I'm not too sure about discharge summaries not being scut. The forms have differed a lot at the hospital I'm at depending on the service. I had to do a discharge summary for my clerkship grade and it was essentially a complete H&P plus progress in the hospital plus discharge meds. The ones I do at the hospital are much, much shorter. I suppose that it just varies depending on where you're at?
Well, for a two week hospital admission, with multiple procedures and imaging results and blood tranfusions, and dietary changes, and FFP, and about a dozen different lab test done, this was more like a 12 page document. A discharge summary at my institutions (how a good discharge summary should be done) is a narrative of the hospital course, and can be complicated, i.e. paracentesis, emobolization of a hepatic artery, etc . . . a H and P and discharge meds means nothing in terms of time as this can be easily pasted from the H and P. Try to piece this together in 4 hours if you
haven't seen the patient and you will literally have to stay overnight to complete this. "On hospital day #7 the patient was transfused two units of PRBC why? his hematocrit looked ok, I need to go ask resident, . . . the patient had procedure x done, why? on and on and on, I agree if you have seen the patient this is fair game, but a different ballgame if you haven't seen the patient (which i seem to have to repeat myself as you haven't read/noticed this in my previous post), and if you can't read medicine's notes, . . . Please read my post again as I didn't say discharge summaries are not scut, . . . it all depends on the situation. For good hospitals you have to go chronologically by day and basically write a small chapter, at other hospitals I have seen they don't really care about dischrage summaries. Imagine Ypo if I said I wanted you to write a discharge summary by the end of the day for a patient who had a liver transplant, cellulitis, and pneumoniae and I wanted listed everything, i.e. blood cultures, medications used, ALL tests results, all consults done integrated chronologically (say 8 consults!), . . . it will take you a long while my friend, and is frustrating as you haven't seen the patient during rounds for the past three weeks, and I want each day done chronologically, and you can't read my progress notes, GOOD LUCK!!
For example:
On hospital day #7 the patients Hematocrit was 18 and hemoglobin was 6, and order was place to begin transfusion of 4 units PRBcs. Midway into the first unit the patient began to have chest pain, lasting for 4 minutes which was associated with diaphoresis and was of a different character of the chest pain that the patient presented with so STAT EKG was performed and serial cardiac enzymes were sent at 11:00 am. The troponin, CKMB, etc . . . results were received and came back at x, x, x, and were negative for MI. Cardiology was placed on this day and completed by 4 pm, and the cardiology fellow advised that a stress test be performed for our patient. We decided to delay the stress test until after the third blood transfusion was completed, at this time during the admission 6 units of PRBCs had been transfused over 7 days, without a source of bleeding so surgery was consulted on this day for ongoing bleeding without obvious source and continuing abdominal pain. . . .
This would be easy to write if you were there on rounds, but IMAGINE doing this for a patient you don't know!
