Transfer of care from one doctor to another has been a topic bandied about in the mainstream media in the years since Libby Zion, the college student whose death from serotonin syndrome led to the Bell Commission and eventually resident work hour restrictions. Dr. Darshak Sanghavi, a pediatric cardiologist, wrote about this in the New York Times in 2011, noting that the British psychologist James Reason likened transfer of care to Swiss cheese: overlapping holes in medical care that usually – hopefully – do not line up. I agree in part. But a good signout can also be a good consult – fresh eyes and ears from new doctors, often with different areas of expertise. Meanwhile, a poor signout can be dangerous, more hole than cheese. And once in a while we do receive particularly poor transfers, especially when censuses are large. The natural reaction to receiving bad signout is alienation. Often, we put less thought into these cases, when in fact we should do the opposite. If you suspect that you’ve received bad signout, invite the following thought: Start over.

Finally, don’t just give and receive signout from your fellow doctors – include your patients in the process. Inform your patients that your shift is ending and a new doctor will meet them soon. Ask them, “Is there something that I need to communicate to the doctor coming on duty?” You’d be surprised what they will remind you.

It is the rare shift in which you can tie up all of the loose ends before quitting time. If you infrequently have to sign out a few patients, you probably aren’t seeing enough of them. You can’t always hit those base-clearing, game-ending home runs. Don’t feel badly about that. Many Hall of Fame ball players hit for average, not only power.

So take pride in hitting a few singles and doubles and getting a pinch hitter to drive in the runs. And when it is your turn to come to the plate to pinch hit, take an active role in the process. Be a Sultan of Signout.

Dr. Faust is an Emergency Medicine Resident at Mount Sinai Hospital and Elmhurst Hospital in New York City. He tweets about classical music and #FOAMed @jeremyfaust.