Discharge summaries

I can’t believe how the time flies

We’ve already said our goodbyes

I got into the groove

And now we must move

And drive east into the sunrise.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. I just finished two months in western Nebraska. Any patient information has been included with permission.


Friday dawned clear, cool and bright. We got up early for the finishing touches on moving out.

The townhome the agency rented for us surpassed all expectations with cathedral ceilings, hardwood floors, good construction, comfortable mattress, serviceable equipment, and a killer view. I moved stuff out the front door to the walk by the car while Bethany packed. We left notes for the landlord and the neighbor.

We stopped at the hospital. I had forgotten one bit of documentation when I discharged a hospital patient on Wednesday.

The discharge summary recounts what happened during a patient’s hospital stay. When I finished residency, I would go through the whole chart from the first day, giving lab values, reading x-ray and consultation reports, and recounting vital signs in detail.  Later I learned to dictate my hospital notes so I could do the discharge summary from them.  Later still, I changed my model to answer the question: What does the next doctor need to know?

In the 80’s I deliberately waited two weeks after discharge to do the summary, because vitamin B12 levels and thyroid functions could take that long to come back. Paper charts in those days dominated the doctors’ lounge; you couldn’t get your coffee without being reminded you needed to clean up your paperwork.  And you could see everybody else’s backlogs.  I’d clean things out once or twice a month.

By the last half of the first decade of this century I had started to dictate the discharge summary at time of discharge, so I could have a copy when the patient came to see me a week later.

Some attending physicians pay residents, Physician Assistants, or Nurse Practitioners to do the discharge summaries.

Now the hospital’s Electronic Medical Record puts in all the lab values, discharge medications, and x-ray reports. I summarized 11 days of hospital care with 4 sentences typed into the middle of the document under the heading Hospital Course.  The next doc will have to scan through pages of note bloat to get to the part that he or she will need to know.

With all the documentation done, we drove the loaded car through town to a chain diner.

Over a luxury breakfast out, we talked about how fast the time had gone. It hardly seems two months since we arrived.

I found 4 new cases of Parkinson’s disease, 2 new cases of hypothyroidism, and 1 case of vitamin B12 deficiency. I referred people with, variously, a hernia, a hot gallbladder, and a bad appendix to the surgeon.

When major trauma cases came in I kept things moving in the outpatient clinic.

On the weekends when we didn’t go to Denver, visit a niece in Wyoming, or go shopping at Cabela’s, I made rounds in the hospital.

We went to the movies three times; the tickets cost less than half of what we usually pay.

We ate at every Chinese restaurant in town at least once. We saw eagles, deer, jackrabbits, migrating ducks and geese.

After breakfast, we started east down the highway, under clear blue skies with the wind at our back.


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