A handsome young man with a real medical disease, but also a personality disorder, no PMD, and substance abuse, travels from hospital to hospital complaining of symptoms and asking for pain meds. I recently spoke with two physicians from other hospitals who have taken care of a patient of mine in the last few months. In between those two hospitals and this one, this patient has been to at least two other hospitals. He knows the system and plays it very well. Without getting in to detail I want to say thank God for the telephone and for networking. In 30 minutes I got valuable information which will save the patient, myself, my hospitalist colleagues, the nurses, the psychiatrists and security hours of time and frustration. Makes you salivate over the day when we will (will it ever happen?) have a nationally synch-able electronic health record and in the meantime it makes you realize how valuable it is to have a community of colleagues in your area and a really good sign out system. Hospitalist medicine has many benefits but it also has holes. If a patient knows the holes well, he or she can take advantage of one program after another.