The follow-up advice we give our patients when they leave our care in the hospital, is one of the most under-talked about areas where we are currently falling down in healthcare. I’m not going to mince words here. I believe the discharge instructions paperwork that thousands of patients are getting all across the country every day, are absolutely atrocious! Let me back up here and explain what I’m talking about and why this is a serious issue.

Years ago, before the widespread adoption of electronic medical records (EMRs), we used to give patients a handwritten list of instructions telling them what to do after they leave the hospital. This was less than ideal—doctors’ handwriting is not exactly known for being perfect and legible. Fast forward to what’s happened over the last several years, as EMRs have been rolled out and everything is now computerized. I speak as someone who has worked in dozens of hospitals in different states, with almost every electronic medical record out there. The print-out that is generated to give our medical patients upon discharge is universally terrible! Typically, it’s a garbled mish-mash of information, several pages long, that you can’t make head or tail of. The writing is tiny—and the whole thing is basically incomprehensible. How on earth are elderly patients supposed to understand this? Literally no thought or common sense has gone into it.

This is a problem for multiple reasons, but not least the fact that discharging any patient from the hospital is actually quite a dangerous moment when you think about it. Patients are still very fragile—especially the elderly and medically complex. They frequently end up leaving in a rushed and confused process, as hospitals—which face enormous pressure—are in a hurry to free up the bed. Questions are left unanswered and patients and their families, often realize afterwards that they have additional concerns. I actually have a term for this: The Discharge Haze.

I’ve actually gotten so frustrated with electronic medical records, that I have figured a way around this for my patients when it comes to their discharge paperwork. As I explain in the above video, I simply copy and paste the information that I have entered into the computer, onto a Word document. Larger writing and spaced out bullet points explaining what to do next. The basic template looks like this:

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Discharge Instructions for: Mr Joe Bloggs

Diagnosis: Chest pain, dizziness, slow heart rate

Instructions:

1.Follow-up with your primary care physician in 1 week and cardiologist in 2 weeks

2.Repeat your BMP blood test in 1 week to monitor your kidney function and electrolytes

3.Your metoprolol dose has been reduced to 25 mg daily. Please discuss this at your next clinic visit

4.Go over your CT scan report with your primary care physician (you have been given a copy of the report, and may need a follow-up after 3 months)

5.Please seek urgent medical attention if you have any chest pain, shortness of breath, palpitations or dizziness

*Additional info like dressing changes, dietary restrictions etc, can also be added above

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I receive excellent feedback from my patients about this simple sheet of paper I give to them. It literally takes 30 seconds to do, and far eclipses the rubbish that is computer-generated.

My advice to any physician or other healthcare professional taking care of patients, who sees this same issue I do with electronic medical records, is consider doing the same thing with your discharge instructions. I hope that one day, our computer systems will fix this, but I’m not too optimistic. This is a classic example of how we fall over with the simple little things in healthcare. And too often these issues hinge around our lack of good communication. I repeat: no patient should ever leave hospital without being crystal clear on what comes next.

Suneel Dhand is a physician, writer, and YouTuber. He is Founder at MedStoic Lifestyle Medicine and DocsDox . Follow him on YouTube and Instagram