Gina Kolata wrote a Feb. 18 front-page article about hospitals and their increased interest in reducing suffering. She explains how the story took shape.
I never thought of suffering in the way hospitals are thinking of it now — endless time in a waiting room, a doctor blurting out that you have cancer while your hospital roommate looks on with embarrassment, a medical team that seems not to communicate with one another or with you. And it never occurred to me that you could fix a lot of these things by measuring them and giving doctors feedback, just as is done for things like medication errors.
All that changed when I got an email from a company I had never heard of that wanted to come by and discuss suffering. It wanted to bring its chief medical officer, Dr. Thomas Lee, whom I had heard of because last I knew he was in charge of Harvard’s hospitals.
I just about never agree to such requests, but because the topic was intriguing and the medical officer was very well known I said O.K. He was passionate and riveting and made me realize that suffering has become a
real issue for hospitals these days. And many of the nation’s leading hospitals are making changes and seeing results.
Dr. Lee told me that he joined the company, Press Ganey, because it told him, while recruiting him, that one of its goals was to reduce patient suffering. He was fascinated, and a bit discomfited by the idea, and wrote about it in an opinion essay for The New England Journal of Medicine. The piece was called “The Word That Shall Not Be Spoken.”
He wrote: “The word ‘suffering’ would take some getting used to. I couldn’t remember the last time that my colleagues and I had used that word. ‘Suffering’ made me uncomfortable. I wondered whether it was a tad sensational, a bit too emotional. But on reflection, how could I object to its use? After all, from the perspective of patients, that is what’s going on.”
Dr. Lee decided to join Press Ganey, which measures suffering with patient surveys.
After I spoke with Dr. Lee, I talked to hospital administrators and doctors, who had stories to tell. There were so many ideas, some clever, some that seemed so obvious you wonder why they weren’t done before.
At the University of Utah hospitals, for example, there are whiteboards in every patient’s room. Doctors and nurses write their names on the boards when they go in, so patients know who is there. And family members can write notes for the staff.
At Stanford, instead of waiting for patients to push a button to call a nurse, nurses go into patients’ rooms every hour to check on them.
At the Cleveland Clinic, administrators discovered that their doctors often seemed to lack empathy. Then they discovered that if a doctor entered a patient’s room smiling, the patient relaxed, even if the doctor conveyed bad news. If a doctor entered frowning, no matter what the doctor said, the patient feared the worst. So Cleveland Clinic doctors have been trained to smile every time they enter a patient’s room.
I asked Dr. Lee – who still sees patients once a week at Harvard – if he had changed. Yes, he told me, he has. “Now that I know that patients are afraid and that teamwork is so important, I start every visit by saying, ‘I just want to let you know that I talked to the oncologist, I emailed the orthopedist,’ ” he said. “I want to make a real point to the patient, ‘I am sending you to someone I know.’ ”