Friday, August 22, 2014

In Redesigned Room, Hospital Patients May Feel Better Already -

PLAINSBORO, N.J. — Can good design help heal the sick?

The University Medical Center of Princeton realized several years ago that it had outgrown its old home and needed a new one. So the management decided to design a mock patient room.

Medical staff members and patients were surveyed. Nurses and doctors spent months moving Post-it notes around a model room set up in the old hospital. It was for just one patient, with a big foldout sofa for guests, a view outdoors, a novel drug dispensary and a bathroom positioned just so.

Equipment was installed, possible situations rehearsed. Then real patients were moved in from the surgical unit — hip and knee replacements, mostly — to compare old and new rooms. After months of testing, patients in the model room rated food and nursing care higher than patients in the old rooms did, although the meals and care were the same.

But the real eye-opener was this: Patients also asked for 30 percent less pain medication.

Reduced pain has a cascade effect, hastening recovery and rehabilitation, leading to shorter stays and diminishing not just costs but also the chances for accidents and infections. When the new $523 million, 636,000-square-foot hospital, on a leafy campus, opened here in 2012, the model room became real.

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Thursday, August 21, 2014

In ‘Doctored,’ Sandeep Jauhar Examines a Broken System -

In Sandeep Jauhar's arresting memoir about the realities of practicing medicine in America, "Doctored: The Disillusionment of an American Physician," he describes an interaction he has with a patient at Long Island Jewish Medical Center, where he is the director of the heart failure program. The patient has an abdominal mass and has been transferred to the medical center from another hospital for a preoperative evaluation. Dr. Jauhar tells her that there are some things he needs to figure out before sending her to the operating room.

"Like what is this mass," he says. "Is it cancer? Has it spread?" Neither her paperwork nor the doctor from the other hospital had provided answers.

"Do you know if it has?" she asks, wondering if the cancer has metastasized. He does not. "No one knows what is going on," she says, her eyes filling with tears.

And she is right, says Dr. Jauhar, whose writing has appeared in The New York Times and whose first book, "Intern," chronicled that grueling year of his medical career. "It is hard to imagine such a thing happening in the era of 'my doctor,' " he says, referring to the days when patients primarily had one doctor who knew them well.

It's not news, of course, that our medical system has become dysfunctional. But Dr. Jauhar's personal account shows that brokenness on a human scale, starting with the doctor-patient relationship, which is in tatters.

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