Why are hospitals so unpleasant? I mean, yes, obviously, they’re full of sick people and much that is painful takes place in them. But it’s more than that, isn’t it? Hospitals are harsh places. The lighting is harsh. The bureaucracy is confusing. The furniture is uncomfortable. There are often few windows. They are not beautiful places. They are certainly not welcoming.
That should strike us as strange. A hospital is, after all, a place for healing, and if it’s a place for healing, people should feel as good as possible there. The food should be good, the lighting should be good, the architecture should be beautiful, the people should be kind, the process should be easy.
I have had to go to a hospital twice in the last decade. Both experiences were absolutely awful, and not because I was sick. In the first instance, I was forced into an ambulance against my will (which later cost $1,000). The (private) EMTs were rude and made unpleasant jokes about me. At the hospital, I was left alone in an uncomfortable bed, bewildered and delirious. The lighting was aggressive, and staff kept darting in and then leaving before I could tell them what was wrong. Eventually I was released without really understanding what was wrong with me, and wandered the streets of an unfamiliar neighborhood, still delirious, before fumbling my way home. The second time, I remember being shunted from room to room, sitting in hallways watching people pass me by on their way to other patients. The layout was confusing, the rooms were windowless, and I felt alone, baffled, and neglected. Both times I left the hospital feeling worse than when I came in. Both were world-class facilities. (I was one of the lucky ones. One in 30 patients gets an infection at the hospital.)
Bad experiences at hospitals are incredibly common. A close relative of mine called me today having just been released from the hospital, and having had to fill out papers while in horrible pain, then sitting for hours in a harshly lit room being ignored. What’s strange to me about the bad experiences people have is that they are some of the easiest possible things we could change about medicine. You can’t cure cancer, but you can certainly cure paperwork. You can cure depressing architecture. You can cure indifference and bureaucracy and discomfort.
The problems with hospitals are strange, because they violate the first principles we would use to design a “healing place.” The first thing you should do when designing a place to make people feel better is to make sure they suffer no unnecessary stress or confusion or unpleasantness there. In fact, there is apparently hard evidence that this can make a difference to patient outcomes, which is why sensible hospitals have gardens. I’d like to suggest, though, that “first person experience” needs to be put at the center of every single discussion of healthcare. When we talk about providing healthcare for all, we are not just discussing “improving outcomes” or “insuring everybody.” We want to eliminate paperwork, eliminate feelings of confusion and stress associated with healthcare, and make the institutions that take care of our health and heal us when we are sick into places that we are proud of, that we do not fear or dislike.
That is not the case now. Meghan O’Rourke, in an excellent 2014 Atlantic essay, described the general feeling of being a patient:
[I was] startled by the profound discomfort I always felt in hospitals. Physicians at times were brusque and even hostile to us (or was I imagining it?). The lighting was harsh, the food terrible, the rooms loud. Weren’t people trying to heal? That didn’t matter. What mattered was the whole busy apparatus of care—the beeping monitors and the hourly check-ins and the forced wakings, the elaborate (and frequently futile) interventions painstakingly performed on the terminally ill. In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me.
As she says, “ours is a technologically proficient but emotionally deficient and inconsistent medical system,” and despite rhetoric around “patient-centered” care, patients are still ignored and mistreated. O’Rourke says that we need to get past the bloodless policy language of insurance rates and “utilization” and think more about what it actually feels like to be in an emergency room, where the main things one notice are “organizational chaos” and “emotional detachment.”
We accept so many plainly dysfunctional things as normal, like the crazy hours doctors work and the lack of empathy for patients. We pretend that ugly, soulless places where everyone is stressed out and overburdened can be healing centers. As we rethink healthcare from the ground up in the years to come, it is important to question every aspect of the medical system. Why is it that nobody wants to die in a hospital, of all places? Something has gone wrong and we should refuse to accept that “nothing better is possible.” Hospitals will be failures until they are places that you feel a little sad to leave. Personally, I want every waiting room to feel like being in an arboretum, giant glass walls behind which are beautiful gardens. One cannot make human beings immortal. But we can at least make them feel cared about and comfortable in their most trying moments.
Have you or someone you know had an unnecessarily unpleasant experience in a hospital? What would have made it better? Email [email protected]