Clinically excellent physicians consider the setting of private conversations with patients and families. Quiet rooms with a door that closes are ideal for sensitive discussions.
Clinically excellent physicians consider the setting of private conversations with patients and families. Quiet rooms with tissues available and soothing artwork are ideal for anything requiring attention and sensitivity. In reality, so many critical conversations take place with only the protection of the flimsy hospital curtain, a furnishing that we sometimes forget has no magical soundproofing properties.
Embarking on these conversations, what do we expect the curtains to achieve, aside from a superficial nod to protocol? On reflection, the main benefit is the suggestion that something is happening behind them that shouldn’t be disturbed. They also separate us from other patients and colleagues in the background who may distract from the discussion. Out of sight, out of mind, as they say, but it’s important to be aware others may be listening through no fault of their own. Afterward, when we finish speaking and pull back the curtains, it almost suggests that the bad news is over, and that life will continue as normal. For us, perhaps, but probably not for the patient and their family.
Recently an older patient asked to speak to me about something that had happened during a recent hospital stay, or more accurately, something that had not. She described lying in the hospital bay and how over several hours, four of the other patients were approached by various doctors, who drew the curtains around and then gently explained to the person inside why resuscitation and associated treatments was not felt to be in their best interest. Overhearing various facts and comments regarding dignity and comfort, my patient waited for someone to come to her bed, to close her curtains, and to explain these same things to her. She explained that those overheard conversations had clinched a decision for her—resuscitation was not something she wanted. But no one came, and she wondered why this might be. Was her comfort and her dignity less important, or had she merely been forgotten? After talking with her, she then brought her thoughts on resuscitation with her GP, so perhaps her unintended eavesdropping enabled an opportunity, although it came at the the cost of feeling worried and disregarded.
I further discovered the pitfalls of the hospital curtain during my own cancer treatment when one day another patient sat near me in the chemotherapy unit and broke down in unrelenting tears. The curtains were swiftly drawn around her as she wept. I wanted to reach out, to say something kind and reassuring, but the barrier of those curtains, both physical and symbolic, made this seem taboo and I merely sat, awkwardly listening. I had fallen victim to “the emperor’s new curtains” and it cost me an opportunity to reach out to someone in need. I still regret this. I wonder how many other patients have encountered something similar, and how many, like me, still struggle with the memory.
What then, should we do? We should try harder to provide more private spaces, even if this takes a little more time or a little negotiation or organizing. We also need to remember that breaking bad news can be like a bomb, with repercussions stretching to places and people we might not consider. And we need to remember that just like “the emperor’s new clothes,” most hospital curtains provide little protection and dignity for patients, regardless of what we may have trained ourselves to believe.