The Book of the Week is “God’s Hotel” by Victoria Sweet, published in 2012. This is a medical doctor’s account of the radical changes that occurred at a county-funded hospital, formerly an almshouse in the San Francisco area that treated mostly disabled and elderly patients who were indigent.
The author describes the series of consequences stemming from an ever-increasing annual budget, a power struggle, office and mayoral politics, and bureaucratic shenanigans. There was a tug-of-war over turning the hospital into a psychiatric facility.
Florence Nightingale summed up the field of medicine in a nutshell when she said there have to be checks and balances in connection with practicing medicine, doing nursing, and handling administration. If doctoring becomes too powerful, patients get overtreated; if administration becomes to powerful, too little doctoring is done. When there is excessive nursing (emotionally and spiritually caring for patients), medical progress suffers.
Over the course of several years, a Justice Department investigation and a special relationship with the mayor’s office prompted the hospital’s executives to increase the administrative staff even as the number of patients fell. The additional staff was required to generate assessments, policies and procedures. When an incident resulted in the death of a demented patient and the media gave the facility bad publicity, the executives pointed to budget cuts that caused the understaffing that led to a compromise in safety. The hospital then hired a PR firm, an in-house director of government and community relations, and an assistant medical director to help with all the new paperwork, decisions and questions. Quietly, even more draconian budget cuts were being made to the hospital. Yet there was still enough money to hire the mayor’s communications consultant.
Read the book to learn how misdiagnosis and home care (rather than hospital care) make healthcare significantly more expensive, and of the controversies surrounding the push for progress on one side, and preservation of personal patient care on the other.