Hospitals Are Terrible

by Belle Waring on February 23, 2017

Being in a multi-bed room overnight, or being in the OR, or even sometimes when the chemotherapy room is crowded over-full and they are putting people in cheap plastic chairs before hooking them up to clear bags of poison—this is the worst. And the worst thing about being in the hospital overnight is that you can’t sleep. I understand intellectually that your doctors need to know what your blood pressure is. I mean, sort of. What if you don’t have any heart problems? Why always with the blood pressure? But between your IV bag running out and beeping and the irrational fear that air bubbles will get inside you and kill you, and the checking of the temperature and blood pressure every four hours, and the breakfast you actively don’t want being slammed down at 6:30, and the cleaning staff, well, you don’t sleep. No knitting up the raveled sleeve of care for you! And this is true even in a private room! This article in the NYT explores a very obvious point, namely that multi-bed wards are a terrible idea all the time. I felt vindicated to read that the decrease in hospital-borne infections outweighs the cost of constructing a hospital with individual rooms.

As a doctor, I’m struck daily by how much better hospitals could be designed. Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we’ve been building them all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us.

It’s no secret that hospital-acquired infections are an enormous contributor to illness and death, affecting up to 30 percent of intensive care unit patients. But housing patients together very likely exacerbates the problem. Research suggests that private rooms can reduce the risk of both airborne infections and those transmitted by touching contaminated surfaces. One study reported that transitioning from shared to private rooms decreased bacterial infections by half and reduced how long patients were hospitalized by 10 percent. Other work suggests that the increased cost of single-occupancy rooms is more than offset by the money saved because of fewer infections. Installing easier-to-clean surfaces, well-positioned sinks and high-quality air filters can further reduce infection rates.

The whole thing is worth a read. Perhaps unsurprisingly, having a window out of which you can look at trees or nature has a huge impact on recovery time. I personally have always wanted to get the Magic Mountain treatment in which I am bundled in specially folded blankets and put out on a lounger to enjoy a view of the Alps.

The author doesn’t discuss bad fluorescents, though the commenters do. New compact bulbs can mimic the warmer light of incandesents reasonably well now, and that is another terrible hospital thing that could be fixed. I feel I should note two things here. One, the staff at hospitals is almost uniformly composed of kind helpful people who are working very hard. Nurses are great. The sub-nurses who are supposed to be just emptying bedpans or whatever are delightful. But let’s be honest: the actual doctors are the least friendly. Sorry actual doctors. I know you are busy. (But so are the ladies emptying the bedpans, probably?) Two, I am not in the hospital or accompanying anyone to same at the moment and this is just a general complaint so don’t worry about me; more importantly my migraine treatment worked. Since I made it to the first week (at which the Botox takes full effect) I have used my migraine meds only once. John was disappointed that I can have a headache at all but he doesn’t know that not having a real migraine every day after having had that happen for months oh God is a fairy wonderland (I don’t know why I’m not being more sparkly and cheerful all the time; I’m sorry, beloved family. I have terrible jet lag still). I asked my neurologist if there were any side effects and he said, “you’ll be running back here every twelve weeks begging me to do it again, but other than that, no.” OMG Dr. Fineman you are right. Thanks for the Tinkerbell-clapping, everyone! Now tell me of your experiences with flimsy curtains separating you from people with dementia shouting all night. The airing of grievances can be therapeutic; anyway it’s better than reading articles about politics amirite?

{ 43 comments }

1

Gareth Wilson 02.23.17 at 9:25 am

A hospital is where all the most miserable people are collected. When they feel better, they leave. So there are limits to how pleasant you can make them.

2

Faustusnotes 02.23.17 at 9:50 am

What’s with the air bubble fear!? I got that too with an IV drop in Korea, watching the air bubble slowly moving in the tube and thinking am I gonna die? But clearly I didn’t …

3

MattF 02.23.17 at 10:52 am

Thanks to sharing a room on my last visit, I know drill for emergency gall bladder surgury. And I know the drill for impacted feces. And my former neighbors know what to say when a -large- catheer is removed (Yikes!)

