Episode 28 - Holding the Bag: Discharge, Follow-Up, and Lost Ownership in Medicine

Discharge from hospital is often treated as a conclusion, but in practice, it frequently marks the start of a less clearly defined phase of care.In this episode of The Host Response, we explore the concept of “holding the bag” in infectious diseases and internal medicine: what happens when responsibility for follow-up is not clearly assigned after discharge.We discuss common real-world scenarios from consult and inpatient practice, including management of resolving infections requiring ongoing antibiotics, intra-abdominal abscesses with drains still in place, pending biopsy or microbiology results, repeat imaging requests, and medications started in hospital without a clear stop date (including anticoagulation, glucocorticoids, and antimicrobial courses).When ownership of these elements is ambiguous, follow-up work often shifts to outpatient consultants, primary care physicians, or patients themselves, regardless of who made the original plan.This episode focuses on practical challenges in transitions of care: discharge documentation, assignment of responsibility for results and procedures, and how unclear follow-up plans contribute to fragmentation in clinical care.A discussion relevant to Infectious Diseases, hospital medicine, and anyone involved in post-discharge follow-up or consult-based care.