Hospitals Aren't Hotels. And You Wouldn't Want Them To Be.

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When it comes to seeking medical care, my focus is always on: Who is the best person for the job (replete with mounting evidence of good outcomes)? Which hospital is most familiar with the diagnosis at hand? Who has performed the most surgeries on that diagnosis in that particular field? Dealt with the most complex cases? Who has the most qualified team of highly trained support? Has the ringing endorsement of all staff from specialist colleagues to surgical nurses to anesthesiology to residents and so on. In other words, would the people in the know send their most cherished loved ones to them? 

Convenience would be low on my priority list. As would the beauty of the facility itself. Clean and sterile-seeming, out of concern for infection risks, would come to mind as important, but not a preference for luxury or the ability to order in food from the outside world. In fact, the greater the marketing or sales type feel of an institution or individual the more I would tend to suspect they were overcompensating for a deficit in capability, knowledge or skill. Don't get distracted by the bells and whistles, especially in health care.

With the misguided cultural trend of turning patients into so-called customers and consumers with scorecards and Yelp reviews (mainly prompted by hospital administration, not medical personnel), a disconnect has grown as to what really matters in providing and receiving excellent care.

My litany is endless, but a few scenarios come to mind to underscore my point.

For one, it would always baffle me - in a city like Manhattan where well-equipped hospitals abound - to hear how many people wanted to give birth in a specific hospital given its abundance of private rooms and its comparatively grand accommodations. This medical center, among others, lacked the highest level neonatal intensive care unit (NICU). If there were any issue with the baby, then he would be transferred to another institution away from his mother. In intense and serious circumstances, this delay could unnecessarily challenge the infant, postpone appropriate intervention and limit windows of opportunity that meant the difference between short- or long-term disability, even death. Plus, those attempting to stabilize the infant for travel would often be less experienced in these matters.

In 2017 in New York City, when so many readily accessible options exist to avoid such a situation, the decision not to do deliver in one of them would surprise me. In fact, the choice itself is a luxury many regions of the country don't have given the paucity of comprehensive tertiary care and academic centers in those areas.

Then, there are the VIP floors or rooms which would always be a misnomer to me for a number of reasons. First, if a physician only treated that patient and no one else, then I could appreciate the one-on-one attention and nature of care. But, the reality is if a physician’s work is centered around the care of a solitary patient for years on end, then that physician would lose continued exposure to a diverse case load, varied disease states and therapeutic interventions. Basically, they would dumb down their skills. Second, this is not the typical case at all. When it comes to VIP floors or rooms, they are traditionally located further away from nursing stations and the majority of the doctor’s other patients. Given the volume of patients doctors follow and that they can’t be in two places at the same time, they and their fellows or residents tend to hover mostly where most of their patients are hospitalized. This should be the last thing you would want if you have a serious condition. In fact, being in the mix of things would be in your best interest. Being where more eyes can see you is much more ideal. These rooms or sections are typically more remote from the hourly to daily necessities of your care team.

I could go on, but let’s not belabor the point. Somewhere along the way we have erroneously conflated the surface with the substance. It might work in fancy resorts, luxury spas and wellness retreats, but in medicine it is often losing sight of the forest for the trees. When the goal is a successful hospitalization, is your preference to be discharged healthier and in better long-term condition than you were upon admission or to feel like you went on a vacation? I get that making sick care environments less scary and more nurturing is an important part of the healing process. I strongly advocate those measures that can actually assuage suffering be implemented at every turn when possible, but with a guiding principle that the safety and well-being of the patient are always at the forefront of any and all such accommodations. Kindness should always be rampant, but you'll notice that cost is priceless.

For the best in hospitality services, stick to the Four Seasons. They do it better.