American College of Physicians: Internal Medicine — Doctors for Adults ®

Monday, December 23, 2013

Why do we neglect food and sleep in the hospital?

Being a doctor, the main part of our job description is to listen to complaints. Patients come to us with their problems, and we utilize our skills to get to a diagnosis and cure. It’s what we learned in medical school. Most of these complaints, as we may expect, fall under the category of symptomatic ailments. Pains, discomfort, disabling symptoms—hearing about them and fixing them is what we do.

The reality of frontline medical practice, however, is that not all the problems patients tell us about fall under the category of symptomatic problems. In my job as a hospital medicine physician, many of the complaints I hear have little to do with the patient’s actual illness, and more to do with how they are treated when they get admitted to hospital! This may sound unbelievable to anyone who hasn’t experienced the typical hospital, but it’s very true. In fact, I’m amazed by the fact that patients, often afflicted with some of the most terrible physical illnesses (unfortunately causing a lot of suffering) will feel the need to focus on these other aspects of their hospital stay.

It’s a bad reflection on health care. I’m sure my experiences are not unique, but I’d say that the biggest complaints I hear are ironically related to two of the most basic things we need for our survival: sleep and food. To use a cliché: if I had a dollar for every time I’ve heard these two complaints.

Inadequate sleep will often be the first thing that a patient will remark about when I enter their room in the morning and ask them how they are. It will go something like this; “I hardly slept a wink because there was too much noise!” This could be for a number of reasons, but the most common will be; noisy neighboring patients, noisy staff, and the fact that they kept on being disturbed to have their vital signs measured (which may not always be needed in a stable patient).

With their food experience, I typically hear criticisms about the lack of food options and the blandness or tastelessness of the food. While I’m not suggesting that hospitals be gourmet restaurants, surely we should understand that at a time when someone is already sick, few things could be more important than good nutrition.

Let’s address sleep and food, then, in more detail.

Scientifically speaking, there’s much debate among scientists about why we actually sleep. We do know that a large amount of the body’s natural regeneration and healing processes occur during this time. Logic would therefore follow that getting a great rest is especially important when anyone is sick.

How can we go about giving our patients a better night’s sleep? The answer should be simple enough: we create a quieter and more restful hospital environment. I’ve heard of some new initiatives, such as using computers to record sound, but surely some basic common sense wouldn’t go amiss. Do we really need computers to record sound? We should all know what’s loud and what’s not! A little noise has to be expected, and certain situations cannot be helped—such as a sick patient requiring lots of attention or a new patient being rolled into a room late at night.

It isn’t possible to eliminate noise completely. But the current problem is that, bar a few scattered exceptions, we don’t even try significantly to improve the situation. Health care staff are also partly to blame. Many patients have complained to me about staff holding loud personal conversations at night, which really shouldn’t be happening. The last time you took a red-eye flight you may have noticed how quiet the cabin crew were when the lights went out. In hospitals, we have to be more careful, because noise tends to travel a long way down those spacious echoing hospital corridors. All health care staff, including doctors, should keep this in mind at night. We could also focus more on the design of hospital floors, with certain areas reserved for the less acute recovering patients, to make it easier for them to sleep.

Hospital food is the second major area of well-being that we tend to let slip. Let’s put a lot more thought into the meal choices, and while making them good for our health, also provide a variety of tasty options. At every opportunity, load the plate (diet permitting) with healthy vegetables, fruits and other nutrient-rich foods. There’s a huge opportunity here too, not just for healing, but for education. We could use healthier, tasty food choices as a teachable moment, also providing some brief educational materials to our patients on a card or pamphlet.

Or, how about food services staff getting involved? Perhaps it wouldn’t be a bad idea to collaborate more with these hard working folks, who do their good work under our noses every day, and barely get noticed. Many of them would greatly appreciate the feeling that they are playing a part in the patient’s care and recovery.

Of course not every hospital provides bad food, and everyone has their own individual tastes and preferences, but we don’t have to accept the universal joke about “hospital food being terrible.” I hardly ever hear anyone tell me that they liked their meal. The patients may be sick and not enjoying their food as much, but that’s all the more reason to make it better. Solving this problem will require a multidisciplinary approach. We need to form workgroups from a number of hospital departments; medical, nursing, food services, dietary, and administration. This would also be a great quality improvement initiative, and at teaching hospitals would be the ideal type of project for interns and residents to get involved in.

By focusing on food and sleep, hospitals will be exhibiting a much-needed “back to basics” approach. The problem with any complex organization is that we often lose focus of the little touches that really matter. We shouldn’t allow this to happen, because in reality it’s usually these so-called little things that are noticed the most. There’s also the matter of HCAHPS scores, the Hospital Consumer Assessment of Healthcare Providers and Systems, which are now being intrinsically tied to reimbursements. The drive to improve patient satisfaction by striving for quality medical care and having great communication with doctors and nurses is a wonderful goal, but how about also giving the patient appetizing food and a good night’s sleep?

The hospitals of the future should be healing institutes, which promote recuperation by also focusing on many of these other crucial aspects of health and well-being. Rest and relaxation (anyone for some soothing music?—studies have shown how this can benefit ICU patients). They will also serve up nutritious and delicious food to their sick patients.

There’s a good lesson for all of us here too. In our age of state of the art hospitals, revolutionary new technology, and miraculous new medicine—there’s one undeniable fact. Humans will still be humans. We will always need our food and sleep.Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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