The skin in general medicine

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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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