Academic

Hospitals and Cancer Treatment Centers--Stuntz

By David Skeel and Bill Stuntz

I?ve spent a fair bit of time around hospitals over the years: two major abdominal surgeries, three lower-back fusions, and more injections and films and tests of various sorts than I can count. The Boston-area hospital I?ve come to know best is Massachusetts General, where my last three surgeries were done.

This past week, I paid my first visit to a cancer treatment center: the Yawkey Center, named for longtime Red Sox owners Tom and Jean Yawkey, whose charitable foundation helped build it. The difference between that center and the hospital that sits next door to it is mind-blowing. Mass General embodies bureaucracy of the coldest sort. Yawkey oozes warmth. The waiting room?where cancer patients sit while waiting to have blood drawn or to see their oncologists?faces one of the best views of Boston I?ve ever seen. You can?t look at that view and avoid smiling. Notice: that smile-inducing vista belongs not to doctors in their offices, but to cancer patients.

It gets better. Sitting in that waiting room, I twice saw a volunteer wheel a cart past my seat, asking whether I wanted something to drink or a snack?no charge. I didn?t, but the offer made me smile more. I felt like a human being, not a number or an item on someone?s checklist. The same was true when I met with my oncologist?actually, it has been true in every conversation I?ve had with anyone at the Center so far. In my experience, most doctors will answer one or two questions, quickly, after which they?re looking for a way to end the conversation and get to the next appointment. (One of the many things I love about my internist, who is nearing retirement, is that he practices medicine the old-fashioned way: he talks with and listens to his patients. Definitely not the norm these days.) My oncologist answers every question my wife and I ask, as though he had nothing else to do that day?which is emphatically not the case. The nurses and assistants do likewise. That kind of behavior lends dignity to the patients who experience it. And for people whose bodies are assaulted by this disease, dignity is in short supply.

Most hospitals are the last places to seek dignity. The physical spaces are, for the most part, ugly and cold (both figuratively and literally: I?m always freezing at Mass General). Some of the doctors and nurses go out of their way to show patients warmth and consideration?and may God bless each and every one of them; the smallest interactions with them are like a drink of cool water in the desert. But for the most part, hospital conversations are tickets being punched, not human beings communicating with one another. The unspoken message goes like this: ?There is something I have to do here, and I?m going to do it as quickly as possible. What YOU do or say makes no difference, so you might as well shut up and let me get on with my job.? It isn?t entirely their fault?hospitals are understaffed; the doctors and nurses scurrying around their hallways and operating rooms are overworked. Treating people like people takes time, and the professionals who work in big-city hospitals?they ARE professionals: smart and knowledgeable and relentlessly competent?have far too little of that precious commodity.

Still, however excusable the bottom line may be, it?s deeply wrong. Sick human beings need to know that we?re still human beings. If, as so much medical literature attests, health depends in large measure on attitude, those who work in the health care industry (?industry? is the right word here: hospitals are to the early twenty-first century what factory floors were to the early and mid-twentieth) should think hard about the attitudes they foster. The Yawkey Center may be the exception: the world of cancer treatment is still new to me; I don?t know it well. If it?s the rule, the men and women who dispense that treatment have figured out something very important, something the world of big-city hospitals needs to learn.

Full post as published by Less than the Least on March 28, 2008 (boomark / email).