Blog | 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.