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Friday, December 9, 2011

A Night of Revelry and Compassion in Action

Last evening, more than 300 revelers in glittering formalwear packed Oheka Castle for Huntington Hospital’s annual Gala.  There was a Joan Rivers impersonator, a lively auction (with an authentic auctioneer), delicious food and more different forms of chocolate than I’ve seen in a long time.  Spirits soared, the dance floor rocked and generous donors dug deep in their wallets to help hospital leaders realize a  plan to create a new kind of patient care unit, one built very consciously to promote a vision of patient and family centered care for the 21st century.


“Illness is the night-side of life,” writes author Susan Sontag, “a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.  Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

Sontag’s characterization of the experience of illness resonates for every person who has occupied a hospital bed, or sat at the bedside of a loved one in the throes of severe illness.  At those times, we are gripped in turn by feelings of discomfort, dislocation, fear, anxiety, impatience, lack of control and anger. 

Under the worst of circumstances, the professionals rushing in and out of the room seem to inhabit another world altogether, citizens, as it were, of the “kingdom of the well.”  Forging and sustaining an empathic connection with patients and families is central to our identity as health professionals, and among our most solemn obligations.  We want to be present for our patient. How can we physicians and nurses do this, consistently and well?   

Patient “experience of care” data are now ubiquitous.  Every hospital in the country looks at these, and devotes resources to improving the results.  Not only that: as a result of publicly available on-line “report cards” community members can see how their local hospital compares with others.  Back at the hospital, front line professionals, administrators and Board members are reviewing this information and reacting to it.  And so it should be: such surveys results are the “unfiltered voice” of our community.  Presenting the data on dashboards, alongside hospital length of stay and “days cash on hand” we convey to one another that our interactions with patients may be understood, in their aggregate, as an operations problem, susceptible to good management.  Are we right?

Jerome Lowenstein, Professor of Medicine at NYU Medical Center hints at another perspective on the problem in his powerful essay, “Can You Teach Compassion?” To illustrate the issue, he catalogues the litany of “facts” that comprised the standard social history on the urban, university hospital teaching service where he attends, a place where everyone knows that an IVDA means an “intravenous drug abuser,” and where all interns have been taught a “formula” to efficiently report on their patients in units of chemical consumption: x pack-years, y quarts-per-day, z bags of heroin…

“This is the first NYU admission for this 35 year old IVDA…” 

It is dangerous to disrupt any entrenched social order, and the hospital staff is unmistakably a society unto itself.  And so this physician’s efforts are especially noteworthy.  One day, he interrupts the intern with a challenge :

“Would our thinking or care be different if you began by telling us that this is a 35 year old Marine veteran who has been addicted to drugs since he served, with valor, in Viet Nam?

With this brief, poignant observation Lowenstein illustrates the profound influence of the patient’s story – of Narrative – on our understanding of the patient, and ourselves, and, by extension, on the delivery of compassionate, patient and family-centered healthcare generally.   More on this another time.  Next installment:  Item number 7 on our countdown of tips for “Positive Parenting in 2012.”


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