4

chris y 02.23.17 at 12:45 pm

Last time I was in hospital they woke me up every hour to ask me if I could remember my age and date of birth [SPOILER: I could]*. There was a kind in the bed opposite who pleaded with them with tears running down his cheeks to move him somewhere he could sleep. Eventually they did, but it took them 24 hours to find a bed.

The other thing is when you’re reasonably compos mentis and you’re sharing a room with somebody who isn’t, and they’re not meant to get up and they keep trying to and you can see they’re going to fall out of bed and injure themselves any moment and you’re frantically ringing for an attendant and they’re all busy elsewhere and you can’t go and wrestle the other patient down because you’ve just had major surgery and what the fuck do you do?

*They were right to do so. I had a major haematoma and they needed to know if my brain was still in gear.

5

chris y 02.23.17 at 12:49 pm

Faustusnotes @2. We’ve all read the detective novel where somebody commits the perfect murder by injecting air into their victim’s bloodstream and giving them a heart attack. Does it work like that IRL? Who knows, but I don’t want to take any chances.

6

CDT 02.23.17 at 1:01 pm

First-born son was in NICU for a month. Nearly killed all of us.

7

Abigail 02.23.17 at 1:02 pm

My one and only stay in a hospital, what made it impossible for me to sleep was the needle in my arm. It was impossible to find a comfortable position. By comparison, my neighbor – a senile old lady who talked incessantly throughout the night – was a minor irritant.

8

Ugh 02.23.17 at 2:53 pm

In a semi-private room with my son right now. The lack of sleep alone from the doubling of nurse doctor etc. visits is insane. Even in a private room it’s bad. How is it that hospitals don’t understand that sleep is absolutely necessary for healing? And of course my wife is staying in the room 24/7 with him and she doesn’t get any sleep either and gets more irritated and angry as the days (two now and likely at least five more) go on helping no one.

9

Ronan(rf) 02.23.17 at 3:15 pm

“But clearly I didn’t …”

How do you know?

10

Kiwanda 02.23.17 at 3:24 pm

Staff who walk in without knocking and just start talking, interrupting a last moment with family before surgery, that turns out to be *the* last moment.

Staff who address old people in wheelchairs as if they are small children. No, actually even small children shouldn’t get addressed in such a patronizing way.

No, doctor, these parents have been in the NICU 24/7 for weeks, you just showed up, you don’t own the place.

No, Bob, if you’re Dr. Smith, then I’m not “Chris”, I’m “Dr. Jones”, or “Prof. Jones”, or at least “Mr/Ms Jones”.

Why again were the hospital charges alone for that outpatient surgery $40K, not the $20K discussed?

Yes, you’re the doctor, but a second opinion on a scan is not an outrageous assault on your competence.

If I ever look to need intubation for more than a very clearly limited time, just let me die.

11

John Garrett 02.23.17 at 3:48 pm

Amen re hospitals: they are organized and run to limit docs’ transit time, so they can get out of your room and start making money. Too bad re sleep, infections, pain – but at least we have oxycontin, lots of it. But most hospitals are paradise compared to the ER, where you confront head on the opioid crisis which we avoid so successfully most of the time: jam packed ERs of young whites whimpering and nodding their lives away, all across America.

12

ah 02.23.17 at 4:09 pm

shared rooms do allow other patients to look out for each other (e.g. press the call bell if the person in the next bed can’t) and also for the nurses to watch several beds at once. I’ve visited elderly relatives (with dementia + complex needs) in hospital and always ask for them to move to the bed nearest the nurses station to be watched more. that wouldn’t work if everyone had single rooms.

13

James 02.23.17 at 5:21 pm

I spent a night in the observation room at Tan Tock Seng a couple of years ago, not a pleasant experience although not much to complain about the staff. A cold and crowded room under cold fluorescent lights at 2am. Reading this at first I thought maybe you’d had a similar experience.

14

MamaLiberty 02.23.17 at 5:25 pm

Having been a nurse for 30 years, I’d say you barely scratched the surface here. Boy, oh boy could I tell you stories…

Infection control… When I was a young nurse, the “wards” contained up to 20 beds. Yes, with the muslin almost see through curtains around each one. Big difference? In those days ALL nurses WASHED their hands between patients. Period.

Today, if you see any staff member come into your room, demand that they wash their hands before they touch you or anything else in the room. If they say they already did, or used that fake anti-bacterial gel, tell them to wash again. Or throw them out. Husbands and hefty girlfriends are very good to have around in case that becomes necessary.

15

Trout 02.23.17 at 5:25 pm

I learned to be wary of junior doctors bearing needles – the nurses were far better at finding veins with a minimum of hoking around. That said, everyone was incredibly kind and helpful (junior doctors included). My fellow citizens, on the other hand, voted for Brexit while I was out of action. God knows what they’ll do the next time I’m laid up…

16

Andrew Larkin 02.23.17 at 6:48 pm

Hospitals are run by the administration. They determine the staffing levels.
The for profit Insurance companies try to spend as little money as possible.
The doctors have become high end labor.

17

Dave Maier 02.23.17 at 7:39 pm

The one time I was in the hospital overnight (as a kid, in a room with several others, for tonsils I think), the reason I didn’t get a wink of sleep (glad to see no one else mentioned it!) was the TV blaring all night long, presumably for the entertainment of the night attendant. In the morning they offered to turn it my way so I could see it (no thanks!), but did not accede to my heartfelt request that they turn it off. So it goes.

18

Faustusnotes 02.23.17 at 8:09 pm

for the benefit of our American commenters id like to point out that the NHS and the Aussie system also have shared rooms, but there is no profit incentive in those systems. I think it’s just the way we do things, and have done since the era of the Victorian sanitarium. When you get sick you have a role to play, a new social position, and traditionally in your new position you lose the right to privacy and are expected to endure your measure of pain.

I’m sure this has nothing to do with the relative status of doctors and the rest of the community!

19

levi civita 02.23.17 at 8:33 pm

Cannot fix medicine unless cost of admin goes below 10 percent. http://www.oftwominds.com/photos2017/docs-admin.jpg

20

megamike 02.23.17 at 8:47 pm

Three men are laying in a recovery room and the first man says what a terrible time he had he came in for a appendicitis and the surgeon left a sponge in me during the operation. I had to be cut back open to retrieve it. The second man says thats nothing I came in for a gall bladder operation and my surgeon left a scalpel in me and they had to cut me back open and get it out of me. Just at that moment the surgeon for the third man walks in and asks “has anyone seen my cellphone.”?

21

LarryArnold 02.23.17 at 9:04 pm

Wow. Thank goodness I had my only stay in a small-town hospital. Much better. The only night I didn’t sleep was the one after they removed the catheter and before they shut down the IV. Had to sit up (ouch) and find the bottle every hour.

Of course I still had to do what every person my age does: learn to trust doctors and nurses who aren’t old enough to be my children.

22

Belle Waring 02.23.17 at 10:43 pm

So sorry Ugh and best wishes for your son’s recovery.

23

brandon 02.23.17 at 10:49 pm

When I had to stay in the hospital a couple months ago I found the multi-bed rooms – which weren’t open, there were dividers and curtains – a lot more psychologically tolerable than the private room, which started to make me feel crazy pretty quickly. Seeing different people, talking to different nurses, etc. I mean I’m pretty quiet and private but being in one room on that listless hospital sleep “schedule” got to me.

One additional problem is the usual spot for the IV insertion makes it hard to read books, since bending your elbow breaks the fluid flow.

I definitely understand the infection risk (in my case, I was the infection risk: MRSA in a skin abscess, probably)

24

derrida derider 02.24.17 at 12:41 am

Hospitals aint ever going to be pleasant places to be in (they’re full of sick people), but really there is no excuse for cross infection or for serious sleep deprivation. I had a nightmare – literally – spell in hospital a few years ago because of this last.

On cross infection, what MamaLiberty said. The hospital’s Infection Control Manager (I assume US hospitals also have these) should keep staff, particularly all those distinguished honoraries who think their skilled hands are far too distinguished to carry bugs, in a state of perpetual terror on this. On sleep deprivation, the only argument for shared wards was the “monitor a bunch of patients at once” one, but with really cheap monitoring equipment (including CCTV) these days that no longer need apply.

