This Mary Washington Hospital discharge sheet contains abbreviations the average patient may not understand.

Patients leaving the hospital need clear instructions on follow-up care and medicine

Date published: 2/3/2008

AN OPEN LETTER to doctors on the well-being of patients being discharged from hospitals:

Dear colleagues:

Help!

I know we're all busy, and I hate to add to your burdens, but the discharge process employed at most hospitals is inadequate.

Innumerable patients are coming to me--and I suspect other primary doctors as well--having been recently discharged from hospitals without adequate knowledge of how to continue the health improvements achieved by their inpatient stays.

I know we all think we adequately explain things to our patients, but doctors, it just isn't coming across. We all look upon ourselves as healers, but the word "doctor" is defined in Webster's dictionary as "teacher." If we're not teaching our patients how to take care of themselves, we're failing in our primary responsibility.

My criticism is centered on the Discharge Instruction Record given to patients at discharge. (Patients, this is the sheet that lists the medications you are to take, follow-up treatment you are to get and other recommendations you are to follow after leaving the hospital.)

Doctors, please consider making the following changes when you fill out these sheets:

A handwritten sheet may be inadequate because it is illegible. I needn't remind my colleagues that most of us flunked penmanship. Discharge instructions need to be printed, preferably typed.

Do not use abbreviations, especially Latin ones. As a doctor I know what you mean, but the instructions are for the patient. Please, use plain, common English. "QD," "QID," "Q12H," "PO" and "QHS" mean nothing to my patients (though doctors know "QD," for instance, means to take a medication every day).

Never write a prescription or instructions that state "Take as directed." Believe me, I wouldn't remember from your examining room to my car what that meant. Can you imagine the chance for error if you gave me four prescriptions, all with instructions to "Take as directed"?

Also, spell out all medications. I know what drugs HCTZ, ASA, INH and FeSO4 are, but does the patient?

Indicate the dosage clearly. If instructions are handwritten, make sure "mg" is not misinterpreted as "mL." Use Arabic numerals, not apothecary symbols. (Better still, have the form printed out.)

Date published: 2/3/2008

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