Hospital Hospitality, Then and Now

Written by on August 31, 2012 in Features, Practice tips - No comments

Hospitality has become an omnipotent theme in modern America.  Predating the 14th century, the term was defined as the cordial and generous treatment of guests and the supplying of a pleasant environment to visitors.  The word “hospital” itself was a direct derivative and enthusiastically described the envisioned physical existence of hospitals as a location of such hospitality.

Today, the concept may be visibly displayed in hotels, airports, shopping malls and theme parks.  Hospitality in fact has become a valuable corporate marketing concept and many universities of higher education have taken note by offering advanced degrees in hospitality.

Yet, historical examination of American hospitals in the 1700 and 1800s often describes them as localities of dreaded impurity, rather than a pleasant environment, filled with shards of exiled humans; a far cry from the French pseudonym for hospitals in the Middle Ages of Hotel d’Dieu or Hotel of God.

Charity hospitals as they were known in the 1700s existed in the community and were maintained by volunteers and trustees.  As locations to be avoided, hospitals served as the last resort for the infirm, the mentally and physically disabled and the homeless population.  Furthermore, due to a lack of true curative means, the hospital staff predominately focused on promoting morals and religious beliefs rather than health.

Such hospitals, which were usually akin to almshouses, were solely for the “worthy” poor and destitute and were often unhygienic spaces where the insane and rats ran free.  Patients that were of more advanced fiduciary means received care in their residence from private physicians.   These patients were afforded the most experienced doctors of the time and treated in the most hospitable fashion.  Of course, this came with a substantial fee.  Thus having means afforded patients the comfort of not resorting to a hospital stay.

Hospitals were once exclusively charitable enterprises and financed by means of donations and government appropriations to fund their operations.  Although the “charity case” or patient needed to be initially approved both on a moral and worthiness spectrum, most people in need were able to obtain shelter and care in the community hospitals.  Yet since medical science and doctors were unequipped at the time to offer definitive diagnostic or curative therapies, the “treatments” focused on stringent moral reform and religious endeavors.  Hospitals were not viewed by the public as comfortable, rather were perceived as loathsome and a place to die rather than live.

In the 1800s, the charitable institutions began to focus on “wage wards”   and initiating the charging of patients to buy care for a fee or wage.  Ironically, charging patients occurred when medicine finally was at a point to offer more effective treatments and expanded resources.  During this period, the middle and upper class slowly began to realize the utility of the hospitals and physicians vied for entry as an opportunity to enhance their education and increase the size of their private practice. As such, previous to the Civil War, a practicing, well-educated physician may have not set foot in a hospital throughout his entire career in medicine.

Suddenly with the discovery and advancement of anesthesia and complicated medical devices, modern hospitals were glamorized. Although the physical hospital is comprised of brick and mortar, it has become an incredible metaphorical icon highlighting the advancement of modern medicine and the healthcare profession in the 20th and 21st century.  The sweeping modifications in hospitals are due predominately to the age of scientific discovery coupled with the relationship between therapeutics and the patient.

The historical relationship between a doctor and patient has been altered in many ways as well.  In the past, doctors were not able to offer many tangible diagnostic or curative treatments to their patients.  The holding of a hand and an ounce of verbal reassurance were their most valuable asset.  Together they shared an intimate bond and hospitality was extended in the form of intimate human touch and a generosity of time.

Over the years, the time and touch element of the relationship has significantly diminished and patient’s perception of hospitality is now reflected by their physician’s bedside manner.  However, as of late, the traditional concept of hospitality appears to be making a reemergence in medicine and the hospital setting. Concierge, or boutique medicine as it has become known, has surged.  Under this title, concierge physicians care for far fewer patients than in a typical practice, perhaps as little as 100.  For a substantial fee, the patient is afforded the luxury of truly personalized, private care in their own setting.  Additionally, patients are entitled to the physician’s cell phone, email and specially-deemed services.

As noted, hospitality has reemerged as a vital theme in today’s culture.  Hospitals are now being designed with a “healing hospitality” in mind.  Long-ago banished wards and double rooms are increasingly being replaced with private rooms and a view.  The cold tile floors are out and warm wood floors with cabinetry are in.  Internet access is a given and small uncomfortable bedside seating for visitors have been replaced with comfortable, oversized, upholstered chairs.

The concept of medical hospitality, whether as described in the 18th or 21st century, evokes a sense of generosity with time, care and concern.

By Paula C. Rapp

Leave a Comment

Please type the characters of this captcha image in the input box

Please type the characters of this captcha image in the input box