June 28, 2006

A hospital discovers conversation

Maybe it's the after-effect of my just spending a week in the hospital but it seems to me that medical practitioners may be gradually starting to talk with their patients more. Two years ago, when I had an even longer stay in the same hospital, the doctors and nurses seemed to be far more interested in conversing only among themselves and when they spoke with patients, they used the well-known, in-group medical jargon that tends to isolate them from the rest of us non-medical types. But this time they actually spoke understandable prose to me most of the time, cheerfully explaining what was going on with my body. They also spent what seemed to me to be a great deal of time talking about lots of other things, small talk I guess. It would appear, based only on my admittedly small sample of participant observation, that the medical field may be discovering actual CONVERSATION.

Why was my hospitalization so different this time? Maybe it was because I had different attendants. Or maybe this time my floor had a bunch of easy cases for personnel to deal with. But I suspect that this new relaxed and informal experience had something to do with the fact that my hospital now has a new breed of physicians called "hospitalists."This is a new word in my vocabulary but when I checked google, I found 817,000 references to it, showing how slow I am to catch on I guess. Hospitalists are physicians who've decided that they want to lead a real life, just like other people, replacing their old grind of seeing patients all day in the office, being called at all hours, and visiting their patients in the hospital (definition here). My own internist quit his practice a year ago to become a hospitalist in a nearby city. My smallish hospital now has six of these, each working 12 hour shifts with the rest of the week free to lead their personal lives. They are never on call because other hospitalists take over when they're off-duty. They say that they now can lead a real life and, in my opinion, this makes them more fully human, capable even of engaging in CONVERSATIONS with patients.

The hospitalist who stopped by my room twice a day spent far more time with me than any other doctor ever has. She took time to explain my procedures in clear, non-technical English, discussed how she got into the medical field, showed me photos of my intestines that were taken during my procedure, took care of my medication needs, sympathized with my boring diet of jello and chicken broth, talking about hiking with her husband in the mountains, and joked about the irony of giving me new blood while at the same time drawing some of it out during my innumerable blood test monitorings. We even discussed a little politics. When the day of my release came, she saw to it that I didn't have to wait around all day to get release papers signed. I was out of there by 10 a.m.Two years ago it took until 3 p.m. to get this simple task accomplished.

What I noticed most, however, was the increased amount of CONVERSATION that took place during my stay. Nurses, phlebotomists, aides, all talked as much as I wanted them to. They seemed to have the time. And they were even interesting. The old tensions caused by waking up doctors in the middle of the night for changes in pain medication didn't seem to be present any more. The hospitalist took over. She seemed to be around all the time. The overall feeling of the place was far more relaxed, something that can be very encouraging to patients. At least it was for me.

Maybe one thing that medical practice has needed all along was a redistribution of authority. The "doctor as God" idea definitely needed to change. Sharing responsibility for patient care with another doctor may be one answer to the stressful life that caused my own excellent internist to quit his practice. All I know is that this hospital is not the impersonal, stressful, and frenzied place that it was two years ago. Personnel now seem to have the time and inclination actually to carry on extended CONVERSATIONS with their patients. And when this happens, there doesn't seem to be the need for using shorthand jargon with patients. Most of all though, it was just nice to be talked with once in a while.

Posted by Roger Shuy at June 28, 2006 12:07 PM