Over the telephone, the patient sounds typical of our county hospital clientele: a homeless drinker with an ejection fraction of 19% and a triad of recent hospitalizations for his failing heart. He stays at a shelter near the city's fashionable bars. Three days ago he began coughing and developed a fever, the emergency department physician tells me. The last discharge note had him taking the usual cocktail of cardiac medications, but like many of our recurrently hospitalized patients, he hasn't filled the prescriptions or visited a primary care physician.
Young A, Schleyer AM. The Hospitalist’s Story. JAMA. 2006;296(17):2067–2068. doi:10.1001/jama.296.17.2067
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