Teachable Moments

It seems like every other time you turn on the television or read a paper, there is something about a catastrophic medical error. A surgeon amputates the wrong limb, or a doctor’s handwriting was so bad, the pharmacist dispensed the wrong medication, which almost killed the patient. The list of widely publicized medical errors is exhaustive, proving that physicians, like all humans, make mistakes.

Whether it is a matter of being sleep-deprived, overworked, hypoglycemic from missing meals, or simply just making an honest error, mistakes will happen. Unfortunately, in medicine, an otherwise simple mistake can be devastating.

Instead of pretending our medical school training somehow lifted us above the ranks of the human condition and taught us the elusive art of perfection, why not embrace our normalcy? Like everyone else, we put our pants on like everyone else, one leg at a time. A little humility never hurt anyone. To lessen the odds of adverse events, why not acknowledge our limitations and invite our patients into their own medical care?

We have all had patients who were cynical or anxious, and whose mistrust of the medical profession could hardly be hidden. Perhaps we can help assuage their concerns by empowering them to help themselves during the current hospitalization, and future ones as well.

Simple things, such as counseling patients about the importance of ambulation, not just to prevent deconditioning, but to help prevent blood clots, takes mere seconds.

Informing them that while keeping that Foley catheter in may be convenient, it increases their risk of a UTI is yet another of numerous brief, but power-packed lessons we can teach them. While the thought of a simple bladder infection may not be enough to motivate some of your most difficult patients, the chance that that UTI may turn into septic shock, endanger their life, and prolong their hospital stay, and their medical bills, is sure to put a fire under many patients to get it out as soon as possible.

We are part of their medical team, but they should play a vital role as well. We need to empower them to play a major role in their own care to improve their care, both in the short and long term.

A few seconds can go a long way at improving care and lowering health care costs.

Dr. Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

It seems like every other time you turn on the television or read a paper, there is something about a catastrophic medical error. A surgeon amputates the wrong limb, or a doctor’s handwriting was so bad, the pharmacist dispensed the wrong medication, which almost killed the patient. The list of widely publicized medical errors is exhaustive, proving that physicians, like all humans, make mistakes.

Whether it is a matter of being sleep-deprived, overworked, hypoglycemic from missing meals, or simply just making an honest error, mistakes will happen. Unfortunately, in medicine, an otherwise simple mistake can be devastating.

Instead of pretending our medical school training somehow lifted us above the ranks of the human condition and taught us the elusive art of perfection, why not embrace our normalcy? Like everyone else, we put our pants on like everyone else, one leg at a time. A little humility never hurt anyone. To lessen the odds of adverse events, why not acknowledge our limitations and invite our patients into their own medical care?

We have all had patients who were cynical or anxious, and whose mistrust of the medical profession could hardly be hidden. Perhaps we can help assuage their concerns by empowering them to help themselves during the current hospitalization, and future ones as well.

Simple things, such as counseling patients about the importance of ambulation, not just to prevent deconditioning, but to help prevent blood clots, takes mere seconds.

Informing them that while keeping that Foley catheter in may be convenient, it increases their risk of a UTI is yet another of numerous brief, but power-packed lessons we can teach them. While the thought of a simple bladder infection may not be enough to motivate some of your most difficult patients, the chance that that UTI may turn into septic shock, endanger their life, and prolong their hospital stay, and their medical bills, is sure to put a fire under many patients to get it out as soon as possible.

We are part of their medical team, but they should play a vital role as well. We need to empower them to play a major role in their own care to improve their care, both in the short and long term.

A few seconds can go a long way at improving care and lowering health care costs.

Dr. Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

It seems like every other time you turn on the television or read a paper, there is something about a catastrophic medical error. A surgeon amputates the wrong limb, or a doctor’s handwriting was so bad, the pharmacist dispensed the wrong medication, which almost killed the patient. The list of widely publicized medical errors is exhaustive, proving that physicians, like all humans, make mistakes.

Whether it is a matter of being sleep-deprived, overworked, hypoglycemic from missing meals, or simply just making an honest error, mistakes will happen. Unfortunately, in medicine, an otherwise simple mistake can be devastating.

Instead of pretending our medical school training somehow lifted us above the ranks of the human condition and taught us the elusive art of perfection, why not embrace our normalcy? Like everyone else, we put our pants on like everyone else, one leg at a time. A little humility never hurt anyone. To lessen the odds of adverse events, why not acknowledge our limitations and invite our patients into their own medical care?

