Clarity

"We don't always have to be clever, thank goodness. Often simply being clear is enough." So says the linguistics expert Christopher Johnson in his book Microstyle.

Apply this maxim to crafting the 140-character tweets. It works. Or, if you like, Facebook updates. And prayers too. As a doctor, I know that should also be the code for writing patient's discharge summary.

Neat summary leans heavily on the writer's efforts to distill the real important messages. Oh well, that won't happen if the computer allows us to copy and paste with ease. The first doctor jots down ten lines. The next copies them and adds some more. The third builds on that. The fourth joins. The discharge summary simply grows like the very hungry catepillar, eating one apple on Monday, two pears on Tuesday, three plums on Wednesday ...

Why bring up this overfed caterpillar and longer-and-longer discharge summary? Let's consider a case in more detail. One of our patients had a recent heart attack, and the cardiologist propped open the clogged coronary arteries with metal cage-like tubes, or stents. To keep these stents from blockade, our patient had to take two anti-clotting medications that stop platelets from sticking together. The price to pay for such "double anti-platelet" medications is a higher chance of bleeding.

Soon, the patient suffered from a stroke. A stroke is no joke; it means a clot is impeding the flow of the blood to your brain, wreaking havoc in your ability to talk or to walk. Doctors can't fix that, but can stop another blockade by adding a blood-thinner drug. In other words, that patient ended up taking an anti-clotting cocktail of three drugs. The bleeding risk of such "triple therapy", as you might imagine, is even higher.

Just don't expect the doctors to know (we don't) the best way to handle the tricky situation. The doctors discussed and decided to whittle down the time of taking triple therapy.

To cut the long story short, the resolution goes something like "drug A plus B plus C for 3 months, then A plus C for another 9 months, followed by B plus C forever." This is complicated, I know. The most complicated part of the story, alas, is how the discharge summary was written. That simply looked like a diary with one event after another, one medical decision after another - so much so that the summary ran for two whole pages. The last paragraph, under the heading of management plan, (where you expect to see the concluding remark) was "Home. Clinically stable and fit for discharge." Finding the crucial drug cocktail details within that two-page discharge summary is tough. Or at least, it's like finding a needle in a haystack.

I don't think I need to tell you the ending of the story: the patient ended up receiving the drugs in wrong way.