The Modern American Hospital

Introduction

The number of American hospitals began to increase in the antebellum period, and after the Civil War, the numbers increased dramatically. The first survey of American hospitals in 1873 counted just 178; by 1900, American institutions caring for the sick numbered in the thousands. They included hospitals of various kinds: General hospitals treated patients of both sexes, of different ages, and suffering from a variety of illnesses, and a multitude of hospitals were dedicated to the care of specific illnesses and patients.(Gamble, 12) In addition, institutions referred to as asylums or homes also delivered medical care, for example, maternity homes.

The increase in hospitals was the result of public and private initiative. Municipalities and benevolent organizations founded charity hospitals in response to the growing number of Americans, usually city dwellers, who were no longer able to rely on traditional means of care and support in times of illness or infirmity. In the early 19th century, hospital affiliation and experience was a credential of elite, usually urban physicians, but doctors were not the primary caretakers or decision makers in hospitals; hospital administrators were. Cultural and religious aspects of hospital care were central to the patient's hospital experience in the 19th century.

Challenges

Some have called the development of hospice care a “people's movement.” If existing health care programs had been meeting the needs of the dying and supporting their families throughout their periods of illness and bereavement, no one would have needed hospices. The hospice movement originated in local communities as a result of the desire of health care professionals and civic leaders to provide better care than was previously available.(Gamble, 12) Many leaders of the movement envision eventually working themselves out of their jobs as the larger health care system adopts the principles of hospice care. In the meantime, however, hospices pose a number of critical issues for health care in the United States, in areas such as patient quality of life, the patient-family as the unit of care, the cost of hospice services, the training of professionals, and public attitudes.(Reverby,65)

Quality of Life

Proponents of the hospice movement proclaim that every human being has an inherent right to live as fully and completely as possible up to the moment of death. Some traditional health care professionals, emphasizing the curing of the patient at any cost, have ignored that right. Many physicians have been trained, for example, to emphasize restoring the patient to health.(Reverby,65) Accordingly, many patients are subjected to series of operations designed to prolong their lives even though curing them is sometimes impossible, as in the case of rapidly progressing cancer. Most hospice patients have had some surgery, chemotherapy, or radiation treatments.(Vogel,321) Some continue these even while they are hospice patients because the treatments provide some pain relief (radiation, for example, may reduce the size of a tumor and, therefore, reduce the patient's discomfort). There comes a point, however, if good quality of life is a goal that the patient should refuse further surgery, seek ease of pain without curing, ...