As the Parisians say, “in the cafe or on the way to the cafe.” Life is not “either in the hospital, or on the way to the hospital”. Even doctors have moments when they change out of their white coats and into hospital gowns. As hospital delivery gradually replaced home delivery, everyone was born in hospital, and the swelling desire to survive and the development of “survival” technology made most people die in hospital. People are more aware of health care, even if there is no disease, they have to go to the hospital regularly for physical examination. Anyway, I don’t want to go to the hospital, but I have to.
Some people say that the hospital is the cradle of philosophers. It is easy to say, but the reality is cruel. The hospital is the entrance to Death Valley. Death rates in hospitals are often higher than in families and communities; Even if they can manage to land on their feet, the hospital is also a cliff of suffering, a gallows of body and mind. Under the oppression of suffering and death, under the torture of capricious fate, the trembling of human nature is displayed, showing the essence of life and soul.
In the final analysis, the sign of hospital is “transition”, once in the hospital, it indicates that life may transition, not only the body transfer, from family to hospital, from hospital to funeral home, or psychological/social/spiritual role transfer, but also the fate of the transfer, from healthy people to patients. Of course, there are babies who move from the warmth of the womb to the warm and cold of the human world, who are either saved or not saved in the ICU. In the long era of low productivity and lack of materials, disease was the inevitable outcome of hunger and cold. Curing disease was to relieve the poor, and hospitals were to improve food and clothing. Today, disease is a state of emergency with scientific causes and technological intervention. The classification, division and order of modern hospitals reflect individual identity, status, wealth and morality. Some people are poor and have no medical treatment because of poor circumstances, and some people are treated seriously for minor ailments. Some serious illness but not in hospital, and some minor illness and must be hospitalized; Some people feel grateful for medical care and repay their kindness, while some people feel resentful and even bite the hand that feeds them, hurting the hospital. This creates the complexity of the doctor-patient relationship. Therefore, it can be said that hospital culture is the philosophical culture of life and death, suffering, rescue and treatment. However, the philosophy of hospital should not be ungrounded, but the real dilemma and spiritual concern of “running a hospital” and “living in a hospital” become the key to solve many problems of the people running a hospital and the inpatients.
Hospital metaphor
There are many hospital metaphors, but one of the most famous (from Discipline and Punishment) is that “the hospital is the prison,” an argument that is being debated only because of the fame of Michel Foucault and the critical tradition of French philosophy. In fact, Foucault only discerns this metaphor from the history of the lunatic asylum and the pattern of psychiatric regulation. In his view, guardianization is surveillance, and supervision is monitoring, there is no difference. A case in point is god s hospital in Paris (Hotal – Dieu) was destroyed by fire, and rebuilt chose the panoramic architectural form, this design paradigm from the design of the French prisons, the main body of a circular building, can radial space as a small room, the center is a tower, can have a bird’s eye view of the whole building on the tower, monitoring of action, People in each room cannot see the monitors because of backlight, creating a one-way glass effect. The circular architecture was invented by English philosopher Jeremy Bentham and his brother Samuel and was inspired by architectural plans for a military school in Paris. Therefore, the panoramic building was originally intended to facilitate the management of students, not to monitor prisoners. However, modern hospital buildings generally adopt the Pavillion Plan, which gives priority to ward ventilation and ventilation. After being strongly advocated by Nightingale, St. Thomas’s Hospital in England and Johns Hopkins Hospital in the United States have adopted this architectural style. In modern hospital management, the control mode of madhouse and leprosy hospital has long been abandoned. With the advocacy of hospital humanities, Nightingale opened up professional service centered on care, and the facility transformation movement centered on comfort, striving to let patients enjoy a good life and treatment environment. Now humanized, artistic hospital situation everywhere, and gradually become a fashion.
The second metaphor, The meal of strange-intimacy, comes from Charles E.Rosenberg’s hospital history, The Care of Strangers: When people are healthy, they live in a comfortable and quiet family atmosphere and enjoy the care and warmth of their loved ones. Once the disease, body and psychological damage, but to temporarily leave the family around, thrown into the “strange” environment, to “strangers” talk, and accept the “stranger” rescue and care. Medicine is “care from strangers” as well as communication with strangers. For the purpose of medical treatment and health care, patients have to tell their personal secrets to doctors, let doctors see and touch their private parts, and even take huge risks to meet the intervention of drugs and surgery, but they know little about doctors’ virtues and skills. If patients want to enjoy professional care, they have to accept strange environment and strangers, while acquaintances and family ties are always accompanied by non-professional care. Ethicist David Rothman’s book Strangers at theBedside further reveals the nature of the doctor-patient relationship, which is a game between Strangers, Strangers to each other. In the book Foundations of Bioethics, H.Tristram Engelhardt defined the core of this “strange-intimate relationship” as “community of interests and moral strangers”, and the progression of doctor-patient relationship follows a certain order. From a community of interests (game, fight) to a moral community, an emotional community, and finally to a value/destiny community.
