An unholy racket was coming from our clinic waiting room. It is never what you would call serene out there, but this degree of noise immediately penetrated everyone’s primal brain: Something was definitely wrong.

Staff members ran toward the clamor, one nurse pushing a wheelchair. The epicenter of disruption was one small man doubled over in a chair, bellowing loudly in apparent pain. The secretary said he had staggered in from the corridor, sunk into the chair and begun to scream.

The other patients, understandably frightened, quickly cleared a circle around him so that we professionals could do whatever it is we do for people in such distress.

In situations like this, we function like clockwork. Granted, we didn’t know who this man was, or whether he was having an internal hemorrhage or a temper tantrum, but we knew without discussion exactly what to do for him. Namely, bundle him into a wheelchair and get him directly to the emergency room, the correct place for someone to have whatever catastrophe he was having.

We may do health care, but not his kind, not at that moment, and the sooner he got to the right place, the better off we all would be.

It is increasingly critical for patients to be sick in the right place, and increasingly difficult for them to do so. As the great plates of medical care heave and split in cash-based tectonics, the options are multiplying in confusing plenty.

There used to be the doctor’s office and the hospital. Now we have street corner wellness centers and urgent care centers, free-standing emergency rooms with no hospital attached, chain pharmacies with occasional doctors attached, and nursing practices with no doctors attached.

We have hospitals that have merged and split and merged again into configurations that put all the cardiologists uptown, all the neurosurgeons downtown, and all the pediatricians somewhere that keeps changing.

Accordingly, we spend a lot of time and energy getting people to where they need to be, launching them according to condition, severity and, always, insurance. Predictable mix-ups occur: Doctors leave insurance plans, patients forget appointments. Or they see the kidney guy, who sends them to a vascular guy, but they already have a vascular guy, and then the cardiologist recommends yet another vascular guy, and now what?