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Matt Morgan: Hospital doctors should step outside

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4914 (Published 06 August 2019) Cite this as: BMJ 2019;366:l4914

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Re: Matt Morgan: Hospital doctors should step outside

Dear Editor,

This article demonstrates the stark contrast between seeing a patient in hospital and at home, and the potential to re-evaluate their needs.

Discharge plans from hospital often do not fully encompass patients’ needs that are outside the medical realm. Hospital readmissions have continued to rise at an accelerating rate; a 2017 NHS report showed that over the previous four years, readmission within 30 days increased by more than 20% (1). A more integrated approach between hospital care and the community in patient follow-up is needed. A meta-analysis of methods to reduce readmission to hospital showed that interventions such as visits by healthcare professionals in the community and continuity of care post-discharge do significantly lower readmission rates (2). This gap could be bridged if hospital doctors step into a patient’s world to truly understand their needs.

Growing more familiar with the hospital environment over the last few years has made me realise how uncomfortable I was initially. It felt so busy with doctors and nurses rushing around attending to important jobs and it used to make me feel insignificant even as a medical student. Doctors may be at home in hospitals, but patients are not. At a time in someone’s life when they are seriously ill and are anxiously waiting to see the doctor, hospital is a scary place. For doctors to take time to walk out of the hospital and into the real life of somebody that they are treating, the patient becomes much more of a human being rather than just a name on a long morning list. Home visits reveal much more about underlying problems that affect patient recovery and factors that must be addressed in order to provide more holistic care for our patients and reduce readmission to hospital.

References
1. Healthwatch NHS needs to do more to understand why people are returning to hospital after being discharged. London: Healthwatch, 2017. www.healthwatch.co.uk/news/nhs-needs-do-more-understand-why-people-are-r....
2. Leppin AL, Gionfriddo MR, Kessler M, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med 2014;174:1095–107.

Competing interests: No competing interests

12 August 2019
Charlotte R Valentine
Medical Student
Jessica Omassoli, Amber Jennifer Sara Moore, Katherine Joanne Lewis
Imperial College London
Imperial College Rd, London SW7 2AZ