86 Becoming a Patient
Yet, far more commonly, these physician-patients encountered prob-
lems in their care.
Problems with Hospitalizations and Bureaucracies
These ill physicians now became more aware of difficulties concerning the
larger social organ ization of health care. Their complaints ranged from the
physical plant to the bureaucracy of hospitals. These institutions’ vast
size and complexity caused problems beyond inconvenience and aes-
thetics alone. At the extreme, some saw these shortcomings as symp-
tomatic of a larger crisis: the system as a whole was ‘‘falling apart.’’ They
saw these deficiencies, too, as reflecting institutional bias against patients,
and as communicating messages that patients ‘‘do not matter’’ much to
the institutions designed to benefit them most. These organizational fail-
ings incurred high psychic costs, reinforcing humiliation and degradation
due to disease.
The extent of problems with the physical plant astonished these phy-
sicians. Harry, the war refugee with heart disease, described the situation
thus:
I was put in a room with a broken window—a big crack, and a
missing piece. It was a cold night, but they said they didn’t have any
other place to put me. I thought: hang a sheet or a towel over it!
I had a bad night. Silly meals at silly times . . . but that’s the system.
Surprisingly, at times these problems constituted the most dissatis-
fying and disappointing aspects of medical treatment. In the current era
of fiscal restraint, institutions devalued not only amenities, but even basic
necessities, as priorities. Herb, the neonatologist with MI, said:
My memories now are of the physical environment—the room was
ugly, spartan, inhospitable. A roach was on the wall. The cathe-
terization lab was crowded and cold. This medical center is erecting
a big new cancer research building that is probably not going to
treat a single patient. Less money proportionally goes into patient
treatment.
To Herb, medical centers increasingly focus not on patients, but on
fundable research.
Similarly, Nancy, the endocrinologist with breast cancer, felt that
‘‘hospitals are filthy, dirty, and the food sucks: awful, inedible.’’ Institu-