Paradoxes in hospitals
The hospital is full of paradoxes, outsiders do not understand, sometimes people in the circle are also “confused”, what are the paradoxes?
Bureaucratic paradox: there are such professional values in hospitals as “golden academician, silver director, and bronze director”. When it comes to who listens to medical decisions, the authority of academician and director is often greater than that of president. In many decisions made in the hospital, administrative power is ceded to technical authority, which seems to violate the principle of bureaucracy (flexible hierarchy) and challenge the rigid and rigid official standard. In the administrative series, the will of the chief is supreme and the level of management is the highest, while in the medical decision-making, the administrative power is subject to the disciplinary experts, because the arbitration power and originality of the experts are the core competitiveness of the hospital. The core of hospital discipline construction is to get rid of artificial shackles and emancipate personality. This “counter-attack culture” is exactly the source of hospital vitality.
Host-guest paradox: In medical activities, the medical staff is undoubtedly the service subject and the hospital is also the main field (compared with family medicine), but the principle of medical decision-making is that the appeal of the weak is given priority and the interests of the patients come first. At this point, expert authorities must lower their heads, listen to the voices of strange patients, and give more humane care and humanistic care to patients without power or money. Popularization, is should respect science, adhere to the standardization in decision making, and to take orders from the patient’s preferences, emotion, will, timely and flexible, guide the medical staff in medical services have resilient and relaxation, try to calm and indifferent, calm and not indifference, professional sacred and have a temperature, realize the unity of the healer affinity and authority.
Paradox of right and wrong: hospital operation is like “dancing in shackles”, and it is necessary to seek high-quality services and efficient management in the uncertain medical science and the uncertain journey of life and death. A hundred years ago, the medical master William Osler observed that “medicine is the science of uncertainty and the art of the possible.” This maxim is called “Osler’s proposition” by later generations, which reveals the eternal uncertainty of life, disease outcome, suffering and death, the uniqueness of life, the uncertainty of medicine, the diversity of intervention, and the instability of treatment advance and retreat, which enforces the sanctity of medicine and the particularity of hospital culture. Hospitals often face the dilemma of “both human and financial resources” : even in today’s highly developed technology, there are still quite a number of unclear etiology and pathology, uncontrollable progress of the disease, uncertain curative effect, and unpredictable prognosis (progression, deterioration, disability, and death). How to deal with this situation? Hospital managers should figure out whether there is nothing they can do, or whether there is something difficult to do, or whether there is something wrong to do, clarify “no fault” injury, “force majeure” crisis, help patients and their families to establish a sense of risk and cost, break the fluke mentality of “zero risk” and “low cost”… All this tests the humanistic wisdom of managers. Medicine is often trading with death. In the emergency room, there is no infinite vitality, only life hanging on the line, and many crises. The enthusiastic treatment of doctors may get nothing but helpless, which is not the defect of management process and details, but the fate of life. In many cases of all-out rescue-ineffective, the essence of humanistic management is to highlight the “dedicated” and “forced” all-out rescue, rather than the “ineffective” (powerless – helpless) outcome, to help patients accept the suffering, open-minded face death.
Ethical paradox: hospitals always advocate the principle of no harm, but surgery and drugs themselves are the harm to the integrity of the body and the functional state. The key lies in how to deal with the relationship between relative harm and absolute harm. Hospitals advocate the principle of benefit for patients. In treatment, we can only expect small harm (cost) to gain large gain, but in the real world, small gain may also be obtained by large harm (risk). Hospitals also advocate the principle of autonomy, but in acute (diagnostic) operations, the situation of proxy decision-making exists (informed consent cannot be achieved). Hospitals advocate the principle of justice, but due to the shortage of high-quality surgical resources, there is a huge room for human discretion in the treatment, waiting for bed, selection of date and selection of persons. Absolute fairness cannot be achieved, but relative fairness can only be pursued, following the principle of first come and the principle of priority in severe cases…
Paradox of professional circumstances: Hospitals and doctors are often praised as “contrarians” in times of crisis, not only in times of human disaster, but also on moral and emotional slopes. They must firmly pursue the professional value of altruism in an era of pluralistic values, and understand that altruism means self-interest and helping others means helping oneself. In an age of faith confusion still maintain a firm professional faith, respect life, heal the wounded and rescue the dying, willing to sacrifice, pure kindness; In an age when true love is scarce, he still keeps the warmth of love in the clinic and unremittingly transmits the great love of the human world; To remain in awe and compassion in an age of self-indulgence; To be natural and straightforward in an age when innocence is considered childish; In an era of moral reconstruction, we take the lead in practicing the trust between doctors and patients with empathy and common prosperity, and surpass the community of interests and take the lead in establishing the community of emotion, morality and value.
