Know When to Use the Hospital

The hospital is expensive. It is not home or hotel. Lives are saved and lost. The hospital must be used, and it must be avoided. To manage these contradictions, the need for hospitalization for you or a member of your family must be carefully considered in each instance.

Don’t use the hospital if services can be performed elsewhere. The acute (short-term) general hospital provides acute general medicine; it does not perform other functions well.

Don’t use the hospital for rest; it is not good place to go for rest. It is busy, noisy, unfamiliar and populated with unfamiliar roommates. Its nights are punctuated with interruptions, and it has an unusual time schedule. It has many employees, a few of whom will be less thoughtful than others.

Don’t use the hospital for the “inconvenience” of having a number of tests done in a few days. It does not provide tests in the most efficient manner; indeed, most laboratories and X-ray facilities are not open on the weekend, and special procedures may require several days just to be scheduled.

Many people have urged that we establish a system of “hoptels.” “Hoptels” would provide lodging at minimal cost, allow for efficient test performance, and be appropriate for periods of rest and minimal activity. A number of experiments along these lines are underway. Until more appropriate facilities are available,
however, use the acute hospital with great reluctance.

Over a century ago, the Hungarian physician Inaz Philipp Semmelweiss noted two events: (1) Mothers giving birth at home and their infants fared better than those in the hospital, and (2) the existence of the often fatal “childbed fever” was one of the risks of the hospital. This problem, due to poor hygiene in the deliver rooms, has long since been corrected. But in our present age, new evidence suggests that for many conditions home treatment may work better than the treatment in the hospital. For example, home treatment for minor heart attacks in the elderly has been reported as possibly better than hospital treatment. It is apparent to most hospital visitors that the crisis atmosphere of the short-term acute hospital does not promote the calmest state of mind for the patient. Many therapeutic features of the home cannot be duplicated in the hospital.

The hospice movement attempts to provide humane, caring, medically sound treatment with a minimum of the technological trappings of the hospital. Hospice and home-care programs are growing rapidly and are very worthwhile.