Keeping away the doctor

Steve is lying almost flat in the hospital room, an IV attached to his arm.  I am happy to see he is more comfortable, last night’s crisis has passed.  He smiles as I enter and walk to his side.  I touch his hand as I sit down on the pressed clean blanket.  And then… a shrill loud wail breaks the silence… lights flash above his bed… fear grips his face … the nurses come running … it is …dare I say it … the dreaded bed alarm.

Years ago we prevented hospitalized patients from falling by putting everyone together in one big room, the ward.  A nurse supervised from a desk in the middle, so if a frail someone tried to get out of bed, she was there to protect.  Then we moved to semi-private rooms and each bed could not be directly watched.  Therefore, we locked each patient in with four bed rails.  The problem is that it did not work. Confused patients climbed through or over the rails and were more likely to be injured than if they had simply oozed to the floor.  In addition, this was defined by the courts as restraint and of questionable legality.  Therefore, now we only put up two bed rails.   Nevertheless, patients still occasionally fall and may be injured.

I have never liked bed rails.  What bothers me is that they keep family members from touching. They send the message that on the other side of the rails is an alien sick person, and the rest of us should keep our distance.  Doctors often examine patients without lowering the bed rails, which adds an element of cold distance. Even comatose patients with families keeping end-of-life vigils are usually locked in.  How many times have I seen families visiting patients who have died, with the deceased still caged behind metal slats?

Therefore, the invention of the bed alarm.  A bed alarm monitors the weight of the person in the bed.  If that weight shifts suddenly, up or down, a bell or buzzer sounds. The bed alarm is an improvement in safety, but it has limits.  If a well-meaning physician, like say me, tries to touch or examine a patient without disarming the system, they are “caught.” Some patients are too anxious to roll over in bed, lest they trigger the alert.  Families are careful to keep their distance.  Moreover, I, in my paranoia, fear an attempt to add distance between my patients and me.

Many well-intentioned hospital systems have the risk of compromising nurturing relationships.  They can create distance between the patient and caregivers.  Family support may be threatened.

We use isolation with the goal of preventing the spread of infection.   While making rounds this morning I had to wash, gown, glove and mask because the patient was reported to have had a communicable disease, four months earlier.  I understand the benefit; I worry about that word, “isolation.”

Visiting hours.  I admit that I ignore them when one of my family is sick.   I need to be with someone I love when they are ill.  In addition, we all require support to deal with the hospital and all its intrusive complexity.  I understand hospital staff needs time to organize, especially at change of shift, but worry about the gaps that result.

We have moved from centralized many person hospital wards with their chaos, infection risk and noise, to private rooms.  However, the result is long silent hospital corridors with rows of single rooms.  No one would propose going back, but there in lies the threat of medical exile.

No pets.  Animal lovers will note that the obsessive optimism of a dog can heal many deep personal wounds.    I suppose we must continue to keep out infected rodents and high-risk species such as birds.  However, there is a lot of love to be shared by our furry (and not) friends.

Finally, there is that most modern of threats to human interaction, electronic medical records (EMR).  We all have seen a couple alone together in fine restaurant, as they are busy texting.  In the hospital setting, EMRs have the ability to suck physicians and nurses into electronic quicksand, to the detriment of human contact.

All these are positive systemic innovations, which solve vital problems.  They prevent harm, control infection, augment organization and improve quality.  Laudable goals.  My concern is that they can interfere with critical healing relationships.   As we continue to refine and perfect the practice of institutional medicine, let us be careful it does not institutionalize each of us.




  • When the day came when my mother had to relocate to a long-term care facility I never imagined she would be in a place as good as the one I found. Most of the staff had years of service, even decades, and everyone looked forward to meals because the kitchen served really good food. My first clue, however, was before Mom got there when I went to do the paperwork. There was a friendly, playful boxer dog who obviously had the run of the whole building, elevators and all. Everyone knew and liked him (or her) and she was a bubbling bundle of affection and energy. The moment I saw the place had a dog I felt better about where Mom would be living.
  • During a hospitalisation for CHF and AFib, I was determined to be a fall risk and the bed alarm was turned on. Unfortunately, no one told me and when I got up around 2 a.m. to answer a call of nature, the room suddenly sounded like a bank being held up by John Dillinger. While I was a fall risk, I was not witless and a simple order not to get out of bed without calling for an RN, LPN or CNA would have worked as well as the damned alarm,.
    • James Salwitz, MD
      I must be a slow learner, because although I have been now well "in-serviced" on how to turn the darn things off, I still get caught at least once a week while making hospital rounds by one of those alarms. I am certain my obituary will say, "Dr. Salwitz dropped dead when startled by a siren which sounded when he touched his patient." Still, it is a great way to get a nurse in the room quickly if I need help with a boost. jcs
  • IBS
    Dr. S....You certainly make me laugh! Most everyone I know love their animals. Sometimes when people get to a certain age, adult children have their own children and life must go on, thus the grandparents are not forgotten in a nursing home, but they are. I always used to adopt older dogs that needed love, medicine and people that care about them. So, I brought in one my dogs because no one had to bend down to pet her. She was a large English Mastiff, and I put a bib on her. (I knew she wasn't sick, had her shots, and loved people) The patients eyes all lit up, and they were asking me a million questions. They are then using their minds. It would even be better if the patients can see their own canines. Patients worry about their pets, and the pets are extremely sad because they don't understand where their owner is. For me, it would definitely cheer their owners up more than a shot; lying in a hard hospital bed and depressed. It would work for the young oncology patients and the elders. Their loved ones can then take the dog home when it's time. They have people do this all the time for people that don't have allergies. If a patient is really ill, move the patient to a separate area. They also have special dogs that have to pass through tests helping Dr. S with a boost.
    • James Salwitz, MD
      The relationship of people to pets and its place in healing is truely remarkable. I know for example that if I have a tough day that our dog, a puggle, is always waiting at home to remind me that she cares much more for my wife than me, and will sit tucked next to my wife on the couch and give me a look that I believe best translates as, "your kidding, right?" jcs
  • IBS
    Whomever feeds the dog, takes them out, pets, kisses on them, is their first priority. Give puggle a small piece of american cheese or some toast everynight when you come home. You may also have a smell of medicine on your clothing that you're not aware of, but dogs do know. If a dog is very ill, the other dogs will go near it but walk away. To lil puddles...Give kisses to Daddy, and you'll get a GOOD snack. Your Daddy is so nice, funny, smart and tries to help people. (A better snack than what your wife gives!)
    • James Salwitz, MD
      Steve Martin used to talk about how he picked up women. "I put a tuna fish sandwich under each arm. Maybe one or two behind the ears. I don't smell like any other guy." That may be my next dog-friendly step. Thanks for advice, I need it, jcs
  • IBS
    Puggles may begin to love you more than you want....Ummm, your wife might meet you in her flannel pj's, bathrobe and lock the bedroom door. A piece of chicken for Puggles and a glass of wine and a rose for your wife would do it

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