Exit Without a Map? Why Your Discharge Summary Matters

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As a patient advocate and someone who’s worked in the field of aging for many years, I cannot emphasize often enough the importance of communication: Finding your voice, having your say about how things will go and where you end up, even planning to have a voice when you cannot speak for yourself.

Today I'm talking about a voice, alright, but not the one you’d think. I am talking about obtaining a voice from your provider to you, and beyond a medical appointment.

There's a “voice” you will want to hear, read, and HAVE, and that is the voice from the provider as to what just occurred in your medical encounter and what you must do going forward. I'm talking about your discharge summary.

I am sharing this today because I just had a highly unusual encounter, or at least what I consider to be highly unusual by today's standards. It’s a story from my recent exit from a medical encounter.

The tale unfolds following a terrific medical encounter involving a minor office treatment. Leaving, I reported to the representative at the desk near the exit. That person’s first order of business for her, and the practice) was to arrange another visit (oops, did I say that? I thought it, you know, “Mo’ Money, cha-ching”, all that). They confirmed my already scheduled annual visit. Quizzically, I asked the rep, “Do I get a discharge summary?” and the stunning answer was  

“No, we don't give those out.”

Wait, what??

I think I blurted out “You’re kidding right?”, and the rep then became confused, not knowing how to respond to my utterance. So, I followed up with and tried to involve the rep in the solution (i.e. Give Me One) by chatting that I thought we as a healthcare nation had gotten so much better in providing discharge summaries over the last few years.

Clearly, I had upended our conversation. The representative was confused as to how to respond. I went on to share that I’d been a professional patient advocate for over a decade and had seen the increased occurrence of patients leaving the office armed with information needed, a real boon, and wonderful uptick in communication on the part of the providers, all that.

Come to think of it, I had not been reminded at the conclusion of our encounter that a prescription had been transmitted to my pharmacy, as a prompt to go and pick it up.

“We don’t give those out - unless a patient asks for one” the rep had shared. It was not an invitation to do so, her tone told me that.

Knowing I could access their portal when I arrived home should there be a need I let that conversation go, because the poor rep nor I were in a position to effect lasting change at that moment.

How many people would have stopped right there?

Well, y’all, it bugged me. All the way home. I then accessed the summary in their portal (and they were recently a newly formed practice so creating my online relationship with that office and its portal was good use of my time, I justified. I read my summary.

As it turns out I had to have another prescription to manage or offset the side effects of the first prescription, the very case in point of this segment. Hence my call back to the provider’s office.

Sigh.

Back to my original beef: Why hadn't I received information from the encounter, my at-a-glance list of what to expect or do next? What was done, the time and date stamp, who or how to contact them if there were questions? Plus a reminder of the prescription to be picked up, and any return visit expected of me or scheduled. That would have been nice and it would have been appropriate. I needed that tool, (not courtesy) because I needed to refer to something.

Since that particular provider was a specialist and is no longer a part of my GP’s and hospital system’s portal, I could have taken that discharge summary with me to my upcoming GP appointment. That summary could render important medical information, and I’d be contributing to my own continuity of care. I would have been “an active participant in my care” (and physicians love that!).

A tragedy, I say. A missed opportunity, missed communication, missed education, missed convenience, and perhaps most important: an opportunity for mistakes, you know, when one hand doesn't know what the other is doing?

I was operating from the assumption that this kind of exit-an-appointment process had gotten better in the last 10 years. That it was part and parcel nowadays. I felt a need to research lightly, to either confirm or deny that. After all, I was relying upon my experience and inclination, my limited cross section or vantage point of health care observed or received, whether I or a client were the patient and wherever we were geographically.

I performed some cursory research using sources like the BMJ, BMJ Journals and BHM, Brown Hospital Medicine, using 2025 and 2026 articles, some other sources. I simply sought to verify if indeed we as a nation had gotten better, and it seems we have – and for all the right reasons:

• “The document functions as a critical handoff, ensuring continuity of care and minimizing the risks associated with care transitions”, and “The discharge summary is a comprehensive medical document of a patient’s treatment and care and communicates essential information to subsequent care providers.

