A Doctor Critiques the Hospital Setting - Is This Really the Best We Can Do for Our Patients? by Will Lasersohn, M.D.
Before I communicate my thoughts on patients’ needs during hospitalization, I want to share the qualifications that I think allow me to speak with some authority on this issue. In a sense, I have been a patient for 65 years, the number of years I have been on this earth. I started working in hospitals in 1952, passing instruments at Lennox Hill Hospital in New York City. I have been a doctor since 1960.
As I look back on my 65 years, there are a few days, perhaps months, that seem particularly important. One of these times was in November, 1984. For ever so many years, too many years, I had been putting up with really bad back pain. Every time I did an abdominal hysterectomy I would be in trouble for days. The pain would be even worse if the patient I operated on was heavy. In November, 1984, I operated on three women who each weighed more than 250 lbs. These three women wanted and needed their surgery but they could not find anyone who would operate on them unless they lost weight. Like so many heavy people, they had tried over and over again to lose weight and could not. Little did I know that when I decided to help them I was deciding to end my career.
After the third procedure my pain never receded like it used to. It was unbearable to be upright and agony to lie down. After consultation with a number of my colleagues it was decided with my approval to try a spinal fusion. I was told and I was aware that 20 percent of the time the operation failed. I was also aware that relief from the surgery would only last for about ten years. I wanted to keep working for a while yet.
On Feb 8, 1995, I entered Salem Memorial Hospital. I had an ominous sense of impending doom that morning but, stupidly, I did not tell anyone about it. Everything started out just great. I went to sleep easily and awoke in the recovery room thinking to myself “you made it” and I felt joy. Such emotion was short-lived. Within twenty four hours I developed severe pneumonia with septic shock. I spent the next nine days in the Intensive Care Unit. I thought I was dying, and so did everyone else. Surprisingly, I found that I was not scared of death so much, but I became very scared of people. Between the fever, the shock and the drugs, I was intensely paranoid. Ultimately, they tied me down and performed a bronchoscopy against my will. Somehow I survived.
Now what is really scary about all this is that it happened to a doctor who had only recently been the Chief of the Department of Obstetrics and Gynecology, and a member of the Executive Staff of that hospital. My colleagues, my friends, the people who loved and cared about me, all did their best and yet this occurred despite all efforts. It took me three years to fully recover. The fusion that I went in for never occurred and I have never been able to work again.
This article was inspired, in part, by my hospitalization. But beyond that singular experience, these are observations formed by years of experience as a practicing obstetrician-gynecologist. I believe that I see and feel the issues involved in being a patient from two very different perspectives, as a doctor and as a patient.
In my years of working at Salem Memorial Hospital I came to value the medical staff secretary, Barbara Halsey. She is particularly special in helping the doctors do a good job caring for their patients. She is one of those wonderful hidden assets patients never get to hear about. After my hospitalization, I would occasionally stop by her office to shoot the breeze. I expressed to her some of the stuff contained in this article. She encouraged me to write down my ideas, offering to pass them on to the people in hospital administration who might be interested in them. I accepted this invitation and wrote my observations in the form of a letter to the hospital administration. She, in turn, passed them on. I never heard from anyone connected to the hospital. Although I was not surprised by this lack of response, Barbara said she was.
Speaking personally, I doubt if I can ever go into a hospital again, even if it means dying.
The Problem is . . . I am convinced, after hospitalizing thousands of patients and being hospitalized five times myself, that we hospital staff send the wrong message to our patients. By our actions, our words, our rules and our attitudes, we convince some very healthy people that they are sick. This is how we do that.
To begin with, we don’t know who our patients are. The patient is asked the same questions over and over again, first by the Admissions Officer, then by the Admissions Nurse, then by the Anesthesiologist, then by the Admitting House Officer, then by the Floor Nurse, then by the patient’s private doctor, and then by the radiologist, etc., etc. Not only does the patient get tired of this repetitive crap, but it soon becomes obvious to the patient that staff members almost never read what other staff have written. This looks, and is, unprofessional.
Next, the patient is put into a room that is aesthetically awful. Even cheap motels offer better accommodations. The beds are very uncomfortable and room furnishings non-existent. Lying neatly on the bed is a paper gown which, when worn, is not only embarrassing and undignified, but is downright dehumanizing. None of us would choose to wear these paper gowns since they expose our rear ends, demeaning our sense of dignity and modesty. No wonder everyone gets in bed and stays there as much as possible.
