medicine: From the physician’s
point of view, the patient is a
set of test results and numerical
readouts. The patient as a person
tends to be forgotten.
I saw this later in a different
hospital in yet another ward. The
attending physician would stand
outside of the patient’s door and
listen to the review of the test
results by all the residents. They
would then discuss the results
and make further recommendations. Then, as we all left to go to
the next doorway and the next
patient, the attending physician
would knock on the open door,
stick his head in and say, “How
are you doing today, Mr. Forbes?”
That was the extent of patient
interaction.
So many numbers, we lose
sight of the person. Scientists
measure what they can measure and pronounce the rest to
be unimportant. But the most
important parts of life are qualitative. One of the physicians on
my study team told us that she
is allowed only 15 minutes to
attend to each patient in her
internal-medicine practice, but
it can take as long as 20 minutes
to fill out all the required paperwork. She has to force herself to
look at and interact with the real
patient. One hospital center estimates that nurses spend only a
third of their time in direct care
of a patient. The remaining two-thirds is spent on documentation
and medication record keeping.
One physician told of watching a nurse who busily recorded
all of the numerical indications
about the patient’s circulatory
and respiratory system, but was
too pressed for time to consider
the meaning of the numbers or
look at the patient—a five-second
glance would have revealed that
the patient was having extreme
difficulty breathing.
Modern medicine is a complex undertaking. It is highly
technical, highly specialized.
The patient has been carved up
into little kingdoms, with different specialties competing for
ownership of each piece, leading
to occasional flashes of territorial wars. Nowhere is this more
vividly presented than in the
operating room, where a vertical
sheet placed over the patient at
the level of the neck divides the
territory belonging to the anesthesiologist (the upper part of the
patient—the head) from the territory belonging to the surgeon
(the lower part of the patient—
the body). But even when
everything works as planned,
the complexity of the process—
involving multiple specialists and
disciplines—combined with the
fetish for numbers and regulations, makes attention to the
needs of the patient almost seem
like an afterthought.
Those of us who have spent
time in hospitals, in whatever
capacity, know how frustrating
it can be. All of us, friends, relatives, and even the patient, are
all pushed aside in the interests
of efficient medical care. And
even where there is a caring
physician or nurse attempting to
help, nasty though well-intended
legal restrictions block attempts
of the patient and especially
of relatives and friends to gain
access to information.
The hospital is a complex
system, with multiple complex
interactions among people,
equipment, laws, institutions,
and a confusing wealth of information. The opportunities for
improvement are numerous:
Health care is a problem awaiting
Donald A. Norman
improvement, a problem that can
keep many people occupied for
many years. A problem so complex that we need to start now,
for it is already life-threatening.
A final comment: Many hospitals recognize these issues
and are working to improve
them. Some have patient rooms
with special areas for family.
Others are trying to address the
extreme attention to displays
at the expense of the patient.
Even more reason for us to be
involved. The opportunity is
right.
ABOUT THE AUTHOR Don Norman
wears many hats, including co-founder of
the Nielsen Norman group, professor at
Northwestern University, and author, his
latest book being The Design of Future
Things. He lives at www.jnd.org.
Permission to make digital
or hard copies of all or part
of this work for personal or
classroom use is granted
without the fee, provided
that copies are not made
or distributed for profit or
commercial advantage,
and that copies bear this
notice and the full citation
on the first page. To copy
otherwise, to republish,
to post on services or to
redistribute to lists, requires
prior specific permission
and/or a fee. © ACM
1072-5220/08/0300 $5.00
March + April 2008