Inside the Emergency Room

The latest issue of The New York Review contains an interesting exchange of letters following up on Arnold Relman's February 6 article "On Breaking One's Neck." This was a fascinating account of a highly experienced doctor describing his own treatment for a serious condition. The exchange was prompted by a letter from a doctor in Puerto Rico asking whether or not Relman's treatment would have been different had he himself not been a famous doctor. Relman replied that did not not think his emergency room treatment would have been any different. He wrote the following:

In the emergency room of a world-class hospital, like the Massachusetts General Hospital, the staff are trained to deal efficiently with every dire emergency. All resources are mobilized to save a life, regardless of the patient’s identity and usually with little or no need for personal communication between doctor and patient.

While this is probably true, it is important to remember that not all hospitals are such "world-class" institutions. Indeed, when my wife was recently admitted to an emergency room, I discovered that all operations there were outsourced. The hospital itself had nothing to do with what went on in the emergency room other than choosing to engage a third-party company to handle those matters.

Perhaps the most important part of Relman's article was his analysis of the nature of communication taking place at all stages of his treatment, including his admission to the emergency room; and I have to wonder whether, in an organization as complex as a hospital, outsourcing imposes a barrier to communication that had not been present when the hospital itself was responsible for all operations.