• It can provide crucial clinical details to outpatient clinicians, specialists, home health agencies, skilled nursing facilities, and case managers during transitions between care settings.

• Use of discharge summaries has been proven to lessen readmissions.    

And then there is communication toward peace of mind, patient education and readiness, and empowerment. Discharge summaries do us all a solid.

Back to my story now.

All this is still bugging me seven days later (and two prescriptions later, and two trips to the pharmacy later) and so I decided I needed to speak up for all us patients. Should I perhaps contact the provider (with whom I have a good relationship as a patient) and suggest consideration of a procedural change? I know my doctor, but what if I didn't? Would I still say anything?

Because this practice had just left a hospital system and had established itself as a stand-alone medical group there was a new portal which I accessed. I registered, creating an account, and went looking for ways to communicate directly with my provider. Here's what I found:

I could call them (which I had), taking up their time and having to relay a question via a representative, to a nurse, to the provider, and back down again. Kind of reminds one of the old game “Telephone”, doesn’t it? What we learned as kids playing that game is that important stuff can be lost in translation, remember?

“We don't give those out” the rep had stated.
“We don't give those out, that is, unless somebody asks.”

I wonder what I would have gotten here had I asked for one then and there?

- What would it look like?

- What information would it contain?

- Would it have kept me from having to call in?

- Would it have answered what might be considered to be ‘normal questions’?

- Would it reduce staff time on the phone and provider time from interruptions to field questions?

On my end, what problems would my getting one have solved?

- Patient education and next steps

- Continuity of care, especially when providers may not be all on one portal, one “MyChart”-kind of system.

- Improved outcomes

- Patient empowerment and peace of mind (for patient, caregivers, loved ones, other providers).

Here’s a quick story on that, and I often include this scenario in my lecture: a story about daughter and patient advocate named Nancy talking with her aging father.

Nancy: “Hi Dad, how’d the doctor appointment go today?”

Dad: “He said I’m fine.”

Nancy: “Can you tell me more?”

Dad: “He gave me a prescription and I gotta go back next month.”

At this point my antenna are up because there was so much in the few words my father had allowed.

Nancy: “I need a little more information. To me, a prescription indicated treatment and so there is some kind of diagnosis. A return or follow up appointment indicates there is something from this treatment that will need to again be checked. Did you receive a discharge summary on your way out?”

Dad: “I have some papers here.”

Along with being in the Right Thing to Do-department there is so much goodness in a discharge summary itself. Typically, you will see time and date, participants (the “who”, patient and provider), what occurred, what was recommended (your action steps, or To Do’s, like picking up a prescription or a Return To Clinic time and date), prescriptions started and sometimes some discontinued, and what to do if you have any questions.

And that's handy because

• You can check it for accuracy (Examine current meds, your address, whatever) and lodge any corrections or edits.

• Patients can always reference the discharge summary to remember or verify what went on.

• They can share that information with anyone in the caregiver role.

• They can upload or share with other providers, effectively keeping everyone in the loop.

It is the same data that can be found in and visible by way of a patient portal. But some people prefer to have a printed copy at the ready so they can reference it later, or share it with others. 

Thank you for revisiting my encounter with me (and my Dad’s to some degree). My goal in sharing all this with you is that I want everyone to come to expect a discharge summary. You can bet that a provider’s noting has occurred for all your medical encounters. Expect, and ask, if we must, for a discharge summary.

Be part of banging the drum for better outcomes for all involved. Become aware. Get the healthcare you deserve. Believe and participate in Nancy’s favorite mantra “We can all have a say about how things will go and where we’ll end up.”

Safe at home, safely discharged, and informed with outcome and next steps. An educated and empowered patient. There’s nothing better.

Nancy Ruffner is a patient advocate whose focuses include aging strategy, healthcare navigation, and solo aging. Nancy consults with clients in a triage fashion, offering one-hour consultations to find a path, gain a deeper understanding of “how stuff works” in eldercare, or specifically to problem-solve. Schedule your 1-Hour session now, without obligation of commitment or continuing costs. nancyruffner.com