We have all had patients who were cynical or anxious, and whose mistrust of the medical profession could hardly be hidden. Perhaps we can help assuage their concerns by empowering them to help themselves during the current hospitalization, and future ones as well.

Simple things, such as counseling patients about the importance of ambulation, not just to prevent deconditioning, but to help prevent blood clots, takes mere seconds.

Informing them that while keeping that Foley catheter in may be convenient, it increases their risk of a UTI is yet another of numerous brief, but power-packed lessons we can teach them. While the thought of a simple bladder infection may not be enough to motivate some of your most difficult patients, the chance that that UTI may turn into septic shock, endanger their life, and prolong their hospital stay, and their medical bills, is sure to put a fire under many patients to get it out as soon as possible.

We are part of their medical team, but they should play a vital role as well. We need to empower them to play a major role in their own care to improve their care, both in the short and long term.

A few seconds can go a long way at improving care and lowering health care costs.

Dr. Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

When I struggled with the notion of giving up my longtime love of primary care to pursue a career in hospital medicine, one of the things I knew I would miss most was the opportunity to counsel patients on the importance of preventive medicine and leading a healthy lifestyle.

One of my most memorable moments was when a patient walked into my office, disappointed that he had to come in before his anticipated grand entrance. You see, he had lost 99 pounds and was hoping to have lost a full 100 prior to seeing me again after our last intense lifestyle counseling session. Finally! Someone had really listened. I relished the fact that he probably would live much longer and have fewer medical issues to deal with as a result of his tremendous weight loss. I was ecstatic to have played a role in his transformation. That, I thought, was what primary care was all about.

While I never regretted making the change from primary care to hospital medicine, I briefly toyed with the idea of switching back recently when a dear friend of mine was diagnosed with prostate cancer, metastatic to the spine and brain.

Less than 10 years ago I had watched him deal with the agony of losing his wife, his lifelong companion, to colon cancer at the early age of 43. Now, in his early 50s he, too, was diagnosed with terminal cancer. As nature takes its course, his new wife will lose her bridegroom, and his four children will lose their wonderful father within a few months.

I had to wonder why this was happening to such an awesome man. If he had gotten his prostate-specific antigen test and digital rectal exam each year without fail, would he and his family (and my family) be dealing with such devastation now?

And so, for a brief moment I seriously considered returning to the office, hoping to find an attentive audience who would listen to my pleas to get a mammogram, make an appointment for a screening colonoscopy, kick that crazy smoking habit, or schedule a prostate exam.

But as I sat there with tears in my eyes thinking about my friend, I realized that just because I am no longer a primary care doctor doesn’t mean I can’t counsel patients on preventive health issues. Later that day, I admitted a woman with pneumonia who had not seen a doctor in over a decade. I was elated to encourage her about the importance of getting a screening mammogram, Pap smear, and colonoscopy, and even offered to give her the names of some primary care physicians in the area who were accepting new patients on discharge.

Who knows if she will follow up on my recommendations? But I do know that it felt wonderful to encourage her to do something that may just save her life. And now, preventive medicine and healthy lifestyle counseling have again become a regular part of my discussions with patients.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

When I struggled with the notion of giving up my longtime love of primary care to pursue a career in hospital medicine, one of the things I knew I would miss most was the opportunity to counsel patients on the importance of preventive medicine and leading a healthy lifestyle.

One of my most memorable moments was when a patient walked into my office, disappointed that he had to come in before his anticipated grand entrance. You see, he had lost 99 pounds and was hoping to have lost a full 100 prior to seeing me again after our last intense lifestyle counseling session. Finally! Someone had really listened. I relished the fact that he probably would live much longer and have fewer medical issues to deal with as a result of his tremendous weight loss. I was ecstatic to have played a role in his transformation. That, I thought, was what primary care was all about.

While I never regretted making the change from primary care to hospital medicine, I briefly toyed with the idea of switching back recently when a dear friend of mine was diagnosed with prostate cancer, metastatic to the spine and brain.

Less than 10 years ago I had watched him deal with the agony of losing his wife, his lifelong companion, to colon cancer at the early age of 43. Now, in his early 50s he, too, was diagnosed with terminal cancer. As nature takes its course, his new wife will lose her bridegroom, and his four children will lose their wonderful father within a few months.

I had to wonder why this was happening to such an awesome man. If he had gotten his prostate-specific antigen test and digital rectal exam each year without fail, would he and his family (and my family) be dealing with such devastation now?

And so, for a brief moment I seriously considered returning to the office, hoping to find an attentive audience who would listen to my pleas to get a mammogram, make an appointment for a screening colonoscopy, kick that crazy smoking habit, or schedule a prostate exam.

