Wednesday, August 17, 2005

NY Times Articles on Hospitals and Patients

This NYTimes article, entitled In the Hospital, a Degrading Shift From Person to Patient - New York Times: includes a reference to one of my favorite thinkers, Erving Goffman:
"In Dr. Goffman's account of life in a mental institution in the 1950's, he describes the admission process as a stripping away of possessions, 'perhaps the most significant of which is not physical at all, one's full name.'

In modern medicine, patients more commonly become exasperated because they do not know the names of the doctors or other medical staff. At many clinics and hospitals, staff members come and go without introductions, patients say. Name tags are in lettering too small to read easily; the names embroidered in script on doctors' coats can get lost in folds."
Based on recent (vicarious) experience, all true, but somewhat overdone. In the hospital I was visiting (I plan more blogs on this, and will limit identification to "upstate hospital") they were trying. Staff were supposed to identify themselves to the patient. There was a white board for each patient that was to show the nurse and aide assigned on each shift.

But as with any bureaucracy, changing procedures and instilling habits is difficult. The white board was someone's bright idea, but it was too small for an older patient without her glasses to read. The markers for use with the board got mislaid. And, I strongly suspect, the "someone" was an administrator who never really got buyin at the working level. A big part of the problem is that change takes time and money. If an organization is strapped for both, the "bright ideas" don't get fully implemented, which increases cynicism and makes future change harder (see Dilbert).

What was good in this hospital was the acceptance that names should be known, so there was little awkwardness about asking. The social norm had been established, even though the practice was somewhat ineffective.

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