And improving the aesthetics (green fluorescents, etc) is dirt cheap and will add significantly to both patient and staff comfort. Just do it already.

25

J-D 02.24.17 at 1:18 am

Now tell me of your experiences with flimsy curtains separating you from people with dementia shouting all night.

I was knocked down by a car crossing the street (at a pedestrian crossing, with the light, and despite a relevant sign saying ‘Right Turn Watch For Pedestrians’) to collect a takeaway pizza I had ordered for my daughter (and kudos to the ambulance officer who collected and paid for the pizza and delivered it to my daughter before taking me to hospital). I lay in the middle of the overfull Accident and Emergency room waiting for the doctor to have time to come back to me for another check to confirm I was not concussed (I wasn’t, but I did develop two remarkable black eyes, the only ones of my life) — both the overcrowding and the delay were only to be expected, given it was Friday night in the emergency room of a hospital in Darlinghurst.

The whole time I lay there I could hear a patient with dementia moaning and complaining nearby without stopping, and despite repeated pleas from her late middle-aged daughter who had come in with her (after the patient collapsed, I think — I don’t think you go to A&E for dementia) to be quiet so that she (the daughter) could try to sleep. At one point a nurse or other staff member came up and asked the daughter whether her mother was like this at home and what they did about it. The answer? ‘She usually goes to sleep at about nine.’

What a window into somebody else’s life! I felt sorry for her (the daughter), not me. I’ve no complaints about my own hospital experience. How I’d react if I had to put up with it for longer (or how I’d have reacted if I had had to live with a demented parent) I feel lucky not to have had to find out.

26

Ugh 02.24.17 at 1:23 am

Thanks belle, my wife does bear the brunt of it, as I’m now back in DC caring for the younger son, who will come back up to Philly with me tomorrow. He should be okay eventually.

It is amazing to me how much she has to manage our son’s care to ensure he’s got the best of it (and thank god for her, I couldn’t fight with the doctors (mostly) and nurses (sometimes) all the time). E.g, He’s scared to death of getting his blood drawn and it takes 4 people to hold him down to get him to go it and he has pulled out his IV in the process more than once (which then has to be put back in) yet they would order up new draws each day, whether they needed them or not, and sometimes more than once because this department doesn’t talk to that department to know that they could each use the same draw.

And this all in a Children’s hospital, as if they’re all little adults and all the little pokes and prods and sticks and vitals and whatever are minor annoyances, instead of potentially big fights. It’s just maddening.

27

Yankee 02.24.17 at 1:33 am

I was imagining injections into where headaches happen like a mini-lobotomy or something; concerned for preserving cognitive function. But apparently the thing is done subcutaneously. Happy for you!

28

Alan White 02.24.17 at 2:00 am

Belle–

In stead of my own recent venture into the health care system compliments of Trump for my first panic attack, I offer this, in memory of my dear mother, just now four years out from her death.

Weaning

The story you told me as I aged into understanding
And away from the early years of infantile amnesia
Was that I loved the bottle, and had one until I was nearly four.
My earliest memory was during a trip when I was two or three
And dropped my bottle—I can still see it shattered on the pavement;
You always told me I said “I have two pennies”
Boasting I could afford a new bottle. I have since bought many bottles
That I could not wean myself from as you did me from you.
And now you, with my consent, are weaned from a tube
That fits so clinically and neatly down your nasopharyngeal
Tract to your stomach, which could never stomach fish,
Because as you told me, your mother ate fish
When pregnant with you and got horribly sick,
Which of course in what you could never grasp
As Lamarckian made you hate fish too.
So Mom I willfully starve you, weaning you from useless life
As you did me from your useful self to those
Countless bottles of milk, soda and now wine,
And I return the favor. “Weaning” was the medical term used,
As if what you did for me was the same act of love.
You weaned me to life—I wean you to death.

29

Jared 02.24.17 at 2:11 am

I second Dave Maier’s complaint about the TV as a major distraction, which makes it very hard to sleep. I was in rehab after hip surgery, and was the only one on the ward under 60 years old–there was a lot of Fox News played at very high volume.

30

Matt 02.24.17 at 3:54 am

I am glad you’re migraines are doing better – as someone who has fought with them for years (and whose life was literally changed by sumatriptan) I certainly understand.

