THE excellent acute care offered at a NSW teaching hospital was recently made apparent when an elderly relative received rapid and appropriate life-saving treatment in the emergency department.
The illness then required admission to a general medical ward. As a visitor to the four-bed, mixed-sex room and the wider ward, I saw a less appealing side to hospital care, including vulnerable elderly people in various states of undress, and a patient of the opposite sex to my relative in an adjacent bed, who was very distressed at being left unattended and exposed after an episode of incontinence.
I didn’t complain, but the experience has left me wondering how medical excellence can stand alongside some of the dehumanising practices we accept as normal in our hospitals, and where such practices sit with the rhetoric of “patient-centred care”.
An MJA InSight news story this week canvasses these issues after the Canadian authors of a research letter published in JAMA Internal Medicine questioned the custom of inpatients wearing hospital gowns and no lower body attire, even when there is no medical reason for them to do so.
The authors believe that the resulting loss of dignity gives patients low status in the hospital, sending the wrong message to the staff who care for them. The experts we approached agreed that a range of practices in Australian hospitals, including mixed-sex wards, engender similar indignities here.
Our lead news story is also about hospital care, and the importance of what happens before and after surgery for patients with hip fracture. An MJA study has found a striking variation in the 30-day mortality rates for such patients in NSW hospitals, with hospitals that involve a geriatric team or geriatrician in the care of hip fracture patients having better survival rates than those which do not.
The study does not reveal what aspects of the medical team’s involvement are beneficial but, according to one expert we spoke to, they are likely to include individual patient factors such as “medical optimisation before surgery, prevention and early detection of medical complications, better coordination of care, better communication between staff responsible for care, and better management of comorbidities”.
Patient-centred care requires the emotional intelligence (EI) to take into account the differing needs and perspectives of all those in the health care environment, especially the patient! It’s a quality that intern Megan Hickie has discovered hospital doctors require in spades. In her InSight comment she describes how her EI kicked in when faced with a deteriorating patient’s care.
Two items in our news in brief section provide evidence that centring on patients can bring important clinical benefits. A study from the US shows pregnant women choose less rather than more invasive prenatal testing if they are fully informed, and a Cochrane Review reveals assessment of quality of life in chronically ill children is not complete without the perspectives of the children themselves. The finding held for children as young as 4 years old.
In her blog this week, Jane McCredie recalls the definition of patient-centred care embraced by health departments and institutions throughout Australia — “Care which puts the individual at the heart of all that we do in terms of caring for patients, health service design, policy and service delivery”.
She rightly wonders where this sits with some of the arbitrary bureaucratic processes patients endure in trying to access health and disability services. With the recent memory of my afternoon in a teaching hospital medical ward I too am left wondering.
A spokesperson from NSW Health told MJA InSight for our article on hospital attire: “There are no exemptions from the need to ensure that the privacy and dignity of all NSW Health patients is respected at all times during their health care experience”.
Strong words and a fine ideal, but where is the evidence that we are living up to it?
Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight