Suffering. The very word made doctors uncomfortable. Medical journals avoided it, instructing authors to say that patients “'have’ a disease or complications or side effects rather than 'suffer’ or 'suffer from’ them,” said Dr. Thomas H. Lee, the chief medical officer of Press Ganey, a company that surveys hospital patients.
But now, reducing patient suffering - the kind caused not by disease but by medical care itself - has become a medical goal. The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real issue.
The problem is, how to measure it and what to do about it.
Dr. Kenneth Sands, the chief quality officer at Harvard’s Beth Israel Deaconess Medical Center in Boston, and his colleagues decided to start by asking their patients what made them suffer.
They found several categories. Communications - for example, a doctor blurting out, “Oh, it looks like you have cancer.” Or losing a valuable, like a wedding ring. Or loss of privacy - a doctor discussing a patient’s medical condition where an adjacent patient could hear.
Another approach is to supplement efforts with patient surveys. Patient surveys, of course, have been around for decades. And since 2007, Medicare has required surveys after discharge.
Dr. Michael Bennick, the medical director for patient experience at Yale-New Haven Hospital in Connecticut, noticed a question on a Medicare survey asking, Is it quiet in your room at night?
Maybe, Bennick thought, what is really being asked is: Can you get a good night’s sleep without interruption? Is it really necessary to wake patients again and again to take blood pressure and pulse rates, to draw blood, to give medications?
He issued instructions for his unit. No more routinely awakening patients for vital signs. And plan the timing of medications; outside intensive care units, three-quarters of drugs can be given before patients go to sleep and again in the morning.
Then there were the blood tests.
“I told the resident doctors in training, 'If you are waking patients at 4 in the morning for a blood test, there obviously is a clinical need. So I want to be woken, too, so I can find out what it is.'” No one, he said, ever called him. Those middle-of-the-night blood draws vanished.
Without anything else being done about noise in the halls, the medical unit’s score on that question rose from the 16th percentile to the 47th nationally in the Medicare survey. Now the entire hospital follows that plan.
“And it did not cost a penny,” Bennick said.