And – you are right about hospitals! My experience comes from three sources – having spent more time in them than most people (though much less than many others); having worked in a hospital pharmacy for about 3 years while in college; and having a mother who was a nurse in a hospital for about 30 years. All of this made me want to spend as little time in them as possible. It is not surprising that putting more people in a room than is, from a health perspective, desirable isn’t limited to the US – it’s much worse in Russia, for example (where my mother-in-law was a doctor.) It is traditional, even though bad. If doctors and others could be convinced to wash their fucking hands more often, many things would be better. But, like Belle, I’ll note that one of the things I liked the least while working at a hospital was hearing – very regularly – the doctors literally scream at nurses where patients could hear them, very often for things that nurses could do nothing about (like, the fact that there are only so many minutes in an hour or hours in a day, or that the doctor had messed something up.) Working around doctors did more to lessen my respect for them than anything else has ever done.

31

William Berry 02.24.17 at 6:24 am

What Lee Arnold said:

I have had three 3-5 day stays in St. Francis Hospital in Cape Girardeau for minor to mid-level surgeries and it was heavenly! Even the food was good.

Check for upgrades to private rooms. I did that and found that by paying 20% or so extra above what my insurance would pay I could get one.

Treated like royalty; waited on hand and foot! I could live in a hospital for the rest of my life, short as it may be.

32

William Berry 02.24.17 at 6:26 am

Larry Arnold, I should have said l.

33

Belle Waring 02.24.17 at 8:53 am

James: Zoe was in a six-bed ward at NUH about a year ago which did not have air-con. She didn’t mind it. I was like, “I’m out.” John stayed with her and “slept” in a chair.

34

Glen Tomkins 02.24.17 at 5:00 pm

Hospitals are terrible because they’re not designed to achieve any particular end. What they are, their services and how they are delivered, their physical plant, all of it, is the result of the historical accident of where the battle lines settled in the constant war among a myriad of autonomous forces.

The last revolution in medicine — 150 to 100 years ago — was so successful that it succeeded in creating new conditions that made the state of play it established obsolete. We now have specialties in medicine because the knowledge base and array of interventions has expanded. And for the same reason we now have outpatient care as a standard, not just a luxury provided by society doctors to the very rich. The last revolution created the success that made those two things possible, but it left structures in place, specifically the hospital as the center of medical care, that served the needs of the old system, but are now inherently dysfunctional.

If we had another revolution and were able to design things from scratch, we would disassemble the hospital. The hospital is only central to medicine now because that made sense at the time that Osler passed on. It no longer makes sense. The successor institutions to the hospital that we designed would not have the internal contradictions that make hospitals terrible.

35

Quinn Eastman 02.24.17 at 10:00 pm

Because sepsis is a big deal (deadly, costly etc) in hospitals, many are setting up electronic monitoring systems and screening tools. That might be why they want to check your blood pressure.

36

PatinIowa 02.24.17 at 10:43 pm

A gentle reminder with respect to the physicians.

As someone who has spent a bit of research and instructional time working on empathy in healthcare professionals, I’ve found it good to remember that residents (the newly minted MDs) are not treated with particular empathy by their supervisors and the system. They work very long shifts, are being educated using public humiliation, and are routinely expected to be personable while working miracles. It’s no wonder that the least human of them behave badly. And for all of them, the least slip is magnified by the dire circumstances in which its made. The same is true of all healthcare workers, to one extent or another.

Some specialties attract a disproportionate number of assholes (cough, cough, neurosurgeons, cough), of course, and some specialties (pediatrics, palliative care) attract people who incline to kindness, but it’s the system we need to work on.

As for rooms and expenses, well, it’s telling that when the nurses unionized at the U of Iowa hospitals, one of the things they wanted to negotiate in their contracts was staffing, because then and now, there are safety concerns for patients, and burnout concerns for the nurses. The university was adamant that they would not negotiate staffing, because even for a non-profit, cost control is job one.

Americans could have the system that addressed many of these things. As people have noted, there would still be a lot of anger and frustration on the part of patients and families–it’s and irreducible part of human illness. But we, as a nation, have decided not to put the money and effort into it we’d need to.

