For the past week the news cycle has been dominated by reports of President Trump’s hospitalization for COVID-19. According to the Centers for Disease Control, the COVID-19 hospitalization rate is currently 178.2 per 100,000 people, with the highest rates for people 65 years and older.
Even without a pandemic, sooner or later, all of us have some contact with hospitals. According to the American Hospital Association, over 34 million Americans are hospitalized annually. There are over 6,000 hospitals with nearly a million beds in the United States. The total expenses for all these facilities exceeds $1.1 trillion annually. Grouch Marx once said, “A hospital bed is a parked taxi with the meter running.”
Currently, Indiana has approximately 20,000 hospital beds and 62% of them are occupied. It has also been estimated that now there are about 500 patients with COVID-19 in Indiana hospitals.
At Walter Reed National Military Medical Center, where president Trump was hospitalized, the presidential suite contains its own intensive care unit, a kitchen, living quarters, and a secure conference room. This hospital also has office space for the White House Chief of Staff, as well as sleeping quarters for the president’s physician.
I’m preparing for a brief hospital stay in November, but I suspect my room won’t have an office for my Chief of Staff (Diane). I have to attend a number of outpatient appointments before admission and it looks like I will end up with at least four injections and two blood tests before I even get in the door. I also am not looking forward to having a COVID-19 test before I get admitted. Earlier this year, Brad Pitt portrayed Dr. Anthony Fauci on Saturday Night Live. The writers had Fauci say, ”I don’t know if I would describe the test as beautiful, unless your idea of beauty is having a cotton swab tickle your brain.” Experts, however, say that if done correctly, the test shouldn’t hurt, although they also described it as “itchy or tickly.” To me “itchy or tickly” sounds like Simpson cartoon characters.
My personal experience with hospitals goes back a long time. I was sick a lot as a child and was admitted to the hospital at age 3. My pediatrician at the time was Dr. Berman. He was a short, heavy-set man who wore a bow tie, a starched white shirt and white coat, and he was always chomping on a cigar, which may give you some idea as to how long ago this was. I suspect very few of you have had a physical exam conducted by a guy smoking a cigar.
When I was in the hospital I would climb out of my crib and hide under the other cribs on the ward, so frequently they would have to search for me. Dr. Berman always had medical students with him. My mother said that he would take me with him and the students when he would make his rounds. I was sort of the teacher’s pet. Of course, I have no memory of any of this, but I do remember and still associate the taste of pears with anxiety and being in the hospital as a young child. This pairing of pears and anxiety results in what psychologists call classical conditioning. The hospital was the first place I ever had pears.
With distress, discomfort and being isolated, people can easily get anxious, disorientated and confused in the hospital, especially patients who do not fully comprehend what is happening to them. Psychologist Justin Maps from Queensland University says, “Our research shows about 10 to 15 percent of children who are admitted to hospital… develop post-traumatic stress disorder.” Adults also routinely react to the stress of hospitalization. Several studies indicate that people usually underreport the times they have gone to the hospital, even when the stay has been fairly recent. Psychologists believed that this “forgetting” may represent the repression of traumatic memories. In one study almost one-third of respondents failed to recall a recent hospital visit when surveyed.
Over time hospitals have done a number of things to become more welcoming and patient-centered. Several years ago many hospital started the now commonplace practice of putting dry-erase white boards in patients’ rooms. This occurred after the National Institute of Medicine’s emphasis on providing effective communication. These boards are still used to help orient the patient as to place, time and date. They also may list the diet orders, healthcare providers’ names, the projected discharge date and other important medical information, like the estimated time for the next dose of pain medication.
Jan Hill and Peter Pronovost, from Johns Hopkins Medicine have compiled a list of the most common patient complaints about hospitals. I was a bit surprised to see that food wasn’t on the list. Often described as bland and tasteless, hospital food is frequently the butt of jokes. When, however, my wife Diane and I lived in Florida, the hospital where our youngest son was born was known for its excellent vegetarian food. They even provided a gift basket with baked goods upon discharge. We knew one woman who stayed an extra night in the hospital just so that she wouldn’t miss lunch there the next day.
The Johns Hopkin’s complaint list starts off with sleep deprivation from staff drawing blood in the middle of the night and nurses’ stations being noisy. Patients also complained about losing personal belongings and staff not knocking before entering the room. Some patients were annoyed that the information on their whiteboards was not routinely updated and others felt that there was a lack of clear communication about changes in the patient’s condition. Housekeeping was an issue for some patients as was a lack of proper information about the room and hospital — there were complaints about not being shown how to operate the bed or the television or order food. Finally, some patients said that they felt they weren’t involved enough in their care and didn’t think staff listened to them. I am sure this is not the case for President Trump. Humorist Jean Kerr once wrote, “One of the most difficult things to contend with in a hospital is that assumption on the part of the staff that because you have lost your gall bladder you have also lost your mind.”
In all fairness hospitals try very hard to address patient satisfaction and this is reflected in all those surveys we’re asked to complete. Studies consistently show that physician, nurse and staff caring and verbal expressions of personal concern always have the biggest impact on patient satisfaction. Although I’m not the president of any country, I suppose I can’t complain about a lack of participation in my care. After all I got to make rounds with the doctor.