2The Problem

“Aunt Mary” enjoys a big celebratory meal on Thursday evening while visiting with her extended family. But because the 75-year-old woman—who suffers from chronic congestive heart failure—doesn’t take her diuretic as directed that day, along with 14 other medications, she gains 5 to 10 pounds of water weight. Sometime on Friday she becomes short of breath and calls 911.

Paramedics rush her to a local hospital’s emergency department, where she is treated and stabilized by well-meaning doctors who have never treated her before and can’t access her medical records. They aren’t in touch with Aunt Mary’s primary care physician, so the doctors admit her for a few days to be “tuned up,” just to be extra careful. She returns home without ...

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