Hospital Design: Hello, a real person will be in that bed! (a rant)

I just saw an ad on a design site showing a patient's room.  One look at the bed brought me right back to the horrors of one particular hospital - losing my purse and phone and call button on the floor myriad times because the "cute" bed rails let everything go over the side.  In this ad photo, as in rehab, there is no nightstand-with-drawer for the glasses, the cell phone, the notebook for notes to the doctor.

There is a window, and outside the window is a view.  Unfortunately, the bed is low, and there is furniture in front of the window. The bed would have to be taller than mine have been, or the patient would never see the view.

Hospital rooms are for people.  They are not marketing photo ops.

The very best way for healthcare designers to begin is to take a stranger who has been a disregarded patient in the past.  Put that patient in the driver's seat before you get to the street the hospital is on.  You sit silently in the back with your notebook, writing down what makes the patient grit her teeth to avoid cussing as she learns the building numbers cannot be seen from the car unless she drives with the door open.  Until she learns there is no sign for Main Entrance.

If this "sample" patient is really sick, give her a tape recorder (you may have to tie it to those "cartoon") bed rails,to use at times like when her chocolate bar has vanished from her suitcase into the black hole closet, along with her spare underwear and dental appliances. Like when she is trying to explain to the staff that her hiatal hernia requires 5 small meals, and the promised yogurt has been eaten by the staff.

After all there's a flatscreen featuring health advice plus David and Bathsheba. And a bedraggled copy of A Photo Guide to Your Rectal Surgery.  And wireless access for when someone helps her get her phone back off the floor, again.

So never mind the evidence about views of nature getting patients out of the hospital a day faster. Never mind that the hospital remodel cut the nature view out of the small rooms.  After all, she has a good doctor.


(Yes, I know there are some good rooms (just not enough.)  And I wish you health.)

Apology

We sincerely apologize for the misspelling of Dr. Dhand's name this week,

HOSPITALS: What IS a real healing environment?

I just read some actual common sense from Suneel Dhand, MD, on Kevin,MD: 5 Ways to Improve the Healing Environment of Hospitals.

One statement is so right-on that I wish it would fit on a tee shirt:

"... the whole topic of making hospitals better places to be 

has become a bit of a bumper sticker — 

with lots of convoluted and complex ideas being put forward, 

that often border on being nothing more than expensive gimmicks."

He talks about more doctors and nurses.  And (a note to all who are writing and meeting endlessly about design and marketing) he mentions the hospital reputation for happy patients in the same step as more frontline staff time with patients.

I'm all about happy patients, but not about marketing.  It's really the 5th "way" that I want to dive into, so there will be a post or article about it.

Meanwhile, I hope you'll read his whole article.

I wish  you health.

Three-month visit to medical oncologist . . . any answers?

Tomorrow I will hear the results of my blood work.  I want to know if I've been tested for metabolizing Tamoxifen to endoxifen or if I will be.  Questions like that probably give doctors a headache.  And what about the thyroid test I suggested--was low thyroid responsible for how terribly cold I got last winter?

So many symptoms and so few as to which are old age and arthritis, and which are Tamoxifen.  I've had mysterious pains that went away after a few days. The  most severe felt like being stabbed in my left shoulder, and I regret agreeing to an X-ray for that pain. It never happened again, though my shoulders do ache at times.

Muscle pain or nerve pain:  My right forearm was hurt closing a car door two years ago, and that same sharp pain along the forearm came back for a couple of days recently - then stopped.

A much younger friend of mine who takes Arimidex has a couple of symptoms very similar to mine - the foot pains with arthritis symptoms, and the waves of scary fatigue are so similar to hers - but hers seem to be worse.  In fact her symptoms over the past year make me more scared of Arimidex.

This is all summed up by what I know some other women say:  the worry is not knowing if a problem is Tamoxifen or something else.