That’s probably true everywhere.

37

PatinIowa 02.24.17 at 10:45 pm

One fix if you’re ever redoing the commenting system–allow editing to let us fix our typos.

I am ashamed and I apologize.

38

Ogden Wernstrom 02.25.17 at 12:42 am

Was neurosurgeon a typo? The reputation for the highest incomes may tend to attract, um, highly-driven overachievers to that specialty. Then, they find they are the targets of torts.

39

JimV 02.25.17 at 12:45 am

PatinIowa:

I took a typing class in high school for the NYS Regents’ final exam, I had to type several paragraphs with a time limit. I think I got a 96 (/100) on the test; and I made more typos than you did. (Didn’t notice any the first time I read your comment.) Thanks for the thoughtful comment.

My one hospital visit, for a sinus surgery, was uneventful. The anesthesiologist, a nice Indian or Pakistani lady, visited me during the pre-surgery prep to ask if I had any questions. Aha! Another chance to try my old joke: “Will I be able to play the piano a month from now?” “Yes, of course, ” she replied, then, “Wait–can you play the piano now?” “No,” I replied. She laughed.

The last thing I remember before the surgery, after watching the ceiling as the gurney was wheeled down a corridor and into the operating room, and being moved from the gurney to the operating table, was hearing her say to the surgeon, “Watch out! This one is a comedian!”

The next thing I remember is waking up in the recovery room, three hours later, with no after-affects except bleeding from the nose for the rest of the day.

My advice based on that is: get the anesthesiologist on your side, even if you have to tell a silly old joke to do it.

40

maidhc 02.25.17 at 5:02 am

My wife was in an NHS hospital for more than a week after emergency surgery. We spent hours in A&E before she was admitted, but once they decided she needed surgery things went pretty smoothly. There were I think 8 people in a room. Thankfully there was no TV. (You could rent a TV but no one did.) Someone came around with a cart of newspapers you could buy; it was one Guardian and seven Daily Mails in our room. We didn’t see many doctors but the nursing staff was excellent. It was more of a no-frills experience than a US or Canadian hospital but it was completely acceptable.

When I was in the hospital a few years ago I learned the answer to a question that had troubled me for years. When you wash your hands, you turn on the water with non-sterile hands, wash your hands and then touch the (non-sterile) tap again to turn off the water. Every time the nurse came into my room, she dropped a paper towel over the tap, turned on the water, washed her hands, turned off the water with the paper towel and then dried her hands with the sterile side of the paper towel. Every single time she came into the room, I was glad to notice.

My recovery room story was that I woke up having oxygen forced into my lungs which is not nice because it is very high pressure and it never stops so you can’t breathe out. Evidently my oxygen level was not coming up fast enough. After I woke up the humble orderly was summoned to push me back to my room, and it was he who noticed that the other end of my oxygen tube wasn’t plugged into the oxygen tank, it was just lying on the blanket. He just quietly plugged it in and took me away without saying anything to the recovery room staff.

41

ck 02.25.17 at 1:07 pm

I spent the hot Summer of 2001 in a dilapidated South of England cancer ward. Wonderful, stretched, tired staff working a disintegrating estate.

My fondest memory: coming to at 3AM to discover a pigeon sitting on my chest watching me. I yelped, it took flight and cue a ten minute spectacle of nurses chasing it up and down the ward until someone managed to trap it under a blanket. It was set free out of the hospital’s front door.

42

John Garrett 02.25.17 at 4:03 pm

#36 – totally agree re neurosurgeons and assholes, with the exception of pediatric neurosurgeons, who in my experience are universally saints. I’d add orthopedic surgeons to the high asshole quotient list. And pathologists belong on a different list, closer to pathological.

43

Lew Lorton 02.27.17 at 12:31 am

Had two recent hospital experiences (my wife was the patient), one at Johns Hopkins main hospital in Baltimore and the other at a small hospital in their chain. Both experiences were good, the one at the main hospital was amazing. Incredibly sophisticated system executed perfectly.
Meals from a large menu, delivered when requested and decent, sleep sofa in room. New gloves on every caregiver every contact.
If you must go to a hospital, JHU is the place to go

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