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As a junior doctor, I found Spence's article on written communication
interesting. I have just rotated into my sixth different hospital in two
years, each of which uses a different form of discharge summary. These
have ranged from the lamented third layer of carbon copy that Spence
writes of, to a fully electronic "transfer of care" document which is
immediately emailed to the general practioner on the day of discharge.
However, a discharge summary is, of course, only ever as good as the
effort put in by its author. My personal preference is a briefly typed
discharge summary which allows "free-text" input, rather than scrolling
through lines of ICD-10 codes only for the time-pressed junior doctor to
give up half-way through and settle for "infection - source unspecified".
I also share his fascination with historical medical correspondence.
Having previously worked at a primary care health centre summarising paper
medical records ready for conversion to electronic records, I loved the
opening paragraphs of letters which indulged in banter about rugby results
or golf performances, before moving on to the small matter of the patient
who had been seen. The most personal a letter gets these days is when
correspondence is addressed to a colleague's first name.