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Ongoing Thoughts Three:
By William E. Steinman:
Last week I said I wanted to discuss what hospitals might do
to make the victims stay a better experience. Lest I be misunderstood, this is
not about nurses. It is about how the institution is organized. I can testify
that the nurses care very much about their charges, but they have limited
power. In fact, if anything, they care too much. I had one nurse who tracked me
down in the atrium because she had some stuff to put in my IV and I was out
wandering. She found us. Mrs. Gaffer and I were sitting in the atrium soaking
up some sun. I was kind of dozing and enjoying it.
I said, boy, I didn’t think you would track me down
way over here. There is no sense in me trying to hide from you.”
She just smiled and her eyes said it all. ‘You got
that right bucko, you can run, but you can’t hide.’
I felt like I was in an episode of the fugitive.
Okay, after that I did not worry abut my medications. She
took it very seriously, so I need not.
The nursing care now is totally unlike the situations I
encountered years ago when I was hospitalized at
That is no longer the case. The HMOs reinvigorated the big
thing they were supposed to replace, because it was corrupt. They reinvigorated
Blue Cross, Blue Care, because it turned out to be less corrupt than the HMOs.
Now all of that has changed and even the worst HMOs are starting to get the
message, albeit slowly. Patient care has become important.
So this is not about the nursing care, but about the focus
of the hospital and its various teams. It sounded good when hospitals revealed
they were changing to a focus team approach. Oh boy we think, they will finally
focus on the patient needs first. Of course, the floor nurses actually do that,
but the rest of the game is out of step with that. The other groups are not
patient focused but data focused. There are groups of people who collect and
organize the data for the doctors. There is blood work and other various tests
for collecting information about the patient.
In this set up, the patient is not seen as a person, but as
a data source. The various teams come to get their information from and about
that patient and the patient becomes a victim of the system. The biggest
problem as I see it is these data gatherers are not coordinated with each
other. They each have their own agenda. Consequently, the victim is interrupted
and irregular intervals by each team. He is probed, punctured, and rolled over
so they can get that data. For example, I was not allowed to get two
consecutive hours of sleep in six days. There was always someone waking me up
to collect blood pressure or stick a probe in me somewhere. To be sure, the
information is very important, but it would help the patient a great deal if
these teams would coordinate their effort so they could do the whole set at one
time. I doubt if that will ever happen.
Another thing they did was keep the humidity at about 20%.
If you are a camel or an Arab, that might be okay. For most of us, a desert
environment is not good at all. A staff person explained that it was to control
fungus and mold. In short, they were saving maintenance money by subjecting the
patients to a desert environment. I found that unconscionable, but there was
nothing I could do about it but bitch. It did not change. It seems to me, they
should give more consideration to the patient needs rather than the cost of
fighting fungi.
Okay, perhaps I do protest too much. Over all, the hospital
care has improved a great deal over the years and I was pleased with it. Still,
there are a couple of things I know I would do if I were in charge. These have
to do with food service. One is about the coffee. The coffee that comes out of
that kitchen is a sin against God and Mankind. It should be outlawed. In fact
the entire food service should be outlawed. They should start over.
First, I would have a staff of volunteers on every floor
with a small kitchen available to them. They would make coffee and tea and
deliver it to the patients on demand along with real nutritious snacks. That
would be for patients who are on a normal diet, of course. Think cheese and
crackers, fresh fruit, vegetables, and juices. I would fire all of the people
who call themselves nutritionists and bring in a bunch of Denney’s type
of short order cooks. The patients would have a menu from which they could
order food when they wanted it. The food would be delivered to the patient by
cheerful volunteers when it was hot. It would not ride around the hospital on a
cart.
Tell me it can’t be done.
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