In the Hospital, a Degrading Shift from Person to Patient

Mary Duffy was lying in bed half-asleep on the morning after her breast cancer surgery in February when a group of white-coated strangers filed into her hospital room.

Entering the medical system, whether a hospital, a nursing home or a clinic, is often degrading. At the hospital where Ms. Duffy was a patient and at many others the small courtesies that help lubricate and dignify civil society are neglected precisely when they are needed most, when people are feeling acutely cut off from others and betrayed by their own bodies.

Yet the deeper psychological transformation from citizen to patient that occurs in almost any medical setting can be more jarring, and anthropologists say it begins immediately at admission.

Even when doctors, nurses and nurses’ aides take care to treat people more graciously, as they often do, the patient may have a vastly different perception of the service.

People who have had chronic pain know this dynamic intimately. For a nurse responding to a request for pain medication, appearing five minutes later may seem a prompt response. For the patient, the same minutes may seem a purgatory, or even a kind of punishment, into which a desperate mind can project its worst fears.

So it is that hostility grows between conscientious, reasonable nurses or doctors and conscientious, reasonable patients. And once the feeling is there, some patients begin to fear the very people who are caring for them, they say, and are very reluctant to call a patient representative or file a formal complaint.

Grim, drab, soulless, disorienting – these are the kinds of words patients often use to describe medical buildings, and the words evoke both the buildings’ designs and their effect on guests, experts say.

For the complete article go to http://www.nytimes.com/2005/08/16/health/16dignity.html.