But as I sat there with tears in my eyes thinking about my friend, I realized that just because I am no longer a primary care doctor doesn’t mean I can’t counsel patients on preventive health issues. Later that day, I admitted a woman with pneumonia who had not seen a doctor in over a decade. I was elated to encourage her about the importance of getting a screening mammogram, Pap smear, and colonoscopy, and even offered to give her the names of some primary care physicians in the area who were accepting new patients on discharge.

Who knows if she will follow up on my recommendations? But I do know that it felt wonderful to encourage her to do something that may just save her life. And now, preventive medicine and healthy lifestyle counseling have again become a regular part of my discussions with patients.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

When I struggled with the notion of giving up my longtime love of primary care to pursue a career in hospital medicine, one of the things I knew I would miss most was the opportunity to counsel patients on the importance of preventive medicine and leading a healthy lifestyle.

One of my most memorable moments was when a patient walked into my office, disappointed that he had to come in before his anticipated grand entrance. You see, he had lost 99 pounds and was hoping to have lost a full 100 prior to seeing me again after our last intense lifestyle counseling session. Finally! Someone had really listened. I relished the fact that he probably would live much longer and have fewer medical issues to deal with as a result of his tremendous weight loss. I was ecstatic to have played a role in his transformation. That, I thought, was what primary care was all about.

While I never regretted making the change from primary care to hospital medicine, I briefly toyed with the idea of switching back recently when a dear friend of mine was diagnosed with prostate cancer, metastatic to the spine and brain.

Less than 10 years ago I had watched him deal with the agony of losing his wife, his lifelong companion, to colon cancer at the early age of 43. Now, in his early 50s he, too, was diagnosed with terminal cancer. As nature takes its course, his new wife will lose her bridegroom, and his four children will lose their wonderful father within a few months.

I had to wonder why this was happening to such an awesome man. If he had gotten his prostate-specific antigen test and digital rectal exam each year without fail, would he and his family (and my family) be dealing with such devastation now?

And so, for a brief moment I seriously considered returning to the office, hoping to find an attentive audience who would listen to my pleas to get a mammogram, make an appointment for a screening colonoscopy, kick that crazy smoking habit, or schedule a prostate exam.

But as I sat there with tears in my eyes thinking about my friend, I realized that just because I am no longer a primary care doctor doesn’t mean I can’t counsel patients on preventive health issues. Later that day, I admitted a woman with pneumonia who had not seen a doctor in over a decade. I was elated to encourage her about the importance of getting a screening mammogram, Pap smear, and colonoscopy, and even offered to give her the names of some primary care physicians in the area who were accepting new patients on discharge.

Who knows if she will follow up on my recommendations? But I do know that it felt wonderful to encourage her to do something that may just save her life. And now, preventive medicine and healthy lifestyle counseling have again become a regular part of my discussions with patients.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Just the mention of code status to patients and their families often turns a (sometimes feined) upbeat demeanor into a solemn one. While the mere mention of even a remote possibility of dying understandably makes patients uncomfortable and introspective, the lack of truly understanding the significance of the code status is potentially catastrophic. So teaching our patients the true significance of a DNR order is vital.

It seems as if just about everyone knows or has heard of someone who was inhumanely kept alive far too long, all the while suffering needlessly as a "vegetable." So, naturally, when asked if they would want to be resuscitated should their heart or lungs show signs of giving out, many people quickly answer with a resounding "No!", while others point out that they have an advance directive, not realizing that this legal document is not the appropriate option in all situations. But as physicians, we know that a 3 a.m. run of ventricular tachycardia in a generally healthy woman admitted with severe diarrhea and dehydration may simply be the result of an easy-to-correct electrolyte abnormality, and not an indicator that her heart is giving out.

I have had countless conversations with patients and their family members about code status, and I find it very unfortunate that the general public is so poorly informed on this issue.

I remember a gentleman in his 50s who declared himself a DNR in the ER, not realizing the implications. When I subsequently saw him and explained to him that in many situations, a person’s condition can be completely turned around with appropriate treatment, he changed his mind and revoked his DNR status. Within a few hours, his oxygen saturation plummeted as a result of his pneumonia, and he required intubation. He had no other significant medical problems, and he did very well. Had he not revoked his DNR status, he likely would have succumbed to pneumonia in the hospital. Instead, he was eventually discharged home to go back to his normal life.

