Patients still endure indignities

PATIENTS being obliged to wear gowns that barely cover the backside and genital area is just one example of several unnecessarily dehumanising aspects of the hospital stay in need of reform, experts say.

Associate Professor Eleanor Milligan, academic lead in medical ethics and professional practice at the Griffith University School of Medicine, suggested that many of the indignities suffered by hospital patients went unquestioned because “that’s the way we’ve always done things”.

Other examples were accommodating male and female patients side-by-side in mixed wards, ending visiting hours at arbitrary set times, and using exclusive language and acronyms that prevented patient understanding of their care, she said.

Professor Milligan was commenting after publication of a research letter in JAMA Internal Medicine which found that most patients admitted to acute medical units in Canada did not wear lower-body attire, even though there was no medical reason for them to be exposed in such a way. (1)

The authors wrote that their study demonstrated that most of the patients admitted to acute medical units did not wear lower-body attire.

“This situation occurs despite more than half of them being deemed eligible to do so, despite most of those patients surveyed being interested in doing so, and despite encouragement to wear home clothing …”, they wrote.

The small study included 127 patients admitted on the same calendar day to five hospitals. Attending physicians were asked whether they would agree to allow patient to wear pants if they requested it.

Reasons given for not agreeing included that the patient had a medical problem, wound, line, or catheter precluding their wearing lower-body garments or that the patient was too immobile, too incontinent, too confused, or too ill to wear such attire, given the available nursing resources.

Only 11% of patients in the study were wearing lower-body garments, even though 56% were deemed eligible to do so.

The authors concluded that eligible patients should be encouraged to wear lower-body garments when full home attire was not feasible. They recommended that “functional fashions” be developed to allow those who could not wear or did not have access to their home attire “something more dignified than a one-size-fits-all-open-backed patient gown”.

“Although patient attire can be graduated from an open-backed gown, at one end of the spectrum, to full home dress at the other, we suggest that the absence of lower-body attire that leave the backside and genital areas unnecessarily exposed has an important effect on dignity”, they wrote.

Professor Milligan said another alienating aspect of the hospital stay was regimented timetabling of everything from meals to showering times, which meant that “even something as simple as having a cup of tea is beyond your control”.

“To some degree the logistics of running a hospital does require some structure but I think we could definitely be more creative and responsive to patients’ human needs”, she said.

Dr Michael Kennedy, a consultant cardiologist in Manly, has been a vocal critic of the “appalling practice” of placing male and female patients in the same room in general wards, writing a letter about the issue to the MJA. (2)

The practice was singled out in the 2008 final report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals as something which should “cease forthwith”. (3)

However, Dr Kennedy said that 6 years later patients were still suffering the same indignity.

“An elderly female patient of mine was horrified at having to sleep in a bed next to a male patient in a major metropolitan hospital this year, but was not prepared to make a fuss because of fear it would go on her notes”, Dr Kennedy said.

“This is totally unacceptable. Even in [developing countries] they don’t mix men and women on wards like this. There’s no reason to do it ... It causes a degrading attitude towards people.”

A NSW Ministry of Health spokesperson told MJA InSight it had issued a policy directive in January 2010 to ensure that male and female patients staying overnight in NSW public hospitals did not have to sleep in the same room or ward bay, use mixed bathroom facilities or pass through opposite sex areas to reach their own facilities, except when considered clinically appropriate.

However, the spokesperson said it was the responsibility of local health districts to ensure compliance with the policy.

“There are no exemptions from the need to ensure that the privacy and dignity of all NSW Health patients is respected at all times during their health care experience”, the spokesperson said.

However, there were some “exceptional circumstances” such as when patients needed very specialised or urgent care “where providing rapid safe effective care may take priority over ensuring same gender rooms or ward bays”.

1. JAMA Intern Med 2014; Online 22 September
2. MJA 2009; 190: 516
3. Final Report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals 2008

(Photo: Cristina Pedrazzini / Science Photo Library)