Saturday, 27 March 2010

No flowers please

The list of things that you cannot do in hospital is getting longer.

No longer can you take flowers to cheer the poor patient up and no longer can you sit on the patient's bed. White coats went ages ago (unless it's an American doctor appearing on Panorama) and doctors are no longer allowed to wear ties. Now the young male doctors wander around the hospital in non ironed shirts and sleeves rolled up looking for all the workd like sociology lecturers.

In a brilliant piece written in the BMJ by the excellent GP columnist Iona Heath ('Do not sit on the bed'), she bemoans the, 'lack of humanity, common sense, and even humour' which these health and safety diktats encourage. Because all the bans are based upon so called infection control.

'There seems to be something strange going on, is it all in the interests of being seen to be doing something very noticeable about the worrying levels of hospital based infections, however ineffective and otherwise disruptive? Is this some sort of virtual cleanliness-an illusion of activity with no substance?

And it is an illusion because there is no hard evidence that any of these measures make any difference! What does make a difference to patients and their experience of medical care is professionalism based upon evidence and that human dimension which is immeasurable but noticeable when absent-kindness, thoughtfulness, being valued and other virtues which although 'soft', really matter.

Environments of care matter. That's partly why so many hospices are sited in lovely countryside surroundings. Beauty, whether in trees, flowers, works of art, or whatever, humanises us and gives us hope. So flowers on a hospital ward can surely only help the healing that should be taking place.

It's the loss of the 'home' environment that Iona Heath finds so sad,

'so can we not campaign for home within the hospital and encourage flowers and sitting on the bed and every other informality, unless there is robust evidence to deter us? "Do not sit on the bed" and No flowers" are injunctions that are all too similar to "Do not walk on the grass" and "No ball games"rules that mostly diminish the joys of life rather enhance them, and such rules, unless absolutely necessary, have no place in hospitals, where joy is too often in short supply".

Oh so true.

(The full article is BMJ 2010;340:c1478-it'll be free access in a few months time or take a look at your local library-lets keep them in business).

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