Wednesday, November 17, 2010

After Visit Summary - Little Things Mean a Lot

When I was in high school, the singer Kitty Kallen had a #1 hit - "Little Things Mean a Lot." The ballad is decidedly uncool by current standards, but as a teen-ager I liked its romantic dreaminess.

The song popped into my mind as I was musing about the after visit summary I was given at the end of an appointment with my primary care physician yesterday. The visit involved discussing a treatment decision, tweaking a medication dose, and scheduling a test. Nothing complicated. Even with my porous memory, I would have remembered the key points of the visit.

Even so, I was happy when at the end of the appointment my PCP gave me a simple printed summary and went over it with me. Doing that reinforced what we'd discussed and what the next steps would be. But the tangible "gift" was important as well. An anthropologist would see elements of a ritual behind the medical act - a form of "godspeed" token.

One of my patients as a first year psychiatry resident came into my care when he was hospitalized for a first episode of depression. After discharge he moved to another state. I gave him a handwritten letter summarizing what we'd concluded about his condition and what I'd recommended, and encouraged him to show it to his clinician at the clinic we'd referred him to.

As often happens when depression lifts he just went about his business and did not go to the clinic. But some years later a psychiatrist in the other state called to tell me that my former patient had experienced a recurrence of depression and had come to the clinic clutching the letter as if it was a religious relic. The psychiatrist, a seasoned hand, wanted to let a youngster in Massachusetts (me) know how important the simple act of writing and giving the summary had been.

I don't know how much time it took my PCP to prepare the after visit summary. If the electronic medical record software is well configured it could print out from his own note. This would represent a valuable way for "high tech" to support "high touch." (See here for a description of John Naisbitt's book on "high tech/high touch.")

Kitty Kallen was right. Little things mean a lot!

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