Though our workflow is often hectic, taking a few minutes to confirm that patients really understand what a DNR order means, as well as understand the difference between an advance directive and a DNR order, can literally save lives.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Just the mention of code status to patients and their families often turns a (sometimes feined) upbeat demeanor into a solemn one. While the mere mention of even a remote possibility of dying understandably makes patients uncomfortable and introspective, the lack of truly understanding the significance of the code status is potentially catastrophic. So teaching our patients the true significance of a DNR order is vital.

It seems as if just about everyone knows or has heard of someone who was inhumanely kept alive far too long, all the while suffering needlessly as a "vegetable." So, naturally, when asked if they would want to be resuscitated should their heart or lungs show signs of giving out, many people quickly answer with a resounding "No!", while others point out that they have an advance directive, not realizing that this legal document is not the appropriate option in all situations. But as physicians, we know that a 3 a.m. run of ventricular tachycardia in a generally healthy woman admitted with severe diarrhea and dehydration may simply be the result of an easy-to-correct electrolyte abnormality, and not an indicator that her heart is giving out.

I have had countless conversations with patients and their family members about code status, and I find it very unfortunate that the general public is so poorly informed on this issue.

I remember a gentleman in his 50s who declared himself a DNR in the ER, not realizing the implications. When I subsequently saw him and explained to him that in many situations, a person’s condition can be completely turned around with appropriate treatment, he changed his mind and revoked his DNR status. Within a few hours, his oxygen saturation plummeted as a result of his pneumonia, and he required intubation. He had no other significant medical problems, and he did very well. Had he not revoked his DNR status, he likely would have succumbed to pneumonia in the hospital. Instead, he was eventually discharged home to go back to his normal life.

Though our workflow is often hectic, taking a few minutes to confirm that patients really understand what a DNR order means, as well as understand the difference between an advance directive and a DNR order, can literally save lives.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Just the mention of code status to patients and their families often turns a (sometimes feined) upbeat demeanor into a solemn one. While the mere mention of even a remote possibility of dying understandably makes patients uncomfortable and introspective, the lack of truly understanding the significance of the code status is potentially catastrophic. So teaching our patients the true significance of a DNR order is vital.

It seems as if just about everyone knows or has heard of someone who was inhumanely kept alive far too long, all the while suffering needlessly as a "vegetable." So, naturally, when asked if they would want to be resuscitated should their heart or lungs show signs of giving out, many people quickly answer with a resounding "No!", while others point out that they have an advance directive, not realizing that this legal document is not the appropriate option in all situations. But as physicians, we know that a 3 a.m. run of ventricular tachycardia in a generally healthy woman admitted with severe diarrhea and dehydration may simply be the result of an easy-to-correct electrolyte abnormality, and not an indicator that her heart is giving out.

I have had countless conversations with patients and their family members about code status, and I find it very unfortunate that the general public is so poorly informed on this issue.

I remember a gentleman in his 50s who declared himself a DNR in the ER, not realizing the implications. When I subsequently saw him and explained to him that in many situations, a person’s condition can be completely turned around with appropriate treatment, he changed his mind and revoked his DNR status. Within a few hours, his oxygen saturation plummeted as a result of his pneumonia, and he required intubation. He had no other significant medical problems, and he did very well. Had he not revoked his DNR status, he likely would have succumbed to pneumonia in the hospital. Instead, he was eventually discharged home to go back to his normal life.

Though our workflow is often hectic, taking a few minutes to confirm that patients really understand what a DNR order means, as well as understand the difference between an advance directive and a DNR order, can literally save lives.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Fax machines malfunction. Records are misfiled. Mail ends up at the wrong address. Office staff inadvertently throw away important paperwork. The reasons for doctors not getting the records we know we get faxed to them (and even sometimes personally fax ourselves) are myriad. Regardless of the reason, some things just fall through the cracks. The only (semi) foolproof solution is to speak with each primary care physician about every patient we see. Not only is this time prohibitive for many hospitalists, and private physicians, sometimes this "gold standard" in communication is not really foolproof after all.

Picture this: A private doctor is scrambling to see all of his patients by 4:30 p.m. in order to return calls, review lab results, scan his mail, and still be on the road to get to his daughter’s piano recital by 6:00. His medical assistant pulls him out of the examining room for yet another phone call. It’s you calling with an overview of the hospital stay for patient he vaguely remembers. You rattle off a series of abnormal test results that need to follow-up during the patient’s next visit, and you assure him that all of this information will be in the discharge summary that will be faxed to eventually.

Is that busy physician going to take notes about your conversation? Maybe. Or, perhaps he will rely on the discharge summary to refresh his memory. The problem is there is no guarantee that he will ever receive it. Things happen, despite the best efforts of doctors and support staff alike.

