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.
regular consultant input, potentially I am surprised that most respondents
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