There is an old saying, "If you have to get sick or injured, let it be in the U.S." Getting sick or injured most often means a hospital. There are more hospitals per capita in the U.S. than anyplace on earth. Smart doctors and doctors-to-be from abroad look for every opportunity to work or study in our hospitals. While I have never been in a hospital where Arabic, Swahili, or French for that matter is the language of choice, I am not at all comfortable in our best of the best.

The only places I find more disconcerting than hospitals are graveyards. While they exist to fix you up and keep you going they inevitably force the recognition of mortality as they have their fair share of failures, which are often fatal. Hospitals are impossible to avoid. If we live long enough, we will either be a visitor, be visited, or both.

Hospitals, no matter how clean and modern, are disorienting. Trying to figure out where to go – when to go – how to get there - is daunting. Doctors, nurses, orderlies, administrative staff of all kinds always seem to be rushing, creating a feeling of anxiety, frenzy or despair, even if it doesn't exist.

Medicine is highly specialized. Beyond the emergency room, it is difficult, without a guide, to find a sick friend. Gastro–intestinal – gerontology – obstetrics – gynecology – neurology – neonatal – endocrinology – pathology – orthopedics – pediatrics – orthopedic pediatrics – cat scans – X-ray – MRI – in-patient – out-patient – pain clinic – signs and arrows - sufficiently confusing and frustrating to make the psychotherapy department look like a good place to take a break.

Hospitals deal in cuts and bruises – infections – chronic diseases – broken bones – organ failures – and blood. They also help most people create their only shot at immortality by helping deliver babies and giving them their best chance to live. While they deal with death, they are committed to life.

There is no higher risk business than medicine and no service that costs more. Checking into a hospital – getting an appointment with a doctor is not easy; without insurance, nearly impossible. The number of required applications, consent forms, medical histories, disclaimers and affidavits should make suing a doctor or hospital impossible. In our vast open, free and litigious society, however, malpractice protection is most doctors' largest continuing expense.

This fact and the fact that most people, even those in need, are uncomfortable in hospitals creates an adversarial relationship. Doctors have a highly inflated sense of their own self worth and believe it is appropriate to keep patients waiting endlessly without explanation. Doctors, like airlines, overbook as a matter of policy, believing it is more desirable for the customer to be inconvenienced than for the caregiver to have a minute of unbillable time.

Once summoned from a standing room only waiting area rarely, if ever, puts the patient in front of a doctor – only in one of many examining rooms where the patient may sit for another 30 minutes face to face with pictures of bowels and bladders or three-dimensional models of necks, backs, hearts, livers or spleens.

In a busy hospital, being prepped for surgery is kind of like being in line at a popular salad bar, where each gurney receives a slightly different combination of ingredients depending on procedure – laminectomy – appendectomy – colonoscopy.

Surgical techniques have improved dramatically. Hospital costs have escalated beyond obscene. As a result, little short of organ transplants keeps the patient overnight – a normal delivery has the new mom on her way home hours after the cord is cut.

The need to maximize the productivity of every square foot of space every hour of every day exacerbates the stress levels of the entire hospital population. While we have more hospitals than anywhere else - we have barely enough to adequately service the insured – and no where near enough to care for all the needy.

In spite of all of this, our hospitals are regarded the best in the world – our doctors the most skilled – our labs the most sophisticated – our medical schools the highest rated. If there is a lesson to be learned – stay healthy! If sick or injured abroad – come home. Buy good health insurance and support your local hospital.