Home on paper

Yesterday, I discharged 5 patients from the hospital. Today, I feel dead inside.

For patients, hospital discharge is a happy moment. Leaving the hospital means leaving behind the unflattering gown, the interrupted sleep, the food that does not resemble itself, and the constant parade of people poking and sticking and looking at your business. Most inpatients eagerly anticipate discharge from the moment they are admitted.

For residents, hospital discharges are a little different. Patients leaving the hospital require instructions, follow-up appointments, outpatient testing, prescriptions, and sometimes, home care services. Their health care providers–all of them–require detailed information about their hospital course and about the plans for their medical follow-up. In my hospital, the responsibility for choreographing this administrative hoo-ha falls directly on the residents, and mostly on the interns.

Deep inside, in the part of me that is not an intern, I am happy for patients when they get to leave the hospital. But the rest of me–especially the part that operates computers and makes phone calls–seethes. Yesterday, after spending hours navigating a web of bitchy clinic receptionists and printing, then reprinting, this time on the right paper and on the right printer, I came to an unpleasant realization: I had spent more time discharging these patients than I had cumulatively spent face-to-face with all of them during their hospitalizations.

In theory, it is my job to treat people’s illnesses in order to get them medically ready for discharge. But yesterday, I spent so much time doing paperwork that I wasn’t able to think about or really, take care of, any of my patients who were still in the hospital. Getting patients home on paper left me no time to get patients well enough to go home in body. 

There is a light. Someday, when I am an upper level resident, I will ask my interns how their discharges are coming along. Oh, they will say, we are beginning to feel dead inside. And from my perch at a patient’s bedside, where we are together reviewing the nature of their disease process and the elements of their management, I will say, Let me help you with that. Which printer are you using?

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4 Comments on “Home on paper”

  1. TLR Says:

    As usual, you’ve put it quite eloquently, my dear – I’m on an adult ED rotation right now and it strikes me that I know some of these patients better than the ones I took care of on the floors. (How screwed up is that?!?) Actually, the most satisfying interactions have been in seeing patients in the ED that I had taken care of as inpatients over the past few months – it’s amazing to believe that they actually recognize me (given how little time I spent with them, as opposed to their paperwork/consults/etc.)!

  2. karrvakarela Says:

    Well-written. It’s a shame so much time is wasted in paperwork. Do you think it’s possible to make discharges electronic, thus freeing up time for the residents?

  3. signout Says:

    Ha ha! Karrva, it IS an electronic discharge! We use an incredibly unwieldy system, though, that incorporates a lot of redundancy. What would free up time for the residents is having another person do the discharge: lots of institutions have nurse practitioners who are very happy to function as discharge planners.
    TLR, I’m not sure any of my pediatric patients would recognize me, but a few of my medicine ones might. I’ve gotten to spend much more time with them when I’ve taken care of them on the floors. Doesn’t that seem a little odd?
    Thanks for the thoughtful comments, both.

  4. Peggy Says:

    It’s amazing what I’m learning about what happens in hospitals by reading medical blogs. From my bed, in my only hospitalization as an adult, it seemed everything happened so effortlessly. I knew I could just focus on resting after surgery, doing what was asked of me, trusting that everyone involved in my care were professionally competent and concerned for my well-being. And so it was. God bless each one of you.

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