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A Piece of My Mind
September 26, 2012

Worlds Apart

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

Author Affiliations: Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (dwaxman@rand.org); and Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California.

JAMA. 2012;308(12):1219-1220. doi:10.1001/jama.2012.9980

I work in two emergency departments, one in a university hospital and the other in a VA hospital. One is gleaming; the other is aging. One has every resource imaginable; the other seems to be held together with duct tape. They are less than a half mile apart, but they may as well be in different worlds. Switching between them is jarring. But it is also thought provoking. Suppose I had the choice: Which world would I rather live in?

The university hospital is as happy a place as a hospital can be. There is valet parking, and there are smiling employees everywhere. The positive attitude is infectious. Plenty of staff are available to help the place run smoothly and to make me as efficient as possible. Scribes follow me around and write the charts, allowing me more time to listen and explain rather than “document.” On a recent shift, a clerk asked whether he could transfer a call to my wireless phone. A patient had given a urine sample and then walked out before being seen, and the urine had proven to be full of white blood cells. The patient had left a nonworking phone number, but somehow the clerk tracked her down. The patient was fine. She had gone to her physician and was already taking ciprofloxacin. The clerk seemed genuinely relieved. Meanwhile, a 7-year-old patient was about to have an intravenous line placed. Out of nowhere, a pediatric therapist appeared to help him with coping strategies in preparation for the discomfort: “Some people like to make up a pretend bad word and say it to themselves.” No kidding.

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