The Face of Modern Care
Two hospitalizations in the past ten days have updated my views on modern medical treatment. As a physician who used to practice a standard (albeit obscure) specialty and now provides acupuncture services, I interpret events during my inpatient stays from a unique perspective. As you read the following critique of inpatient care, keep in mind my past sufferings with awful medication side effects, and the fact that I’m currently sitting in a cramped and ugly hospital room.
Skeptics dismiss acupuncture as a ‘mere’ placebo. Although reams of research demonstrate that people improve after treatments, the mechanism remains uncertain. Relevant neural pathways seem to be altered, but these changes can be subtle and may not suffice to explain acupuncture’s effects. Bodily energy (Chi) remains a possible agent, but since it has not yet been proven to exist, it cannot be invoked in a Western context. In short, the data establish that people feel better after acupuncture, but there remains much mystery. It may well be true that much of the improvement is due to placebo action.
Here is my preferred definition of the placebo effect: the triggering of the body-mind’s innate healing response by an external signal. This description is broad enough to encompass sugar pills, hypnotic suggestions, and hugs. The unifying factors are trust, intention, and expectation. If a respected physician prescribes a pill and calls it potent medicine, the chance of improvement is high. This is true whether the pill contains a sophisticated drug or only sugar. (Pharmaceutical researchers often find it difficult to prove that a medication works better than sugar.) Recent work shows that patients may even feel better after knowingly taking inert pills, if they are assured that healing will follow.
Notice that context matters, and that trust is a big part of it. Hugs make us feel good, but not if offered insincerely or by those who abuse us. In a hospital, trust gets fostered by personal attention, smiles, and small acts of kindness. As a patient, you’d like the staff to ask how you feel while looking you in the eyes with genuine interest. You’d like to see a warm smile on the face of the person checking your vital signs. You’d like your nurse to notice if the room feels chilly and bring you a warm blanket.
Although I experienced each of these gestures during my hospitalization, I regret to report that they were rare. Usually, questions about my status were asked as the nurse faced his or her mobile computer cart. Blood was often drawn grimly by technicians who said few words and hardly looked at me. I had to ask for blankets repeatedly, even when being wheeled through drafty public corridors, where the need for coverage seemed obvious.
On a clinical pod of ten rooms containing fourteen beds, I counted two dozen computer screens. At any given time, nearly all the nurses and aides were working on computers rather than caring for patients. Even when they visited my room, which happened rarely, they spent most of their time entering data and asked only those questions mandated by the online forms. I was treated like a mechanical device in a repair shop rather than a flesh and blood human in a center for healing.
In my acupuncture office I keep the surroundings comforting and calm. Meditative music plays in the background and art adorns the walls and shelves. In the hospital the corridors were painted institutional green. There was no music and only a few token photographs. The background noise consisted of a near-constant cacophony of beeps and alarms emitted by all the technology. I didn’t see a single houseplant.
Don’t get me wrong. Sterility of equipment and surfaces is vital in a hospital. But does that require a sterile ambiance? Professionalism is important too, but does it rule out humanism?
Once after midnight I rang the call button. A young man barged into my darkened room and immediately turned on the brightest overhead light. When I told him I had abdominal pain he asked sarcastically, “so you’re having gas?” Worse, he didn’t seem phased by my response: “No, I have internal bleeding.” He simply stalked out of the room to summon the medication (and would have left the light glaring if I hadn’t stopped him).
This wasn’t an isolated incident. To cite one other example: when I was in the ICU I needed the nurse’s help to reach the nifty toilet that rotates out of a cabinet next to the bed. When I asked for assistance onto the commode, she suggested: “can’t you use a urinal?”, which forced me to spell out my bodily need so she’d see that her solution wouldn’t work. After I was in place and she left me to my business, she failed to close the curtain across the glass wall separating my room from the corridor. She expected me to defecate in full view of all the staff and visitors walking by.
I could go on, but you get the picture. This experience wasn’t healing, it was exasperating. At least the doctors seemed highly competent, though they failed to communicate a unified message and often contradicted one another. On the one hand, I was glad of my medical training, since it helped me sort out my options in a confusing situation. On the other, I was saddened to see how hospital care has deteriorated. Apparently, many young people entering health fields have neither empathy nor sense of mission. Computers win more attention than patients.
We hear a lot about evidence-based medicine. It is a good idea, but let’s add in a little placebo-based healing, too.
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