The expectations placed on physicians seem to increase daily. We are expected to provide outstanding patient care--with little or no room for error. We are expected to be compassionate and understanding of the needs of our patients, their families and their caregivers. We are expected to know the limitations of the various health plans in which they are enrolled, as well as the vagaries of the formularies they are subject to by virtue of their health plan enrollment. We are expected to communicate our findings to patients and their families, as well as to their other physicians and allied healthcare providers.

These expectations struck me when I completed an online course in documentation that my professional liability carrier offers in return for an 8 percent discount on my premium. The cogent lesson was that physicians must document every element of their interactions with patients in order to protect themselves from allegations ranging from medical negligence and personal misconduct to failure to return a phone call.

In fact, the course suggested that a physician should always carry a portable dictation device so that every out-of-the-office conversation with a patient or family member can be immediately dictated for inclusion in the medical record. In my 22 years in practice, I have never done this, but I can certainly understand the recommendation and see value in initiating such a practice.

However, I became concerned when the course discussed issues around patient noncompliance with a physician's recommendations. In particular, if I see a patient and advise him to return for follow-up in two weeks or four months, and the patient fails to keep the appointment, the course stated that my staff or I must contact the patient. We must communicate that he missed the appointment and that there are personal health consequences because of it. We must document our communication and any conversations that follow.

I thought to myself, where does the patient's personal responsibility end and physician babysitting begin? Certainly, physicians are not reimbursed for these extraordinary efforts to contact patients in order to confirm care that patients were previously advised was necessary. When do patients and families take responsibility and when do we stop blaming physicians for everything that goes awry in healthcare?

I am sure my sense of frustration is palpable. Medicine is first and foremost about the doctor-patient relationship. Legal considerations aside, we are not our patients' caretakers. Patients must appropriately participate in their own health. At some point, patients should be responsible for their compliance with our recommendations and their adherence to our advice. If my glaucoma patients skip their appointments, they should be responsible for the results--not me. If a hypertensive patient fails to have her blood pressure monitored, it is not her internist's fault.

I am tired of physicians always taking the blame. It's time for a return to personal responsibility in healthcare.