The Doctor’s Surgery
Wards used to be hushed before chatty nurses and TVS arrived
When I was about eight years old, I was chasing a boy round the playground whose nickname, for some reason, was RAF. I tripped and broke my leg.
I remember being given orange squash as an analgesic until the ambulance arrived. What I most remember about the hospital was the notice outside: ‘HOSPITAL – QUIET.’
Given the noise inside hospitals these days, such a notice would now be pointless. Indeed, one of the things I most fear about being admitted to hospital (other than, of course, being ill) is the incessant and inescapable noise.
How much this noise is unavoidable I am not certain, but some of it surely is.
When I was still in practice, my room gave out on to an open but narrow passage between hospital buildings. My window on to the passage was of frosted glass and could not be opened. Every day, at about 11am, without fail, past my window was pushed some kind of trolley which had the sonic qualities of a theatrical thunder-making machine.
One day, I went out to see what it was, expecting to see a juggernaut of some description. It was a very small, wiremesh trolley with a few bedclothes in it. Years of research must have gone into developing so tiny a contraption that could make so much noise.
I wrote to the chief executive but, of course, noise reduction in hospitals – noise being a real torture to very ill patients – was not a government target and therefore was not important.
Once, when I was in hospital myself, I noticed that the tea-trolley lady seemed intent on creating as much noise with her metal trolley as possible. She smashed it through the swing doors, shouting, ‘Tea’n’coffeeemilk’n’shoogah!’
Hospital noise let the patients know that that they were not in hospital to relax or have a nice time.
Of course, beeping machines and other noises are unavoidable, and everyone understands that. But nurses at the nursing station talking incessantly about their social life in the small hours of the morning is agonising for those who are in a completely dependent situation and dare not say anything.
Whether or not fears of retaliation against patients who complain about staff for making a noise are justified, they exist. And, these days, with the destruction of the sense of hierarchy, there is no one in higher authority worth complaining to – certainly not about televisions on at full volume in wards.
Does noise in hospitals do any real harm? It might even encourage people to leave hospital as soon as possible. And, after all, hospital is a dangerous place for ill people to be. But disturbed sleep is associated with relatively poor outcomes, such as delayed healing and a greater propensity to relapse.
A Swedish cardiological study found that heart-attack patients who stayed in a coronary-care unit during periods of much noise had a higher rate of relapse and readmission to the unit than those who stayed in the same unit in quieter times.
But, of course, this does not by itself prove a causative relationship between noise and poor outcome. Insofar as poor outcomes lead to emergencies, which in turn lead to noise, the relationship might be the other way round. Alas, it is unlikely that double-blind (or perhaps I should say double-deaf) experiments can ever be performed to establish the case beyond reasonable doubt.
Nevertheless, the wisdom of ages suggests that quiet is good, if not essential, for healing. Do we really need irrefutable scientific evidence before we make efforts to control unnecessary and avoidable noise?
But the auguries are not good: an increasing proportion of the population confuses noise with liveliness, the way bureaucrats confuse activity with work.