Would you appreciate being cheerfully greeted when you step into your local clinic or hospital? How do you feel about signs announcing, “It’s a great day,” replete with stickers and hearts, on an inpatient ward? And what about a passageway between two hospital buildings labeled the “Compassion Tunnel”?
The Affordable Care Act is in trouble politically, but one of its signature features has been encouraging medical centers to improve patient satisfaction through these sorts of strategies. Institutions that achieve high rates are entitled to reimbursements through Medicare.
But Georgia State University sociologist Wendy Simonds, author of the new book Hospital Land USA, is no fan of uplifting messages, many of which she believes are “profoundly stupid.” As a physician who has experienced efforts to make patients and families happier, I, too, have often rolled my eyes. But Simonds is a bit too tough on us. Indeed, some of what she criticizes is a direct response to earlier criticisms of the medical profession. (Full disclosure: I wrote a blurb for Simonds’ book.)
Simonds’ biggest gripe is with what she calls “medicalization.” She believes that medicine—and the quest for health—has come to “reorganize, redefine and restructure” everyday life. Like other critics, Simonds believes that Americans spend far too much time getting medical tests, which are not only expensive but often reveal “diseases”—such as pre-diabetes or ductal carcinoma in situ—that may not even be real. Her title Hospital Land draws on her conclusion that medical institutions are “surreal” and “emotionally numbing,” akin to a “bad carnival.”
One of the most moving aspects of Hospital Land is Simonds’ chronicling of the illness and death or her friend and fellow sociologist, Chet Meeks, from a rare cancer. Simonds accompanied Meeks to his doctor visits and chemotherapy sessions and, together, they criticized and laughed at the hospital apparatus designed to try to save Meeks’ life.
That Meeks had a tough time is indisputable. He underwent multiple rounds of toxic chemotherapy, even after the point that he was clearly dying. His insights into his disease and treatment are impressive. In one instance, he notes that his oncologist has put him “into a medical category” and “isn’t doing a lot of active thinking about my disease.” At another time, he has to wait 72 hours before learning the results of his latest CT scan—which would reveal whether he was going to live or die. “These doctors are truly sadists,” he wrote. Enormous waiting times were an ongoing problem. The cancer center, Meeks joked, should change its slogan to “We make your terminal illness seem interminable.”
There is a long history of sociologists studying hospitals, and even though Simonds is visiting informally as a friend (and as a family member to her father and other ill relatives), she has a keen eye for things that those of us who work in these institutions cannot see. Like many other patients getting chemotherapy, Meeks often got cold. But his hospital had a strict policy of giving only one blanket to each patient. Simonds perceptively chronicles a Christmas party on the oncology floor where Meeks, now terminal, was severely ill. During the event, one of the nurses rushed up to tell Simonds that she had won the tree-decorating competition. I have seen similarly offensive events occur. Another time, after Meeks was given two extra parking tokens because his chemotherapy was delayed, Simonds asks a pretty good question: “Why should cancer patients have to pay for parking at all?”
But it is the constant upbeat messages to patients that most drive Simonds crazy. She becomes a minor criminal, stealing signs and taking illegal photographs within the institutions, many of which appear in the book. One of the most infantilizing, she believes, was a poster—decorated with pink carnations and butterflies—with an acrostic spelling out the word “mammogram.”
Simonds is well-aware that keeping patients happy is a tough task. But I found myself getting defensive at times. For example, she is horrified when a doctor reaches over and touches Meeks’ leg during a conversation. Yet the virtues of showing physical warmth to patients is something that I teach—and a response to years of criticisms that physicians were too cold and distant. Simonds also aims her pen at the endless, repetitive protocols that Meeks and her hospitalized family members endured: “Sit here; go there; fill this out; wear this bracelet; have your blood taken; get weighed and measured here.” These rituals, however, are ways in which hospitals try to lower rates of medical errors, a topic for which they have been excoriated over the years.
One of the biggest problems with trying to make patients happy, of course, is that patients are all different. Presumably some of the messages that repel Simonds are welcomed by others. So whether or not the ACA survives, we are likely to see similar efforts continued. For my part, I’d like to see more liberal blanket policies. And tone down those holiday parties.
Originally published on Forbes.com on March 14, 2017.