He put me on a three-month visit schedule as soon as I mentioned depression, and that's one of the problems that may just be from my situation - the fact that time's passing and I haven't found work in this area?  Or the fact that I have so many doctors and so many health problems unsolved?

Bottom line:  I like this doctor and he's more patient than his schedule probably tells him to be.

A DOCTOR TELLS . . . A tip on getting more out of a medical visit

Back at the podiatrist's for the second appointment, I had unanswered questions that had been piling up for years.  And what definitely looked to me like arthritis, with toes going off in new directions.  And a few other problems.  I reminded him that he'd told me my legs can cause foot discomfort. 

He told the assistant to see if they had any metatarsal pads.  He asked me if I had an arthritis doctor.  I said no (didn't admit that I never heard of such a specialty.)  

 I asked if toe stands would make my metatarsal arch worse - I need an exercise because I can't pass the balance test.  He sent me over to the counter to do a toe stand, and I barely lasted a second.  

After seeing that he sent me back to Carol (the NP, who's been in this area for many years) and told me to ask her for a rheumatologist. Then he very gently said: 

Let them do their whole spiel before you ask all your questions.  Hear what they think.  Don't distract them.  

I laughed at myself, and acknowleged him for being so tactful about that.  I know I spew out questions/problems at doctors sometimes.  Between the spine fusion and the DCIS diagnosis and treatment, other medical problems have been pushed aside, and are really nagging at me.

Got in to see the NP two days later.  She gave me some rheumatologists's cards, but I kept asking if she knew anyone.  She went across the hall to a different computer, and simply looked up some names in our area.  Coming back to me, she exclaimed:  I'm excited!  Two good people she thought had moved away are back in the area.  So I have names to call Monday.  If they take me, I plan to be a good and patient listener.

I wish you great patient/doctor communications.

WAITING ROOMS. . what's the worst about them - a rant

Yesterday I had some blood drawn in the most depressing lab of my life. Because the only chairs (as usual too tall for me) were jammed into the hall, the other patients and I got acquainted quickly. Since one of them is in treatment for cancer right now, it didn't take long for the talk to center on nauseating and debilitating odors and airborne danger in waiting rooms. (Since we were in the hall, there was plenty of ventilation.) Perfume was mentioned, and my new friends felt there was no excuse for wearing perfume to an oncology office.  Especially if there is a large and very readable sign warning against strong odors and what they do to cancer patients.

Then of course we remembered last winter's horror of a waiting room full of tobacco-smoke-saturated wooly winter coats. (Yes, I'm plagiarizing myself.)   And there was the day in another doctor's office recently when two of us waited in the hall because of the tobacco smoke odor emanating from one single woman.

Yesterday was not my first impromptu conversation to end with this decision:  The trouble with many waiting rooms is the patients!

Is it unethical for a doctor to make someone wait in the hall if that patient is endangering the health of others?
The other possibility (maybe) is excellent ventilation in the waiting room - a very expensive remodel.   I still don't know how to ask a  fine and delightful doctor (or those who may not be quite so fine)  if there is something that can be done about ventilation.

Apparently, patients deciding what to do about waiting rooms is like mice deciding "who will bell the cat."

When a loved one is diagnosed with breast cancer:

If someone you love is newly diagnosed, I hope you will read this advice from a retired female oncologist.  If you are newly diagnosed, I hope your friends and family will read this.

Good advice comes in strange packages.  This is from The Crab Diaries.  Her post was titled:   Love and Loyalty From the Souls of Dogs, about a friend's dog getting ready to die, while another dog stands guard over his last hours.  And no, this is not to insult you or yours.  As an oncologist, she says:

"Sometimes friends and families of my patients are uncomfortable 

visiting their loved ones  after a diagnosis of cancer

,or even more so at the end of life. 

 They ask me, “What should I say?” or “What can I do?” 

The answer is revealed in Nan’s picture of Roo and Barkool: 

 without fanfare, without words, without tears, just be there."