The concept and value of hospital
The essence of hospital philosophy is the differentiation of concept and value, which aims to help hospitals and doctors to understand their own responsibilities, missions and visions and complete their own value anchoring. First, the distinction between hospital and infirmary. Hospital comes from Hospice, but its Latin roots are hospes, host, hospitality, Hotel highlights the functions of reception and service, while infirmary comes from infirmity and implies the need for sympathy and compassionate care. In East Asian history, the term “hospital” appeared after the Meiji Restoration in Japan. The first hospital can be traced back to the “Family of Mercy” founded by The Jesuit Luis de Almeida in 1557. The earliest Boji clinic in China (1835) was a hospital. The subtle difference between the two is that the former emphasizes the existence of the doctor (technology), while the latter emphasizes the existence of the sufferer (suffering). Followed by the “patient” and “patient”, in Chinese the word “patients” first appeared in the lotus sutra “born” 16, scripture to “save all the suffering of patients, such as abuse”, in the English language, patients and patients Shared a patient, patience, meaning “patience” in suffering, closer to the patient’s implications. The third is the distinction between “cure” and “care”. In hospital Settings, treatment is usually dominated by doctors, while care is dominated by nurses. In the era of rampant infectious diseases, the urgency of treatment is greatly emphasized, while in the era of chronic diseases, care gradually becomes the primary responsibility of medicine. Of course, treatment – care both hands, is a symbol of the strength of hospitals today.
Today, people are particularly focusing on “general” and “specialist”, in many people’s minds, from the general clinic, pharmacy accepts to specialized subject hospital, is a great progress in the medicine, breakdowns diagnosis accuracy, also gradually formed “strong specialty, the weak general”, “is a high level of specialized subject hospital, low level general hospitals” consciousness. Therefore, tumor hospital, gynecological hospital, children’s medical center, ear, nose and throat hospital, infectious disease hospital, psychiatric prevention and treatment center, as well as chest hospital, hepatobiliary hospital, anorectal hospital came into being, forming a diversified and differentiated hospital pattern. Nowadays, many general hospitals also want to emphasize their own key specialties, ignoring the progress of all departments and the synergistic effect between departments. Specialty hospitals, however, have a “personality” that allows them to accept only patients within the scope of their specialty, rather than general hospitals. Another blind spot in specialist hospitals is that non-specialist patients do not have an accurate choice, because the organ that produces the symptoms may not be the organ where the primary lesion is located, so the so-called “specialist outside the specialist”. In addition, the advance of a single subject will lead to the weakening of the coordination and support between departments, and even the absence is not conducive to multidisciplinary collaboration and comprehensive solution of complex clinical problems. How to coordinate the proportion of specialized hospitals and general hospitals in hospital ecology is a problem of regional medical planning on the surface, but in essence it is to grasp the trend of medical “subdivision” and “integration”. The dialectical point of view is that there is division and union, and there is division and union within division.
The debate between “inpatient and anti-inpatient” has also become the focus of modern society. It is not the wish of life to bid farewell to the warm family. For a long period of time in history, doctors have been making house calls. Undoubtedly, outpatient and inpatient are two diagnosis and treatment modes, behind which is the difference between disease control and intervention “point”, “line” and “surface”. Most patients with early suffering and mild disease choose “point” diagnosis, treatment, observation and intervention, to point with surface, can achieve the purpose of recovery; For patients with sudden injuries and severe diseases, hospitalization is the first choice, so as to maximize the mobilization of medical resources, so as to control the crisis situation and win the opportunity to turn around. However, with the improvement of diagnosis and treatment technology, the significant improvement of surgical and drug safety, especially the development of minimally invasive surgery, the critical point of hospitalization and non-hospitalization has shifted, and the “anti-hospitalization” thinking is gradually rising, which is manifested in the increasing expansion of daytime surgical list. It can be expected that the concept of “day care” will continue to refresh the spectrum of outpatient business, enabling patients to access effective, safe and affordable treatment models.
The concept of healthy China has given birth to the distinction between “cure the disease” and “cure the disease before”. This concept is derived from the Yellow Emperor neijing. The so-called “work does not cure the disease before”, and the idea is very consistent with the concept of healthy China. As a result, this traditional concept was revived, and many hospitals set up new “health centers” and “prevention and treatment departments”. However, there are two problems plaguing both hospitals and the general public: First, since there is no disease, why intervention? People are willing to spend money on treatment, but not necessarily on health intervention. Whether preventive health intervention will be misjudged as “excessive medical treatment”, leading to a crusade of medical ethics; Second, health interventions earnings yield relative to the disease intervention to reduce a lot, and the current health policy in accordance with the settlement of single diseases, rather than according to the community residents health status and the benefit balance, this mechanism only incentive hospital “” and other people sick, serious illness, hospital to intervene, to maintain the hospital normal operation, instead of collecting from the community residents health into the incentive subject, As a result, the awareness of “preventing disease” in hospitals cannot be truly implemented, the cost of health promotion and health education cannot be listed, and it is difficult to achieve the balance of income and expenditure in the health intervention link.
Speaking of which, I want to shake out a reason that no matter running a hospital or managing a hospital, it should not adhere to pure technical thinking or management thinking. The category thinking rich in philosophical thinking is essential. Only after the torture of value can we understand the truth and true meaning of hospital services.
