Discharge letter with social risk and two GP questions
You are the resident on a Bulgarian internal medicine ward. A 78-year-old woman with COPD (GOLD 3) is being discharged after an exacerbation. She lives alone on the fourth floor without a lift, uses a walker, and has had two falls in six months. Her son lives in another city. Discharge medications: prednisolone 30 mg once daily for 5 days, amoxicillin-clavulanate 875/125 mg twice daily for 7 days, tiotropium 18 mcg once daily, salbutamol as needed. She already takes amlodipine 5 mg and atorvastatin 20 mg. The GP needs a referral for a home oxygen assessment and a falls review. You have 120 words for the discharge letter and must avoid abbreviations the patient cannot understand.
1. Draft the discharge letter in Bulgarian in no more than 120 words. Include the reason for referral, medicines with duration, social risk, and two explicit questions for the GP.
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Draft: 'Уважаеми доктор [име], Изписвам 78-годишна пациентка след обостряне на ХОББ (GOLD 3). При изписването: преднизолон 30 mg веднъж дневно 5 дни; амоксицилин/клавуланат 875/125 mg два пъти дневно 7 дни; тиотропий 18 mcg веднъж дневно; салбутамол при нужда; амлодипин 5 mg; аторвастатин 20 mg. Моля за оценка за домашна кислородна терапия и за преглед за падания. Пациентката живее сама, четвърти етаж без асансьор, използва проходилка; две падания за 6 месеца. Синът е в друг град. Моля да потвърдите кой ще следи стероидната схема и кога е следващият контролен преглед. С уважение, д-р [име]' Reasoning: the letter is under 120 words, gives durations for the temporary drugs, and puts the social risk where the GP can act on it.
2. Justify the structure and register of your letter in three points. Why is 'пациентката' preferable to 'болната' here?
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- Structure: reason for discharge, medication list with durations, social risk, then two questions. The GP can act without reading a narrative.
- Register: formal but plain; no unexplained abbreviations because the patient may read it; drug names and doses are written in full. 'Моля' frames the referral as a request, not an order.
- Person-first wording: 'пациентката' identifies her role in care; 'болната' labels her by illness and is less appropriate in a discharge letter. It also avoids ambiguity with 'болна' as an adjective. The letter still states the diagnosis, so nothing is hidden.
3. Identify one omission that would make the letter unsafe and state the Bulgarian sentence you would add.
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Omission: allergy status and prior adverse drug reactions are absent. For a patient going home on antibiotics and steroids, this is a safety gap. Sentence to add: 'Няма данни за алергии към антибиотици или кортикостероиди; при предходен прием на амоксицилин не е имало реакция.' If that is not verified, write instead: 'Алергичният статус не е уточнен - моля, проверете преди следваща доза.' Reasoning: the sentence is conditional on what is actually known. The second version is safer than inventing a negative history.