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Demystifying Medicine One Week at a Time

Social Hospitals?

Evolution of hospitals is a theme we’ve visited before.  A couple of years ago, these words appeared in GlassHospital:

I once had a teacher tell me, “No one should ever need to be in a hospital. Except for some cardiac conditions that require immediate care, the only people winding up in hospitals are frail elders, and those with social problems and no place to go — the mentally ill, the destitute, the homeless.” I remember feeling a bit shocked by this, but as I reflected on it, I realized he had a point. I should start with the assumption, he told me, “that almost no one really needs to be there and they’re better off at home.”

Hospitals have their origins as almshouses, places where the poor could go to seek care and sustenance. Over time, they co-evolved to become places of teaching, and in the early 20th century university-based medical schools partnered with charity hospitals in particular to train future generations of doctors.

Now a recent NY Times  op-ed  asks, “Are Hospitals Becoming Obsolete?”

Medicine has advanced so that many illnesses and procedures that used to require days in the hospital now can be treated in an office setting. It seems the more we study it, the more we realize that people do better when they convalesce in their home environments.

Another recent article discussed an additional factor contributing to the demise of hospitals: hospital at home. WHY NOT have medical care in your home, including IV therapy and even advanced procedures like dialysis if they’re available and they work?

One other line of reasoning asks about HOW we apportion hospital beds, suggesting that maybe we’ve de-commissioned too many psychiatric beds for treating people with severe mental illness. Given the horrible shooting sprees in the news recently, several commentators are asking if it’s time to re-invest in mental hospitals.

One idea here: if hospitals continue to consolidate and atrophy, perhaps we should re-purpose them to more ably handle social issues that continually confront us: nutrition, jobs, education, housing, etc., etc.–by offering services and information for people with those needs.

The question is how we structure and finance that transition.

2 Comments

  1. What a provocative quote. I’ve often had similar thoughts. Most patients on gen med services could be managed effectively with good outpatient care and someone to check in on the patient. Even many in the ICU could be care for effectively with home nursing programs. This will be a big culture to change!

  2. I agree. I care for frail, elderly and must say that, with mobile diagnostics and technology, most care needs can be met effectively in the outpatient setting. My patients in assisted living, especially those with cognitive impairment, tend to have better outcomes when treated at home with supportive services. Social connections are extremely important for the elderly. Often, poor outcomes result from the lack of support, lack of resources, or poor nutrition. It makes sense to utilize funds for supportive services in the outpatient setting when possible and to reserve hospitalization for events when it’s absolutely necessary.

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