Better Hospitals
By W. 1. CARD
"T,he Spectator," having offered prizes for the best papers on three medical subjects—Better Hospitals, Better Family Doctors and a Better Health Service—publishes today the winning entry in the first category. The article awarded the prize in the " Better Family Doctors" section will appear next week.
HOSPItALS are for the care and comfort of the sick. They do not exist for the convenience of nurses or for the greater glory of physicians and surgeons. They are made of bricks and mortar or reinforced concrete, contain specialised and expensive equipment, and are staffed by fallible men and women. If we want better hospitals, we must spend intelligently more money on bricks and mortar and equipment, and we must breed or educate better men and women. It is as simple as that.
How to find the money is not our concern. Hospitals must take their place in the national queue with all the other demands for better housing and new factories. But let us imagine for one moment that the Chancellor of the Exchequer has become youthful and slender, is wearing white silk tights and is standing in the middle of a big spotlight. He will wave his wand and we car. have the hospital of our desires. What shall we choose ?
There are certain facts about the hospital-consumer. Any- thing in the nature of a " hospital class " in the social sense has disappeared; the hospital-consumer is growing older, and the type of illness for which admission is sought is very different from that of thirty years ago. Since there are fewer people to look after the elderly, a patient may require admission for a slight ailment, because there is literally no one to provide simple nursing care at home. There is therefore a definite place for wards where something like home-nursink care can be obtained.. Such wards would be used for illness not needing complicated investigation or treatment, and the patient could most suitably be looked after by his own doctor, who could thus be linked to the hospital service. - Our hospital should not be too big. Up to a certain point, size makes for efficiency, but the enormous hospital is imper- sonal and a little frightening. The inhabitants don't even know each other. Efficiency is produced, not by-size, but by complete bed-utilisation and the transfer of patients to less expensive institutions like convalescent homes when this becomes possible.
But, whatever the size of our hospital, it should contain plenty of small wards. The large single ward has the advantages of simplicity and economy of nursing; it is otherwise undesir- able. Human beings differ in their desire and need for privacy. Some prefer to be nursed in social groups; to others the thought of sharing a room with other sick people is repellent, though for the occasional patient who " enjoys " ill health to see the genuine illnesses of others may prove a valuable therapeutic experience. But, whether we want privacy or not when we are getting better. there are occasions when each one of us needs a single room. No one ought to be expected to die in public. Elephants are said to leave the herd when their end approaches and to die in solitude. We should demand the same rights as elephants.
Our ideas of the management of illness have changed, and we now favour early movement of a patient after an operation. Bed can be a dangerous place, and the pa Pent is safer and healthier regaining his mobility. With modem anaesthesia it is frequently possible to get an elderly patient to take a few assisted steps forty-eight hours after a major operation, and to leave the hospital .a fortnight later. If we expect patients to leave their beds we must provide, some inducement. A ward should have a sitting-room with arm-chairs and a fire. it should bear no resemblance to a hospital.
Hospitals should be quiet; most noise is quite unnecessary. It is when we are sick, and our irritability is increased, that noise fidgets us. There is no need for the clanging lift-door; the recur- rent telephone, nor the rumbling of' the food-trolley down the corridor. All these sounds can be lessened or eliminated—even the Light Programme. In old hospitals the use of colour was hardly considered. There we dark green to encourage depres- sion and chocolate to nauseate. Our hospital should be cheer- ful. Why should the devil have all the best colours as well as all the good tunes ? There should be a little more gaiety even if it means a litee more sepsis.
How is our administration to be improved ? Government only works at all satisfactorily when you can go and talk to the man who is personally responsible for the decision that has been taken. Remove this opportunity of personal contact and government becomes diffused and abstract. We become numbers, black marks on white paper. We fall into the diag- noses of the International Statistical Code, with a social group attached. The person responsible becomes a " they," whose behaviour can never be observed directly, but can only be inferred. " They " are always polite, imperturbable. " They " attach great store to precedent. 1 ney " do not grow old and resign: age does not seem to weary them. In this way individual human responsibility is being slowly lost. Have we not the courage to restore it and allow the boards in touch with hospi- tals to take more of:their own decAons - - - Many of the hospital problems are problems of technology that can be 'readily solved given inteigence and money. The staffing of hospitals is less tractable. It is not normal and natural to care for the sick. They are frequently bad-tempered and unreasonable and have unpleasant habits. It is 'not normal to care` for them or to like to look after them. In primitive com- munities the sick are carried outside, the village and left to die. In this island the custom is different. We all feel some respon- sibility for the street-accident or the epileptic on the pavement. We pay heavy taxes for the care of the sick; we even give our own blood to aid the recovery of some quite unknown sufferer. Why do - we do these extraordinary things ?• Because it is customary ? But it was not always customary. It is not customary now in certain parts of the world; and it iq easy to imagine a benevolent despotism pursuing .a policy of State extermination of the incurably sick. It would be more natural. It could all be done quite kindly; regretfully perhaps, but quite kindly. It would. be very economical Why do these suggestions revolt us ? Because we have been brought up in the Western tradition, the ethos that derives from Greek philosophy and Christianity. Ultimately we believe in the value of the individual. It is no accident that the first hospitals were annexes to religious institutions, and that the care- of the sick has always been recognised in some sense as a vocation. Whether this sense can survive the disappearance of a faith to which it owes its significance is not yet certain. it will be interesting to see. But somehow there must be love of man, and if we are to have- better hospitals there must be a greater love of man. If it cannot be taught by precept it must be taught by example. For if it is 'not learned our hospitals may provide intellectual exerci!es in physiology, pathology or biochemistry, but they will be inhuman and unlovely places. Hippocrates knew that. After more than 2,000 years he still looks worried and harassed. Perhaps he has too many out-patients: per- haps he's still making silly mistakes in diagnosis; perhaps there's a young thing with tuberculosis and he can't do much about it. Hippocrates didn't know much; but he was certain of one thing : "Where there is Love of Man, there also is Lo'.e of this Art."
Previous page
