Matters in Healthcare: Patient care after your hospital stay

Question: I was admitted to the hospital recently. When I was discharged, I was told a lot of information and was given a prescription drug. In my condition I have to admit that I didn’t fully understand everything I was told or what the prescription was for. 

I went to see my GP (general practitioner) a few days later to try to get a better explanation of what I was supposed to do. However, my GP didn’t really know much about the discharge and wasn’t able to add to my understanding. 

Who are patients supposed to go to in this situation? And shouldn’t discharge instructions be clearer seeing as ill people are not at their best to follow complex instructions?

Answer: Unfortunately, you are not alone and patients often don’t know why they were in hospital at all, and the instructions for them may be unclear. But there are some procedures in place to assist. 

When you are admitted to the hospital for a medical condition such as asthma, diabetes or heart disease, the hospital generally should inform your GP of your admission within 24 hours by email. Contacting your GP in advance allows for exchange of information which may be relevant to your hospital care. 

Your GP should also receive a handwritten discharge summary within 24 hours of discharge with the main diagnosis and medications included. Depending on the relationship that certain doctors may have with hospitalists, your GP may be notified by telephone, especially as the hospitalists may have some questions. 

Hospitalists are physicians whose primary focus is on the general medical care of hospitalized patients.

If a patient is admitted for surgery, the system is not in place to notify the GP of admissions or discharges until the formal summary is dictated by the most responsible physician, which may be weeks later. Upon discharge, it would be the GP who needs to attain the pertinent information from the hospitalists who took care of the patient.

The patient, however, should also receive information from the surgeon involved and if they had a medical complication, they will be seen by a hospitalist and given instructions on how to proceed.  It is recommended that the patient follow up with their GP within a week of discharge. 

In addition, often a patient’s doctor will engage family members in patient care and organization of medications when the patient is no longer able to manage that responsibility. 

The hospitalist or the patient’s doctor can also refer the patient to the district nurses, who can package up medication for patients on a weekly or bi-weekly basis.

Your questions are absolutely valid and they point to gaps in the care process that need to be addressed. The Health Council is working with the relevant parties with the aim of improving the coordination and quality of care.

Question: I was referred overseas by a specialist for a planned hospital procedure, which fortunately went well. When I returned I saw my GP about something else and they had no idea I had gone or what for. This was a shock to me, as I assumed the specialist and the GP would have been in touch about my medical care. 

Surely if I’d had a complication after returning, it would have been terrible for my doctor not to know. 

Was I wrong to assume they would be informed, or was there a break in communication here?

Answer:  It is the responsibility of the specialist to inform your GP of the outcome of your case. The GP refers to the specialist in writing, and it is expected that the specialist will communicate back to the GP in the same manner. 

These responsibilities are also captured in the Standards of Practice for Medical Practitioners, which state: “A specialist physician should receive a written referral (unless it is an emergency) from the patient’s general practitioner to provide care to the patient.

“The specialist physician should communicate to the referring physician the outcome of the referral in the form of a written consultation report. In the absence of a general practitioner, the specialist physician is responsible for providing, and arranging, all necessary after-care.” 

However, sometimes when the patient is referred overseas, that institution may only have the specialist’s details to communicate back, thus the GP doesn’t get the necessary reports and information. 

Often, the specialist will also include the GP information and both will be informed of outcomes. 

Answers supplied by: Jennifer Attride-Stirling, CEO of the Bermuda Health Council. We are grateful for the input of various local physicians. The Bermuda Health Council and the Bermuda Sun have teamed-up to answer your questions about the island’s health care system. 

Visit www.bhec.bm to submit your queries and look for our response in the Bermuda Sun on the last Friday of every month and on www.bermudasun.bm