While it may take a little extra time to give patients a copy of their test results and explain those results, in many cases, this is the safest approach. The likelihood that a hospitalist will be held liable for not addressing noncritical abnormalities is remote, as long as he has made adequate provision for these abnormalities to be addressed at a later time. On the other hand, if a seemingly insignificant lab abnormality blossoms into a more serious one over time because the primary care doctor was not aware of the problem in the first place, the hospitalist could be at fault, even if he thought the discharge summary was faxed or mailed as requested.

I know "things happen." Just recently a close relative of mine was sent for a stress test. Several weeks passed and he never heard from the ordering physician, assuming that if anything were wrong, the physician would have called. And, technically, knowing the physician personally, I know he would have called if he had actually received the report.

So, I contacted the physician. I kind of expected the response I received: He did not realize the test was done because he never received the results. Next, I called the cardiologist who interpreted the stress test. Since I regularly consult him to see my hospitalized patients, I had his cell number. He was absolutely floored. He researched the issue and found the fax confirmation showing his office had faxed over the report. Still, the primary care doctor – an excellent and responsive physician – never received it. Fortunately, everything was fine, but it was a good lesson in "things happen."

If there is even a remote concern about a test result needing further follow-up, it is safest to put the test results in the hand of the patient yourself.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Fax machines malfunction. Records are misfiled. Mail ends up at the wrong address. Office staff inadvertently throw away important paperwork. The reasons for doctors not getting the records we know we get faxed to them (and even sometimes personally fax ourselves) are myriad. Regardless of the reason, some things just fall through the cracks. The only (semi) foolproof solution is to speak with each primary care physician about every patient we see. Not only is this time prohibitive for many hospitalists, and private physicians, sometimes this "gold standard" in communication is not really foolproof after all.

Picture this: A private doctor is scrambling to see all of his patients by 4:30 p.m. in order to return calls, review lab results, scan his mail, and still be on the road to get to his daughter’s piano recital by 6:00. His medical assistant pulls him out of the examining room for yet another phone call. It’s you calling with an overview of the hospital stay for patient he vaguely remembers. You rattle off a series of abnormal test results that need to follow-up during the patient’s next visit, and you assure him that all of this information will be in the discharge summary that will be faxed to eventually.

Is that busy physician going to take notes about your conversation? Maybe. Or, perhaps he will rely on the discharge summary to refresh his memory. The problem is there is no guarantee that he will ever receive it. Things happen, despite the best efforts of doctors and support staff alike.

While it may take a little extra time to give patients a copy of their test results and explain those results, in many cases, this is the safest approach. The likelihood that a hospitalist will be held liable for not addressing noncritical abnormalities is remote, as long as he has made adequate provision for these abnormalities to be addressed at a later time. On the other hand, if a seemingly insignificant lab abnormality blossoms into a more serious one over time because the primary care doctor was not aware of the problem in the first place, the hospitalist could be at fault, even if he thought the discharge summary was faxed or mailed as requested.

I know "things happen." Just recently a close relative of mine was sent for a stress test. Several weeks passed and he never heard from the ordering physician, assuming that if anything were wrong, the physician would have called. And, technically, knowing the physician personally, I know he would have called if he had actually received the report.

So, I contacted the physician. I kind of expected the response I received: He did not realize the test was done because he never received the results. Next, I called the cardiologist who interpreted the stress test. Since I regularly consult him to see my hospitalized patients, I had his cell number. He was absolutely floored. He researched the issue and found the fax confirmation showing his office had faxed over the report. Still, the primary care doctor – an excellent and responsive physician – never received it. Fortunately, everything was fine, but it was a good lesson in "things happen."

If there is even a remote concern about a test result needing further follow-up, it is safest to put the test results in the hand of the patient yourself.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

Fax machines malfunction. Records are misfiled. Mail ends up at the wrong address. Office staff inadvertently throw away important paperwork. The reasons for doctors not getting the records we know we get faxed to them (and even sometimes personally fax ourselves) are myriad. Regardless of the reason, some things just fall through the cracks. The only (semi) foolproof solution is to speak with each primary care physician about every patient we see. Not only is this time prohibitive for many hospitalists, and private physicians, sometimes this "gold standard" in communication is not really foolproof after all.

Picture this: A private doctor is scrambling to see all of his patients by 4:30 p.m. in order to return calls, review lab results, scan his mail, and still be on the road to get to his daughter’s piano recital by 6:00. His medical assistant pulls him out of the examining room for yet another phone call. It’s you calling with an overview of the hospital stay for patient he vaguely remembers. You rattle off a series of abnormal test results that need to follow-up during the patient’s next visit, and you assure him that all of this information will be in the discharge summary that will be faxed to eventually.

