Doubting Yourself

On my current placement, I had a situation where a patient who had been discharged around a week ago was re-admitted to the ward. I had been seeing her for 3-4 days before she was discharged, generally to check on her mobility and current functional status and social situation. Prior to discharge she had been ambulating independently around the ward and performing all ADLs independently, so it came as a bit of a surprise to see her name on the patient list again and I was interested to see why she had been re-admitted. On looking through her admission summary, it was reported that she had a loss of appetite and had generally deteriorated, and that her family were not coping with her at home.

She was a palliative patient, and although had been given only months to live, was still functioning at a fairly high level. The doctors were questioning why she was readmitted, and if someone had missed something to let this happen. It was at this stage that I started to doubt myself and whether or not I had provided adequate treatment and follow up for this lady. I started going through what I had done with her before her discharge- I made sure she was independent with walking, transferring, stairs etc, reviewed her social situation (home set up, family support, etc) and made sure she had achieved her pre-admission functional level. I had also arranged reviews from OT and Social Work for anything else she may need. I was sure I had done all I could to ensure her safe discharge, but in the back of mind was still worried she had been re-admitted due to something I had missed- and could possibly get the ‘blame’ from her doctors.

On review she was independent with all mobility and had no complaints about anything at home. I again reviewed her social situation and there didn’t seem to be anything I missed from my last assessment. I reported all this back to the doctor, who told me that it was her husband who had brought her in reporting he couldn’t cope at home with her because he couldn’t get her eat, causing her to be extremely fatigued. He told me that her disease was actually much more aggressive than first thought, and this had lead to her not being able to eat, causing a more rapid deterioration than expected.

I now realize I should have stuck to my first thoughts- that I had done everything required for her safe discharge, and not doubt myself. I think the best way to avoid this stress of second guessing yourself is to ensure you are completely happy with the patient’s social history and functional status prior to their discharge. Although sometimes you can feel pressured to have a patient discharged by a certain time or day, it is important to be confident the patient is truly ready to manage at home- especially so that if they are re-admitted you can be confident that it was not because of anything you missed.