I ordered blood and urine tests that traced his fevers to a multi-drug-resistant infection in his bladder. We treated the infection with antibiotics and worked on techniques for hygienic catheterization. Because of the infection, his blood sugar ran consistently high, so we also added extra insulin to his diabetes regimen.

He was doing better within a few days, and his mental status had perked up. Every morning, when I asked how he was feeling, he was able to provide one- or two-word answers. Several times he gave me a thumbs-up.

But his hospitalization had taken a toll—especially on Leah, who now realized Michael would need to regain his strength for her to care for him at home. He could hardly move from his bed to a chair without two people assisting him, and even that left him drained. Our case manager identified a skilled nursing facility nearby, just south of San Francisco, with continued physical therapy and around-the-clock nursing care. I remember Leah expressing relief about the choice. She would be able to visit him every day but still rely on a dedicated team of professionals to help him until he fully recovered.

I performed the rituals of hospital discharge that had become second nature to me as a resident. I typed up a discharge summary outlining each of his medical problems. I spelled out his antibiotics plan. I wrote out his new insulin regimen—an additional injection every six hours and extra doses with his tube feeds, on top of his usual morning dose. I summarized what we were thinking, what we had done, and what needed to be done next. Whenever possible, I had learned to bolster that sheet. I used simple and straightforward language. I bolded. I double-checked my medication list. I knew this sheet was often the only guidance a nursing facility would receive. If I didn’t write something here, it very often didn’t exist.

But I also knew that even if I did write it down, it might not be read by the caregivers and health-care professionals who would treat him next. And I knew that only fragments of their notes and charts were likely to get passed down the line of Michael’s care, too. That’s precisely what happened. Over the next few weeks, Michael would return to my hospital more than once, in bad shape as a result of unconnected records that were not easy to transfer. In one instance, he didn’t receive the insulin doses that I had so carefully marked in his discharge form, which left him in a near-comatose state.

Michael isn’t alone. Every year, an untold number of patients undergo duplicate procedures—or fail to get them in the first place—because key pieces of their medical history go missing. Countless others suffer from medication errors. Hospitals, nursing homes, and other medical facilities use a patchwork of methods to track records, relying on proprietary technology or old-fashioned communications such as faxes and paper notes. These systems don’t always sync, and the collective costs to patients, hospitals, and the economy as a whole are impossible to quantify—although some experts say consistent and cohesive health-information technology could save billions of dollars. An initiative from the U.S. Department of Health and Human Services aims to unify these disparate systems, but we remain far from a universal electronic medical record that would solve the problem.