Value of discharge counseling?

[Ivorymist]

Guys, I've done discharge counseling many times as a student and I just cannot see too much of a value in it. Many times when I walk into a room the patient either is in no condition to understand, doesn't care, or both. My last experience was trying to describe some meds to a patient who had just had her chemo. She was exhausted, apathetic, and didn't want anyone to bother her. She was like this for her entire stay. I had a similar experience with another patient on the internal medicine floor - he flat out tuned me out. Also, needless to say, counseling would be of little benefit too for obtunded patients or patients with AMS.

Even if the patient was listening, I find it hard to believe that they'll remember everything I say after I describe how to take 8 different meds along with side effects, what to look for, etc. The best I can do is leave them these information sheets regarding the drugs. Sometimes, I wonder if providing discharge counseling is of any benefit at all. What are some of you guys' experiences?

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[LVPharm]

I did do a number of discharge counseling sessions at the subacute/extended care facility I was at last month. You're right, in regards to the shear number of medications that these patients are discharged with...you hope they remember what you say, and answer any questions they have about the meds. I prepare a list of the meds with directions on how to take them with common side effects, and send the patient home with that along with their scripts. You can only hope they pay attention to it later. Of course, I didn't really deal with patients who were too obtunded to care. They were generally pleasant and attentive.

Through discharge counseling, I have noticed, on several seperate occasions, instances of polypharmacy in the making. Patients are often sent home with scripts for drugs taken during their stay...and at home, their PCP has them on another drug for the same indication...seems to happen with their HTN meds all the time. Nobody, and I mean nobody would pick that up if it weren't for discharge counseling. At least we have the opportunity to contact their PCP prior to filling the new scripts, or talk to the attending about the appropriateness of the new scripts prior to discharge...either way, we head-off duplicative (and potentially harmful) drug therapy.