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LETTERS TO THE EDITOR Response to both Regular formal multidisciplinary has continued in a similar way for years. meetings that document clear plans, pro- One of the factors that bothers doctor- When developing our review we were keen posed timescales, and individual respon- patients most, indeed many patients, is the to generate discussion with a view to raising sibilities (either in clinical notes or on stigma of illness and sickness absence, as is awareness of, and improving practice multidisciplinary handover sheets) can borne out in this study. It is interesting around, discharge planning. We therefore advance this process. We have also found that in reality most doctors do not lose appreciate the comments of Drs Levine and that whiteboards are helpful in focusing their jobs, or have any long-term problem Leung. actions of members of the multidiscipli- resulting from the fact of a particular We agree that sharing accurate infor- nary team. diagnosis or sickness absence. It is true mation in a timely manner is a key factor Discharging patients, both from admis- that long-term sickness absence requires a in both discharge planning and provision sions unit and elderly care wards, can be a multidisciplinary approach and that the of high-quality care. The presence on challenging process, and should be earlier a problem is dealt with the better. ward rounds of nursing staff should actively taught to doctors in training. Many of a doctor’s problems with illness improve this, but can be suboptimal. Unsafe discharges reflect poor care and are arise from a denial of them. Confidentiality, Combined paperwork and single assess- unacceptable. which is different, and as borne out in this ment pathways, alongside daily targeted study, is the key to managing these situa- multidisciplinary meetings have been PHILIP DAINTY tions. Many services for doctors do exist, used in the admission unit at Stafford Locum consultant physician can be accessed via their general practi- with some effect. Many other assessment Emergency Assessment Unit tioners or occupational health depart- units (eg Wolverhampton) provide active New Cross Hospital, Wolverhampton ments, and can be off-site from the elderly care in-reach services and/or workplaces. JIMMY ELIZABETH regular consultant input, potentially I am surprised that most respondents Consultant physician facilitating more appropriate discharge say they would talk to family and friends Stafford General Hospital, Stafford and admission. because in many cases, in my experience Admissions units are a hub in most as an occupational physician, once doctors acute hospitals, and accurate assessment References and other people are ill, they find that and decision making, with early senior admitting illness to family is difficult. clinician involvement at the point of 1 Boccalon H, Elias A, Chale JJ et al. Those answers smack of denial as well and Clinical outcome and cost of hospital admission, can ultimately improve care may be a source of information bias in the vs home treatment of proximal deep vein downstream. We would endorse the points thrombosis with a low-molecular-weight study. raised by Dr Leung regarding the potential heparin. Arch Intern Med 2000;160: Most interesting is that the authors say conflict between early discharge and the 1769–73. that these attitudes and perceptions about provision of high-quality care, and the fact 2 Corwin P, Toop L, McGeoch G et al. doctors’ health should be tackled and Randomised controlled trial of intravenous that many frail patients with complex changed at medical school level as I am antibiotic treatment for cellulitis at medical conditions and social circum- home compared with hospital. BMJ 2005; currently carrying out this kind of work stances cannot be discharged directly from 330:29–135. with students. I have found, sadly, that the admissions units. attitudes written about in this paper are Pathways/protocols for early dis- well-entrenched by mid-third-year stage. A postal survey of doctor’s charge of patients with selected condi- attitudes to becoming tions (eg deep vein thrombosis, cel- CLARE RAYNER m
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