear of infection.
Discharge instructions are important as mentioned: Good discharge instruction and an understanding of the patient of this instruction can contribute to improved outcomes.
I recommend the attending physicians be the ones responsible to do this – verbal and written instructions and close-loop communication and signed by the patient and relatives.