Is that busy physician going to take notes about your conversation? Maybe. Or, perhaps he will rely on the discharge summary to refresh his memory. The problem is there is no guarantee that he will ever receive it. Things happen, despite the best efforts of doctors and support staff alike.

While it may take a little extra time to give patients a copy of their test results and explain those results, in many cases, this is the safest approach. The likelihood that a hospitalist will be held liable for not addressing noncritical abnormalities is remote, as long as he has made adequate provision for these abnormalities to be addressed at a later time. On the other hand, if a seemingly insignificant lab abnormality blossoms into a more serious one over time because the primary care doctor was not aware of the problem in the first place, the hospitalist could be at fault, even if he thought the discharge summary was faxed or mailed as requested.

I know "things happen." Just recently a close relative of mine was sent for a stress test. Several weeks passed and he never heard from the ordering physician, assuming that if anything were wrong, the physician would have called. And, technically, knowing the physician personally, I know he would have called if he had actually received the report.

So, I contacted the physician. I kind of expected the response I received: He did not realize the test was done because he never received the results. Next, I called the cardiologist who interpreted the stress test. Since I regularly consult him to see my hospitalized patients, I had his cell number. He was absolutely floored. He researched the issue and found the fax confirmation showing his office had faxed over the report. Still, the primary care doctor – an excellent and responsive physician – never received it. Fortunately, everything was fine, but it was a good lesson in "things happen."

If there is even a remote concern about a test result needing further follow-up, it is safest to put the test results in the hand of the patient yourself.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.

"Medical noncompliance" is a phrase that makes even the most experienced hospitalist take a deep breath and force a smile as he gently explains to patients why they wound up in the emergency department.

We deal with this issue so often that it may even become second nature to breeze over this as we take a medical history, all the while cringing inside.

Who is to blame anyway? Well, there is often plenty of blame to go around. First of all, the patient is obviously at fault, sometimes unintentionally. He has failed to follow what we may consider to be simple instructions, and as a result, has wound up in the hospital yet again.

But what if there is more to the story?

Was the prescribing doctor too busy to explain to him the common, and sometimes unbearable, side effects of his medication? Maybe.

Was his caregiver remiss in not filling it on time or giving it as scheduled? Perhaps.

Does his insurance cover the entire amount, and if not, could it be that he cannot afford such an expensive drug on a fixed income? Strong possibility.

Or, does he simply not understand that his medication – which costs a lot of money and does not seem to make him feel any better (or may actually make him feel worse) – is in fact protecting him from a potentially catastrophic downward spiral that may culminate in his early demise?

Frequently the reason patients are noncompliant is multifactorial. But regardless of the reason, the bottom line is that the patient needs counseling, and there are a lot of missed opportunities to provide it. Even on a busy day, we can set the stage by introducing the basic concepts of what this medication is doing for him and then ask a nurse to print additional information on his condition for his reading pleasure. If he simply can’t remember to take his medications regularly, suggest that he purchase a pill box, fill it once per week, and keep it near his toothbrush, his refrigerator, or wherever else he will see it several times each day. If he cannot afford the medication or there are unpleasant side effects, explain that there may be alternative medications that may work just as well.

Part of the problem is that docs are too busy to counsel their patients – most leave it up to RNs to discuss pill bottles, etc. However, I believe patients are more likely to follow this advice when it comes from a physician, especially when they are hoping to go home ASAP. And so hospitalists must remind the noncompliant patient that he has to participate in his health to avoid returning to our care.

Certainly, this can be about reducing readmission rates, but it is at least as much about building a healthier patient overall.

Empowering patients to improve medication compliance only takes a few minutes, and can pay huge dividends for patients and physicians alike.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

"Medical noncompliance" is a phrase that makes even the most experienced hospitalist take a deep breath and force a smile as he gently explains to patients why they wound up in the emergency department.

We deal with this issue so often that it may even become second nature to breeze over this as we take a medical history, all the while cringing inside.

Who is to blame anyway? Well, there is often plenty of blame to go around. First of all, the patient is obviously at fault, sometimes unintentionally. He has failed to follow what we may consider to be simple instructions, and as a result, has wound up in the hospital yet again.

But what if there is more to the story?

Was the prescribing doctor too busy to explain to him the common, and sometimes unbearable, side effects of his medication? Maybe.

