Know When To Use the Hospital
Filed Under Right Medical Facility |
The hospital is expensive. It is not home or hotel. It saves lives and it takes them. It must be used and it must be avoided. To manage these contradictions, the need for hospitalization for you or your family must be carefully considered in each instance. Don’t use the hospital if services can be performed outside the hospital. The acute general hospital does acute general medicine well; it does not do other functions well. Don’t use the hospital for a rest; it is not a good place to rest. It is busy, noisy, unfamiliar, and populated with strange roommates. Its nights are punctuated with interruptions, and it has an unusual time schedule. It has many employees, a few of whom are less thoughtful than others. Don’t use the hospital for the “convenience” of having a number of tests done in a few days. It does not provide tests in the most efficient manner; indeed, most laboratories and x-ray facilities are not open on the weekend, and special procedures may require several days just to be scheduled. Many have urged that we have a system of “hcptels,” which provide lodging at minimal cost, allow for efficient test performance, and are appropriate for periods of rest and minimal activity. A number of experiments along these lines are underway. Until more appropriate facilities are available, however, use the acute hospital with great reluctance. A century ago, the Hungarian physician, Inaz Philipp Semmelweiss (1818-1865J, noted that both infants and mothers delivering at home fared better than those in the hospital and that the existence of often fatal “childbed fever” was one of the risks of the hospital. This problem, due to poor hygiene in the delivery rooms, has long since been corrected. But in our
present age, new evidence suggests that for many conditions home treatment may work better than treatment in the hospital. For example, treatment for minor heart attacks at home has been reported as possibly better than treatment in a hospital. It is apparent to most hospital visitors that the crisis atmosphere of the acute hospital does not promote the calmest state of mind for the patient. Many therapeutic features of the home cannot be duplicated in the hospital.