Thursday, April 3, 2008

Illness and aesthetics

The radiation machine I visited in the cold state's largest hospital had a stained drop-ceiling made of weathered acoustic tiles. The various boxes that shot out the lasers or infrared beams or whatever positions the machine looked tacked up and were linked to the electrical mothership with vinyl wire mold. A faded poster of golden retriever puppies peeking out of pastel flower pots was taped to the ceiling directly above the bench where patients lie. I guess the idea was that people could distract themselves with fluffy puppies while their flesh burned.
Flash to New York City, and Memorial Sloan-Kettering's Rockefeller Outpatient Pavillion. Ah, the Pavillion. Although I have not visited Sloan's radiation machines, I feel certain that a puppy poster would be immediately ejected as damaging the carefully crafted feng shui: the bubbling fountain, the blond asian woodwork, the thick carpets, the views of midtown, the sleek one-shot coffee machines. If you are exiled to the (decidedly non-swanky) Memorial Hospital for a more serious procedure, your sensibilities are assaulted by linoleum, but you are given a kimono-like robe that feels way more spa than hospital johnny. These touches, combined with the center's carefully cultivated intellectual aura, make you feel like you're really going to do the business on the cancer, no matter how jerky your actual doctor may be.

Attention to aesthetics, argues Virginia Postrel in The Atlantic, is an increasing trend in health care that may improve patient outcomes:

Such “evidence-based design,” which draws its principles from controlled studies, is the great hope of professionals who want to upgrade the look and feel of medical centers. Much of this research follows a seminal 1984 Science article by Roger S. Ulrich, now at the Center for Health Systems and Design at Texas A&M. He looked at patients recovering from gallbladder surgery in a hospital that had some rooms overlooking a grove of trees and identical rooms facing a brick wall. The patients were matched to control for characteristics, such as age or obesity, that might influence their recovery. The results were striking. Patients with a view of the trees had shorter hospital stays (7.96 days versus 8.70 days) and required significantly less high-powered, expensive pain medication.
And a bit more on the problem with the way most hospitals look and feel, even many of the fancy remodeled ones (who build glowing atriums, but leave the rooms where care happens shoddy):

If you work somewhere every day, after a while you don’t notice eight-year-old snapshots and peacock feathers too tall for the space. The ad hoc, staff-oriented decorating that fills an aesthetic vacuum can be worse than bare walls. Lee Mequet, a Southern California real-estate agent, recalls a chemotherapy visit with her husband, who was so ravaged by lung cancer that his skull and bones showed under his skin. The treatment room, she says, was “decorated for Halloween, with pumpkins and paper skeletons, and the tragicomic horribleness of the images made me want to rip the fucking things from the wall.”

I have my problems with the article, but it's worth reading. I cannot endorse enough the idea of reorienting hospitals toward individual rooms, especially those for serious illnesses. I don't understand the ramifications in terms of cost and care, but I know there are huge upsides in this for patients. Curtains don't always cut it.

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