Was his caregiver remiss in not filling it on time or giving it as scheduled? Perhaps.

Does his insurance cover the entire amount, and if not, could it be that he cannot afford such an expensive drug on a fixed income? Strong possibility.

Or, does he simply not understand that his medication – which costs a lot of money and does not seem to make him feel any better (or may actually make him feel worse) – is in fact protecting him from a potentially catastrophic downward spiral that may culminate in his early demise?

Frequently the reason patients are noncompliant is multifactorial. But regardless of the reason, the bottom line is that the patient needs counseling, and there are a lot of missed opportunities to provide it. Even on a busy day, we can set the stage by introducing the basic concepts of what this medication is doing for him and then ask a nurse to print additional information on his condition for his reading pleasure. If he simply can’t remember to take his medications regularly, suggest that he purchase a pill box, fill it once per week, and keep it near his toothbrush, his refrigerator, or wherever else he will see it several times each day. If he cannot afford the medication or there are unpleasant side effects, explain that there may be alternative medications that may work just as well.

Part of the problem is that docs are too busy to counsel their patients – most leave it up to RNs to discuss pill bottles, etc. However, I believe patients are more likely to follow this advice when it comes from a physician, especially when they are hoping to go home ASAP. And so hospitalists must remind the noncompliant patient that he has to participate in his health to avoid returning to our care.

Certainly, this can be about reducing readmission rates, but it is at least as much about building a healthier patient overall.

Empowering patients to improve medication compliance only takes a few minutes, and can pay huge dividends for patients and physicians alike.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

"Medical noncompliance" is a phrase that makes even the most experienced hospitalist take a deep breath and force a smile as he gently explains to patients why they wound up in the emergency department.

We deal with this issue so often that it may even become second nature to breeze over this as we take a medical history, all the while cringing inside.

Who is to blame anyway? Well, there is often plenty of blame to go around. First of all, the patient is obviously at fault, sometimes unintentionally. He has failed to follow what we may consider to be simple instructions, and as a result, has wound up in the hospital yet again.

But what if there is more to the story?

Was the prescribing doctor too busy to explain to him the common, and sometimes unbearable, side effects of his medication? Maybe.

Was his caregiver remiss in not filling it on time or giving it as scheduled? Perhaps.

Does his insurance cover the entire amount, and if not, could it be that he cannot afford such an expensive drug on a fixed income? Strong possibility.

Or, does he simply not understand that his medication – which costs a lot of money and does not seem to make him feel any better (or may actually make him feel worse) – is in fact protecting him from a potentially catastrophic downward spiral that may culminate in his early demise?

Frequently the reason patients are noncompliant is multifactorial. But regardless of the reason, the bottom line is that the patient needs counseling, and there are a lot of missed opportunities to provide it. Even on a busy day, we can set the stage by introducing the basic concepts of what this medication is doing for him and then ask a nurse to print additional information on his condition for his reading pleasure. If he simply can’t remember to take his medications regularly, suggest that he purchase a pill box, fill it once per week, and keep it near his toothbrush, his refrigerator, or wherever else he will see it several times each day. If he cannot afford the medication or there are unpleasant side effects, explain that there may be alternative medications that may work just as well.

Part of the problem is that docs are too busy to counsel their patients – most leave it up to RNs to discuss pill bottles, etc. However, I believe patients are more likely to follow this advice when it comes from a physician, especially when they are hoping to go home ASAP. And so hospitalists must remind the noncompliant patient that he has to participate in his health to avoid returning to our care.

Certainly, this can be about reducing readmission rates, but it is at least as much about building a healthier patient overall.

Empowering patients to improve medication compliance only takes a few minutes, and can pay huge dividends for patients and physicians alike.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

It’s at this time of the year that being a hospitalist is sweetest. No need to plan months in advance for one vacation during the summer months. With block schedules, there is plenty of time off to take multiple vacations or ‘staycations’, which are sometimes just as nice.

Prior to becoming a hospitalist, I was a primary care physician, seeing patients both in the office and the hospital.  That grew very wearisome. It seemed like I never, ever, finished my work.  Each new day met me with a stack of lab reports to follow up on and a list of callbacks to ensure my patients’ outstanding tests and procedures did not fall through the cracks. After 8 years of trying to "‘do it all," I leapt at the opportunity to practice purely inpatient medicine.

As an office-based doctor, the stress never ended.  It seemed like I could never take enough vacations to reach a steady state of calm.  Even when I wanted time off, a lot of planning went into taking even a simple trip home for  a few days.  As a rule, vacation time had to be requested several months in advance to insure you got your request in before too many others requested ‘your’ time off.  If your request came too late, it was back to the drawing board to completely revamp your vacation plans, and often your family’s as well.  And that irresistible deal on airline tickets would just have  to go to some other lucky soul. 

