Posted on February 19, 2019 at 4:26 PM
“Improving patient experience” has become the mantra of many health care facilities in a highly competitive and regulated environment. But just what is it about the patient experience that needs to be improved? Will better food and gift bags do the trick? Or are more basic changes required?
To answer that question, I turned to an eminent if perhaps surprising authority, Dr. Seuss (the late Theodor S. Geisel). While not a medical doctor or a PhD, Dr. Seuss was a shrewd observer of people and their encounters with authority and absurdity. Behind his colorful images and witty texts for children’s books, he often concealed satire or a moral. Think of The Cat in a Hat as a “disrupter,” creating chaos when Sally and her brother are home alone. Yet everything is restored to its proper place just as their mother returns. The book helps children learn to read but also poses a serious question: Would you tell your mother about what happened when she was out?
On his 82nd birthday in 1986, Dr. Seuss published You’re Only Old Once!: A Book for Obsolete Children, which chronicled a befuddled and anxious man’s journey through the mysteries and indignities of a checkup at the Golden Years Clinic.
More than 30 years later, many of the patient experiences Dr. Seuss depicted have become even more routine and impersonal. Many involve money, machines, and the dehumanization that occurs when both overwhelm human interactions between patient and doctor. The patient’s first encounter in the book is the Eyesight and Solvency Test. A typically bizarre Seussian machine casts a bright light on a screen in which the letters, ranging from very faint to very bold, spell out “Have you any idea how much money these tests are costing you?”
The patient is then passed along a lineup of Quiz-Docs, who ask increasingly arcane and apparently meaningless questions, to another group. These are Oglers, doctors who operate complex machines that peer inside and outside and upside-down over the patient’s body, but what they reveal is a secret. “What these Oglers have learned/they’re not ready to tell./ Clinicians don’t spout their opinions pell/mell.” Ten years before HIPAA, the framework for withholding information from patients was already in place.
Along the way the patient loses most of his clothing and much of his dignity. After all the tests, the patient is left for hours in the waiting area in robe and slippers to commiserate with Norval, the Clinic Fish, who is “quite sympathetic, as Clinic Fish go.”
At the end of the rounds of examinations, the patient undergoes the Pill Drill, where a machine-generated voice says, “Repeat after me . . . This small white pill is what I munch at breakfast and right after lunch . . ..” and on and on, ending with “This long flat one is what I take/If I should die before I wake.” No teach-back here, in which the patient reports in his own words what he is supposed to do—just mechanical repetition.
At last the clinic visit is over, and clothing is restored. “When . . . you’ve been properly pilled,/then a few paper forms/must be properly filled/so that you and your heirs/may be properly billed.” Norval waves Godspeed with his fin, and the patient says to himself, “You’re in pretty good shape/for the shape you are in!”
Dr. Seuss was more than a critic of modern medicine. He and his wife Audrey, a former nurse, supported medical causes. In 2012 the Dartmouth School of Medicine was renamed the Audrey and Theodor Geisel School of Medicine in their honor. Geisel was a graduate of Dartmouth College, class of 1925; and he dedicated You’re Only Old Once to his classmates.
Dr. Seuss’s book might well be required reading for all health care practitioners so that their encounters with patients are humane and compassionate. That would be one step toward improving patient experience.
Carol Levine, a Hastings Center Fellow, directs the Families and Health Care Project at the United Hospital Fund. Her most recent book is Navigating Your Later Years for Dummies (Wiley and AARP, 2018).