Human Connection and the Downside to Private Hospital Rooms

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What the fanciest hospital suites forget

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In a March 4 Atlantic article, Lindsay Abrams asks how much should be spent beautifying hospitals. She reviews evidence that making the hospital experience more appealing and comfortable can actually improve health outcomes. For example, natural lighting can ease pain and elevate mood. But the issue of how hospitals are designed goes far beyond creature comforts. Most notably, the move from shared to private hospital rooms has major implications for what the hospital experience means to patients. Given the choice, who wouldn't opt for a private room? But on closer analysis, the choice for many turns out not to be quite so clear.

A friend has given birth in two very different places. One birth experience took place in an old-world hospital where she stayed on a ward, a large room housing up to a dozen patients. This hospital boasted a relatively thin staff, a skimpy food service, and relatively few amenities. The other birth took place in a state-of-the-art U.S. women's hospital, replete with private rooms and guest services rivaling a five-star hotel. Had some problem arisen with her labor and delivery, there is little doubt that the U.S. hospital would have been able to provide more sophisticated equipment and personnel to deal with it. However, both births proceeded uneventfully. So which birth experience did she prefer?

In our haste to control infections, we isolate them. In our zeal to preserve confidentiality, we prevent patients from getting to know each other.

Many of my colleagues in medicine naturally assume that she would choose the women's hospital back in the States. It offers second-to-none medical technology, world-class health professionals, and out-of-this world creature comforts that leave many patients feeling more thoroughly pampered than at any other time in their lives. Yet when asked where she would prefer to have her next baby, she replies unhesitatingly that she would opt for the old world hospital. Why? There she felt less alone. She could talk and bond with other patients. She felt like part of a community of mothers. "It just felt so good being with all those other moms," she says with a wistful smile.

Over the past century, the architecture of the American hospital has undergone a dramatic transformation. At one time, patients were generally housed in open wards, where each was aware of what was happening with the others and conversations between patients were common. Then wards were replaced with smaller rooms, generally occupied by two patients. In both situations, privacy could be difficult to sustain, in part because doctors and nurses seeking to preserve privacy could often do little more than pull a curtain. Today, the ward is ancient history and the double room is fast going the way of the dinosaurs. Hospitals being built today feature private rooms.

Nobody wants to lose sleep due to a roommate's television viewing or snoring. Yet sometimes our zeal for privacy gets the better of us, short-circuiting opportunities for compassion and community. It is hard to be ill and in pain, especially seriously so, but such burdens are often magnified when we shoulder them alone. When the poet John Donne famously wrote that "No man is an island," he was not making a purely descriptive statement. He was also highlighting our powerful need for companionship -- someone to talk to, a shoulder to cry on, and a human being to share our experiences with. Typically, the events taking place in hospitals represent experiences when we need one another most.

In some respects, hospitals increasingly resemble high-security prisons, where we go out of our way to preclude patients from interacting. In our haste to control infections, we isolate them. In our zeal to preserve confidentiality, we prevent patients from getting to know each other. They sometimes begin to feel as though they are being kept like specimens in hermetically sealed containers. To spend day after day in a single room, particularly when visits from family and friends are few and far between, can resemble a form of solitary confinement. Yet patients are not only threats to one another. They can also serve as mutual bridges to companionship and healing.

RTR3ADHSinset2.jpg A 300-bed maternity ward in Manila [Erik De Castro/Reuters]

Even though health professionals such as nurses and doctors frequently interact with patients, there is a limit to what we can offer. For one thing, the people in white coats and surgical scrubs are often too busy to allow the development of a deep human connection. Moreover, many of us have never been seriously ill or hospitalized ourselves. By contrast, other patients often know what the world looks like from the vantage point of a hospital bed. They have been through similar travails, and certain kinds of conversations may be possible only with another sick person. While some patients may do well in isolation, others long for more human contact.

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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