(A Doctor Critiques . . . )
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. He can be reached by e-mail.