Over the last five years I've spent much more time in the ER than I ever expected, mostly caring for loved ones, though a nasty kidney stone sent me there once.

While no expert, I do consult and write extensively in the fields of customer care and client relations, so I tend to be attuned to obvious wins and losses in patient treatment.

Last night was one of the better experiences, if there is such a thing under emergency conditions.

All told, the stint lasted five hours. During that time, the patient received a CAT scan, an EKG and Echo EKG, various blood tests, a chest x-ray, and all of the vitals were monitored.

These tests were absolutely necessary to rule out ultra-serious heart and lung conditions.

At long last, they were all negative, and the patient's treatment plan was clear and straightforward.

While there were some long pauses between exams, the medical team seemed like it was on its toes, and it was the closest thing I have ever seen to a TV show, where everyone knows her role and does it, sweetly, competently, and without complaint.

Why, on this night was the ER medicine so good, so responsive and so thorough?

Several factors. First and foremost, the patient's primary physician, known to the hospital's staff, called over to the ER before the patient arrived. Having done a recent exam, he was fresh on the case and took this episode as an opportunity to secure tests he had already contemplated for later in the week.

His call definitely altered the cueing and triage intake, making it ultra-efficient relative to my other experiences.

Sheer luck also played a prominent role. This patient's condition seemed the most serious of all that were waiting to be seen, so priority was assigned to it.

Quite providentially, a volunteer spoke the native language of the patient and shared a cultural background, enabling her to literally translate an entire, pertinent medical history in a few minutes, to the attending physician. This calmed the patient and provided an early sense that she would be fully understood, and her recitation respected.

Contrast this with what happened at the primary care physician's office the day before.

The same patient waited five hours to be seen, before being sent to another location for an ultrasound--five long and scary hours, mostly alone in a room, suffering from shortness of breath and chest pains.

The physician's business identity contains the reference: URGENT CARE. It was neither.

ER's are often the same way, if you don't have a referring doctor. On one occasion, I brought someone in that waited for three hours, wasn't seen, and left in disgust as the sun came up, resolving to see a primary care physician instead, later that day.

That ER had the audacity to bill the patient, anyway, for so-called "triage services," though no one else was in the waiting room during the vigil.

Unfortunately, the bad episodes outnumber the good by a factor of five-to-one.

I have a suggestion for enhancing the health care reform debate. Focus on improving the emergency room experience first, because comparatively, everything else can wait.