Key Feature 4: In patients with acute diarrhea, counsel about the timing of return to work/school (re: the likelihood of infectivity).
Skill: Clinical Reasoning
I must admit, I have not been giving advice to patients with acute diarrhea about preventing the spread of possible infection to others, and I've already been on my pediatric ED rotation for 3 weeks, seeing buttloads of it. At the same time, I haven't really been hearing my attending preceptors do this either. But this seems like such a common sense and important part of the counselling around diarrhea of presumably infectious origin, and it is a standard public health consideration.
I took a look at a few UpToDate articles on acute diarrhea and didn't see anything in the body of the information for clinicians. On the patient handouts, however, I found multiple handouts providing advice on preventing the spread of infection. The advice included the following:
From the UpToDate patient handout, "Acute diarrhea in adults"
From the UpToDate patient handout, "Acute diarrhea in children"
Just another reason for providing a patient handout! Not to say this is a cop-out either, I definitely plan to provide verbal advice to stay away from public environments while there is ongoing acute diarrhea. But it has been well understood for a long time that patients have information incontinence when it comes to retaining information provided by physicians. In the article, "Patients' memory for medical information" by Roy Kessels as published in the Journal of the Royal Society of Medicine (2003), "Memory for medical information is often poor and inaccurate, especially when the patient is old or anxious. Patients tend to focus on diagnosis-related information and fail to register instructions on treatment. Simple and specific instructions are better recalled than general statements. Patients can be helped to remember medical information by use of explicit categorization techniques. In addition, spoken information should be supported with written or visual material."
A handout a day keeps the doctor away.