Juggling school schedules, a spouse’s schedule, and my own to try to find the perfect time that everyone can get away could turn what should be an exciting adventure into a veritable nightmare. Scheduled meetings, recitals, and ballgames added yet another layer of complexity onto already difficult task. 

But then, I became a hospitalist.

There were no longer one or two possible vacation weeks each summer -- there were many!  Four days here, six days there, vacation scheduling became easy and surprisingly pleasant.  The cloud had lifted, and she sun came shining through.  It was no longer a tedious chore to plan special time to spend with the family, it was an exciting pre-adventure that would set the stage for a much needed respite from the adrenaline-filled days of life on the wards.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

It’s at this time of the year that being a hospitalist is sweetest. No need to plan months in advance for one vacation during the summer months. With block schedules, there is plenty of time off to take multiple vacations or ‘staycations’, which are sometimes just as nice.

Prior to becoming a hospitalist, I was a primary care physician, seeing patients both in the office and the hospital.  That grew very wearisome. It seemed like I never, ever, finished my work.  Each new day met me with a stack of lab reports to follow up on and a list of callbacks to ensure my patients’ outstanding tests and procedures did not fall through the cracks. After 8 years of trying to "‘do it all," I leapt at the opportunity to practice purely inpatient medicine.

As an office-based doctor, the stress never ended.  It seemed like I could never take enough vacations to reach a steady state of calm.  Even when I wanted time off, a lot of planning went into taking even a simple trip home for  a few days.  As a rule, vacation time had to be requested several months in advance to insure you got your request in before too many others requested ‘your’ time off.  If your request came too late, it was back to the drawing board to completely revamp your vacation plans, and often your family’s as well.  And that irresistible deal on airline tickets would just have  to go to some other lucky soul. 

Juggling school schedules, a spouse’s schedule, and my own to try to find the perfect time that everyone can get away could turn what should be an exciting adventure into a veritable nightmare. Scheduled meetings, recitals, and ballgames added yet another layer of complexity onto already difficult task. 

But then, I became a hospitalist.

There were no longer one or two possible vacation weeks each summer -- there were many!  Four days here, six days there, vacation scheduling became easy and surprisingly pleasant.  The cloud had lifted, and she sun came shining through.  It was no longer a tedious chore to plan special time to spend with the family, it was an exciting pre-adventure that would set the stage for a much needed respite from the adrenaline-filled days of life on the wards.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."

It’s at this time of the year that being a hospitalist is sweetest. No need to plan months in advance for one vacation during the summer months. With block schedules, there is plenty of time off to take multiple vacations or ‘staycations’, which are sometimes just as nice.

Prior to becoming a hospitalist, I was a primary care physician, seeing patients both in the office and the hospital.  That grew very wearisome. It seemed like I never, ever, finished my work.  Each new day met me with a stack of lab reports to follow up on and a list of callbacks to ensure my patients’ outstanding tests and procedures did not fall through the cracks. After 8 years of trying to "‘do it all," I leapt at the opportunity to practice purely inpatient medicine.

As an office-based doctor, the stress never ended.  It seemed like I could never take enough vacations to reach a steady state of calm.  Even when I wanted time off, a lot of planning went into taking even a simple trip home for  a few days.  As a rule, vacation time had to be requested several months in advance to insure you got your request in before too many others requested ‘your’ time off.  If your request came too late, it was back to the drawing board to completely revamp your vacation plans, and often your family’s as well.  And that irresistible deal on airline tickets would just have  to go to some other lucky soul. 

Juggling school schedules, a spouse’s schedule, and my own to try to find the perfect time that everyone can get away could turn what should be an exciting adventure into a veritable nightmare. Scheduled meetings, recitals, and ballgames added yet another layer of complexity onto already difficult task. 

But then, I became a hospitalist.

There were no longer one or two possible vacation weeks each summer -- there were many!  Four days here, six days there, vacation scheduling became easy and surprisingly pleasant.  The cloud had lifted, and she sun came shining through.  It was no longer a tedious chore to plan special time to spend with the family, it was an exciting pre-adventure that would set the stage for a much needed respite from the adrenaline-filled days of life on the wards.

Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center who has a passion for empowering patients to partner in their health care. She wrote her first patient-empowerment book while still in medical school and later authored, "Your Family Medical Record: An Interactive Guide to Health and Self-Empowerment."