Correspondence

Pandemonium in the Modern Hospital

N Engl J Med 1993; 329:211-212July 15, 1993

Article

To the Editor:

Dr. Grumet (Feb. 11 issue)1 reviews the problem of noise in hospitals and offers several valuable suggestions. To ameliorate the problem, I believe physicians as a group must assume their share of responsibility, particularly for the noise generated in the hospital at a time when they are rarely there: during the night. Why must scales be clanged along the halls at 5 a.m. for daily weighings? Why must daily laboratory samples be drawn at 4 a.m.? Why must Housekeeping run the vacuum at 6 a.m.? Many of the functions of the hospital are arranged for the physician's convenience (in this case, to avoid the time scheduled for morning rounds), rather than for the patients' comfort., and as most nurses and hospital administrators know, hell hath no fury like a physician inconvenienced.

Ann Jacobson, M.S., R.N.
University of Texas at Arlington School of Nursing, Arlington, TX 76019

1 References

1
Grumet GW. Pandemonium in the modern hospital. N Engl J Med 1993;328:433-437
Full Text | Web of Science | Medline

To the Editor:

To my surprise, Grumet did not mention the loudest and most ubiquitous noise source of all -- television sets. I have long found it incredible that these sets, often as many as three or four per patient room, all playing loudly, are tolerated. A private earphone should be required for all television sound.

Saul B. Gilson, M.D.
469 Ft. Washington Ave., New York, NY 10033

To the Editor:

I was recently hospitalized for six days after elective orthopedic surgery. To attenuate the usual high level of hospital noise, I used a set of soft earplugs. These allowed me to sleep peacefully at night.

The earplugs cost $1.75, and I recommend them.

Maximo Deysine, M.D.
2000 N. Village Ave., Rockville Center, NY 11570

Author/Editor Response

Dr. Grumet replies:

To the Editor: These letters focus on common sources of noise, which, regrettably, have rendered modern hospitals increasingly inhospitable. Hospital noise can be viewed as a final common pathway for a host of stresses and dysfunctions: economic pressures to admit only the sickest patients and to press for early discharge; stress among the rushed staff; diversion of time from clinical to clerical chores; technological developments that are not properly integrated into hospital operations; and inadequate communication among patients, clinical staff, and the engineering, maintenance, and purchasing departments.

At the risk of being hyperbolic, I think that a degree of brutality is creeping into the modern high-technology hospital. Dr. Francis Peabody warned of this in his classic lectures earlier in the century: “Hospitals, like other institutions founded with the highest human ideals, are apt to deteriorate into dehumanized machines.”1

If the problem is ever to be solved, a shift in focus from “noise avoidance” to “serenity creation” must occur. A serene setting is a precondition for following Peabody's advice: “Time, sympathy and understanding must be lavishly dispensed.”

Gerald W. Grumet, M.D.
Rochester General Hospital, Rochester, NY 14621

1 References