Key result
Hospital medicine is affected by 'phantom policies'—unwritten rules that become accepted custom and practice, such as withholding transport or medication for patients discharging against medical advice.
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Highlights the negative impact of informal 'phantom' policies in hospital medicine and advocates for challenging them to improve patient care and flow.
Much has been written about the informal “hidden curriculum” in clinical training that can influence our behaviours, perceptions, and values.12 Hospital medicine has a parallel problem of hidden or “phantom” policies, which aren’t formally written but become accepted custom and practice. I’m aware of this from working in older people’s acute care, but readers in other specialties will have their own bugbears. This is no exhaustive list, but I’ll give some examples. Contrary to popular belief, patients discharging themselves against medical advice (for whatever reason) can still be offered transport and medication. And people who aren’t self discharging shouldn’t have to wait for medicine to be dispensed before they leave the ward if someone can pick it up later or it can be sent after them. Despite a regulatory impetus for patients to be reviewed by a senior clinician,3 it’s not the case on clinical …
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David Oliver (2019) conducted an editorial in Hospital medicine. Hospital medicine is affected by 'phantom policies'—unwritten rules that become accepted custom and practice, such as withholding transport or medication for patients discharging against medical advice.
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