It was a dark and stormy night, and not a monitor in sight with their squiggly lines and hypnotic beeps. One day had ended and another was about to begin. The hospital remained a distant, imposing dome of light that blotted out the stars’ nightly show. Thinking of great white whales and interminable rivers of knowledge, I began pondering under the canopy of a fake plastic palm tree: How would I build a hospital from scratch?
The entrance signs would have to be great electronic screens, Vegas-style, highlighting the excellent services we provide: Babies born without pain or sorrow, hernias reduced instantly, Nascar-like speed from the ER to the cath lab.
The happy faces of our star doctors, pictured on the covers of publications with “Who’s Who” and “Best of” in the titles, would emerge on a stage, responding to their 10th curtain call, flowers showering their scrubbed hands and bootie-covered Italian loafers. Not only would we have valet parking, but we’d have an interminable army of concierges walking patients from their car to their destination, no more lost faces inside the labyrinthine compound.
Inside the well-lit rooms, fresh flowers (as long as patients weren’t neutropenic) would provide the spring aromas proven to dull the senses into a healing stupor. Nebulized valium would flow from the AC, calming anxiety-prone parents and children.
The nurses would walk around with tablet computers to instantly document vital signs and acknowledge physician orders. When finished inputting data, they’d press “enter,” sending an instant signal to the physician team, alerting them that the patient was ready to be assessed. A screen on the wall in the patient’s room would turn on, showing a picture of each member of the team and identifying each as attending or resident or student or nurse or respiratory therapist or housekeeper.
Once the physicians finish their assessment, they’d “speak” the goals of the hospitalization into their own tablets, which would likewise appear on the TV screen. When each goal is met, it gets crossed off the list. When test results are available, the doctors get an automatic notification to their handheld electronic device. If there is any question whatsoever, a button instantly connects the physician via videophone to the pathologist, radiologist or whoever other consultant.
When physicians order procedures and tests, evidence-based programs recommend the best course of action, based on the diagnosis and the patient’s history. The electronic chart is constantly updated and upon discharge, stored indefinitely in a secure cloud from which patients and their physicians can access it any time, wherever they are, to avoid duplication or loss of information. Patients’ medication and allergy history is also stored and analyzed, and every time a new medicine is ordered, a program checks it to detect cross-reactivity or potential adverse effects.
And speaking of cloud: All records nationwide are kept in a centralized Internet depository, accessible to every hospital, licensing board and insurance carrier. Physicians in this system are credentialed and licensed once, and only once, for every hospital and every state in the country.
In my perfect hospital, patients can access their records at any time, order good food that arrives on time, and get lidocaine cream applied to their skin whenever they have blood drawn. They can make appointments with their primary care doctors at any time, online, and have their prescriptions delivered to their rooms before they are discharged. And despite all the technology that surrounds them, their doctors and nurses examine them, touch them, shake their hands and, occasionally, have time to sit down to play a round of Uno.
In this hospital, the doctor’s lounge is full of merriment, and no one complains about poor Medicaid reimbursement. The food is pretty darn good as are the coffee and cookies. And the hospital administrators–CEO, COO, CFO and president–are all there. After all, they’re all doctors, too.
I’ve been thinking about the characteristics of a perfect hospital for a while. Of course, perfection is not within the realm of the possible. But recently, due to my being in an accident, I’ve had the opportunity to experience medicine as a patient.
Here’s what struck me: Despite all the meds and the X-rays, medicine is still very much a human enterprise, full of emotions and frustrations. The practice of medicine has as much to do with the smile a tech gives you to make you feel better during an uncomfortable procedure as it does the latest MRI.
Sounds good? What is your idea of the perfect hospital?