3.0, Dr. Crichton was a Harvard Medical Student who then trained at Massachusetts General Hospital, back in the 1960's. So this book is non-fiction and rather dull unfortunately but not a hard read.
This is an accurate description of the state of medicine and care at teaching hospitals in 1968. As a Hospitalist, I appreciated it. But I cannot in good conscience recommend this to anyone who isn't a Hospital Medicine specialist.
Each chapter starts out discussing a different patient's case for about 5 pages, followed by about 25 more pages of an essay on Crichton's predictions for the future (many are quite accurate) and thoughts on pros and cons of Hospital treatment. He also discusses the history of the MGH which is modestly interesting.
Passage I liked:
"It is quite possible to forget that the hospital stands in the midst of a larger community, and that the final goal of hospitalization is reintegration of the patient into that community. In this respect, the hospital is like two other institutions which have a partially custodial function, schools and prisons. In each case, success is best measured not by the performance of the individual within that system, but after he leaves it."
I have had that same thought. Patients who are self-willed individuals do poorly in institutions.
I think nowadays the focus is on discharge within 3 to 4 days and the patient being well enough to not be readmitted within the next 2 months.
"People have recognized for a long time that hospitals are designed for the patient's needs only when those needs do not conflict with the doctors' convenience." I would add also the convenience of the nursing staff and administration and the politics inherent in running an institution 24/7 somewhat effectively."
"The hospital is difficult to adapt to. It brings in individuals from outside, and plunges them into a totally new existence, with new schedules, new food, new rules, new clothing, new language, new sounds and smells, fears and rewards."
I am SO empathetic of my patients. It is brutally hard to be in a hospital. My worst day working in one is nothing in comparison to what many inpatients have to deal with.
"Colors are bland but instead of being restful, are more often depressing; space is badly distributed, so that a patient may be stranded in a large room or croweded in a small one."
Yeah, still is like that in many hospitals. This is why I wanted to personally spend large sums of money buy large framed nature photos of gorgeous scenery or gorgeous animals or other beautiful photos of local landmarks. But when I offered, I was bluntly and rudely rejected. (The Engineer Tim Somebody turned out to be a malignant person who hurt me and damaged me by his sheer awfulness. Still makes me feel sick to think of how he treated me and probably others.)
But some hospitals do display wonderful photos and deserve praise (Hershey Medical Center, Alta Bates in Berkeley). Many more do not. I am appalled at the poor excuses for "artwork" that make it up on a hospital wall.
"The hospital makes psychological demands that may retard recovery. According to Stanley King, these may include dependence and compliance with hospital routine; a de-emphasis on external power and prestige, tolerance for pain and suffering, and the expectation that a patient will want to get well."
True, dat.
"The modern hospital is best suited to a severely ill person. These people are most tolerant of hosptial routine and its indignities, irritants and difficulties."
This is why as soon as a patient gets well enough to complain about the food, I put in a discharge to home order.
All these quotes are from the final chapter, by the way. The rest of the book was not nearly as riveting, unfortunately.
Crichton was a gifted genius (1942-2008). It is worth noting that he wrote this in residency.