After the patient has managed to answer all the questions, undress, and now lies safely in bed, wrapped like a package in paper, he or she discovers the food menu. At first this looks like a pretty good deal. There are choices, and the descriptions of the food items are pretty appealing. However, on arrival, the selections are not always identifiable and are often covered with sauces best described as “stuff.” Further, if you happen to be one of those patients on a clear liquid diet, you will learn the joy of lemon Jell-O for breakfast. Personally, I love Jell-O but I can’t figure out what hospitals do to it that makes it so completely unappealing and inedible. Also, when the food arrives, we realize how profoundly alone we are. Eating alone is tough.
Isn’t it amazing that the patient who has been responsible for himself, and probably many others for many years, can no longer take his own medications now that he is hospitalized. He is brought his pills according to the orders of the doctor and given this medication by a nurse who has to keep track of everyone’s medication. I wonder who is more likely to make a mistake in meds, the patient who handles his own medication or the nurse who has to keep track of the meds for thirty patients? What is the message we give the patient when we tell him he can’t even take his own meds anymore? I wonder how often the nurse decides whether a patient needs a sleeping pill rather than the patient. Doesn’t the patient have a better idea how much and how often he needs pain pills?
And here’s another one. I never want to hear a nurse ever again use the word “we” when she means me. “Shouldn’t we get in bed now.” That is not the way respectful adults address each other.
Most patients who are hospitalized arrive mobile (capable of walking), remain mobile during most of the time they stay, and leave mobile. Despite their capable mobility they are not allowed to walk anywhere and have to be taken by wheel chair or on a gurney. Why?
We, the staff, get very uneasy if we don’t know our patients’ whereabouts so we discourage them from leaving their rooms. That’s certainly good for record keeping, but it’s not good for living bodies that need to move and stretch, or minds that need a change of scene.
To me, one of the most disrespectful actions is the frequent unannounced entry into the patient’s room. Our patients have virtually no privacy. I remember, during one of my hospitalizations, a Nurse’s Aid would come into my room at 5:00 AM every morning to fill my pitcher with ice water. I asked her to stop doing this and her reply was that she would be criticized for not doing her job.
So what have we done to our patients by putting them in the hospital? We have isolated them. We have forced them to be self-absorbed, with their major focus on their disease rather than their health, their life or their friends. We have dis-empowered them, humiliated and embarrassed them, prevented socialization, prevented convivial eating of meals, eliminated ambulation—in short, we have basically ignored people’s need for stimulation, excitement, imagination and spirituality. After doing all this, the real miracle is that anyone ever gets better in a hospital.
Looking for Solutions I have become quite critical of a management style that creates “Hospital as Industry” rather than “Hospital as Service.” Surely an administration that listens and responds to concerns of patients can come up with some improvements to address these downers. In the spirit of working together, I offer the following ideas as solutions.
Upon arrival at the hospital, each patient should be assigned an advocate-friend. This person will have studied both the medical and personal information of the patient. Initially, the advocate will ease the patient through the admission process and protect the patient from unnecessary repetitive protocols. On a daily basis, the advocate can visit briefly to discuss activities and help prepare the patient for the upcoming day. The advocate could also be involved in organizing and facilitating support groups for the patients, as well as exploring other ways that patients can help each other.
Patients’ rooms should be designed to be homey, yet richly artistic and creative in appearance. Interior decorators should be used and each room should be different from the next. The beds should be the most comfortable ever made. This is an area that money should be used liberally. Let’s face it, hospitals receive enormous amounts of money from patients, and patients should therefore expect this level of comfort.
All patients should be encouraged to dress in comfortable clothes of their choice every day (obviously, patients incapable of dressing should be assisted). When the patient must to be dressed for a hospital procedure, cloth clothing that is both dignified and interesting should be provided.
Patients should be encouraged to stay out of bed except to rest if they desire during the day or to sleep at night.
Patients should be encouraged to explore the public and commons area of the hospital. There should be rooms for spontaneous discussion and places for games, including cards, board games and computer games. There should be small movie theatres as well as hobby rooms. I believe patients badly need to get away from self-involvement.
Patients should be responsible for their own medications. With a little creative inventiveness, systems could be introduced that satisfy the hospital’s need to monitor and the patient’s need to be empowered.
Patients (and, if appropriate, their relatives) should eat in dining rooms where meals are served. Perhaps tables could be assigned, as aboard cruise ships.
A patient’s room should be entered only after appropriate inquiry.
The above are just a few ways to make hospital stays more valuable and worthwhile. No doubt, hospital administrators can come up with all kinds of reasons why the ideas I present here won’t work: hospital stays are too short now, it’s too expensive, the people are too sick, it will be unclean, etc. Such objections may all be plausibly defensible. However, it has been my observation that even accurate negative thinking is remarkably uncreative. We in my profession can do better, and patients (i.e. health care consumers) should come to expect and demand more for their money.
Will Lasersohn, M.D. is retired. He lives in Salem, Oregon with his wife, Kay.
