Chapter 51 The experience of hospitals

More and more people visit hospital at some point in their lives (Fig. 1) but hospitals are changing from places where one goes to die to places for acute conditions and specialist care. In the past there was a greater risk of dying in hospital, so it is not surprising that for many older people hospitals are places with negative associations. Modern hospitals may appear quite different, and offer cafés and shops to serve patients, visitors and staff.

Fig. 1 Hospital outpatient visits in Scotland 1990–2000

(from Office for National Statistics, 2000b)

Nearly all first births in the UK take place in maternity hospitals. This means that about 90% of women will experience a stay in hospital, and nearly everyone will have known a relative who has stayed in hospital. Elderly people are more likely to be admitted than younger people, although efforts are made to care for them in the community (see pp. 16–17 and pp. 156–157).

The experience of being a patient

When someone is admitted to hospital, even if only for a day or overnight stay, then they enter the role of a hospital patient. Goffman (1968a) suggested that the person becomes invisible, leaving only the illness visible. Doctors and nurses may talk about patients as if they were not present (Fig. 2). Being a patient also carries certain expectations. They must move parts of their body on command, respond to probes in parts of their anatomy with declarations of pain and answer questions about the name of the current Prime Minister.

Fig. 2 The person may become invisible on admission, and be identified only by the condition.

Patients may also resent their loss of freedom. They may wear night clothes throughout the day, and be dependent on others for basic functions. They may have little or no choice about the timing of meals or visits. Lights will go off at a set time and they may be forbidden to get out of bed, or not allowed to stay in bed. They lose their familiar social roles at work and at home.

Not all patients are perceived in the same way by medical and nursing staff. The patients who obey instructions, make no demands, do not ask questions and never complain may be labelled as ‘good patients’. ‘Good patients’ are appreciated by staff and may be easier to manage, but their health may actually suffer. Taylor (1986) points out that ‘good patients’ may not ask for information and may not report important clinical symptoms. The hospital environment may actually encourage patients to become helpless. The more that patients feel they cannot control the environment around them, the more they will feel helpless.

The patients who ask questions, demand attention and complain may be labelled as ‘bad patients’. ‘Bad patients’ who are not seriously ill may be perceived as difficult patients. However, they may be angry and demanding because they are anxious. These patients may assert their sense of control and independence by breaking the rules. Being a ‘bad patient’ could be good for health. If more questions are asked, more information will be given, and if symptoms are reported, they may help the diagnosis and treatment.

Control

The feeling of losing control is unpleasant. Taylor (1986) divides control into behaviour control, cognitive control, decision control and information control.

Behaviour control involves being able to influence procedures in some way. Allowing a patient to control the progress of a painful procedure such as an enema can reduce anxiety. If anxiety before an unpleasant event can be reduced it will be more tolerable.

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