Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any eye contact or tells you what’s going on but you’re quite hungry and so you wait. Other people go get seated ahead of you and you don’t know why.
You finally get escorted back to a table and the host says “a waiter will be with you,” but no one arrives. Eventually, a waiter arrives and sets menus before you but this menu is written in Italian with no descriptors of the food. The waiter takes your order but you have no real idea what to expect and this particular waiter doesn’t ask if you need help, is irritated when you ask questions and gives completely unclear explanations when questions are asked.
You finally get your food. The quality may be phenomenal, but the waiter has been completely absent during most of your meal, only to appear as you are getting up to leave with a bill for $1,700.
Patients often have a similar experience when they visit the emergency department, but instead of Italian food, the confusion is about their ongoing health plan and ED experience. The medical care may be great, but no explanations of what to expect are given. An occasional staff member may be abrupt, and delays are frequent and unexplained. In addition, their visit looks nothing like it was supposed to according the shows they’ve seen on TV.