Hospital Handbook. James T. Wagner

usually not result in any meaningful treatment until a weekday, but it increases costs to the consumer. Being hospitalized for minor surgery because you are reluctant to investigate an out-patient alternative does not mean you will receive better care. It does guarantee higher bills. The patient-physician relationship previously characterized as paternalistic but now becoming more collaborative is probably a healthy one.

      Yet none of these changes is easy, not for individuals nor for institutions such as the health care system. What motivates the changes is the necessity to preserve availability of health care at a cost that is affordable to all. That is the hope. The voice of the Church and ministry is a powerful one. Informed and aware, it can assist in shaping the structures and practices which develop. Historically, it can continue to be a meaningful part of a life experience that is common to all. Its ministry, in both professional and lay forms, must be prepared to increase input. The alternative is further fragmentation of life experience, particularly the search for meaning and purpose in the midst of life crises.

      Bibliography

      Cousins, N. Anatomy of an Illness. New York: W.W. Norton Co., Inc. 1979.

      The author recovers from a serious illness through following standard medical regimens in addition to his own prescriptions. This book is now a classic and highlights partnership between physician and patient.

      Cousins, N. The Healing Heart. New York: W.W. Norton Co., Inc., 1984.

      Cousins offers personal reflections on ways he managed his recovery from a significant heart attack through monitoring his own anxiety and developing a partnership with medical staff.

      Florell, J.L. “Wholistic Health and Pastoral Counseling.” Journal of Pastoral Care. Vol. XXXIII, No. 2, June 1979, pp. 96–103.

      Presents an overview of approaches to wholistic health care in a variety of settings.

      Goldsmith, J.C. Can Hospitals Survive? Homewood, Il.: Dow Jones-Irwin, 1981.

      The author puts forth a thoughtful and insightful discussion of the major changes occurring in the health care field. He describes the already intense competition among hospitals, which is resulting in restructuring of the entire system. Consumer choice as well as cost consciousness are guiding principles which will result in the closing of some facilities and the survival of others.

      Tubesing, D.A. Wholistic Health. New York: Human Sciences Press, 1979.

      The author provides an excellent comparison and contrast between traditional models of providing health care and those which include a wholistic philosophy. As a single resource it provides an excellent discussion of the issues.

      Westberg, R. “From Hospital Chaplaincy to Wholistic Health Center.” Journal of Pastoral Care. Vol. XXXIII, No. s, June 1979, pp. 76–82.

      Reports on developing programs bringing patients into the diagnostic and healing process.

      1. In April 1983, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published a controversial report entitled Securing Access to Health Care (U.S. Government Printing Office, s/n 040-000-00472-9) which said, in part, that “society has the responsibility ethically to provide every person with an adequate level of health care without excessive burden to anyone.” The Commission did not say that everybody in society who could not afford it privately or cannot get it through other resources, is entitled to all the care that the person wants or all the care that may be beneficial. This is a position quite different from that which is politically expressed but may, in fact, more accurately describe what occurs in our society.

      2. Meg Cox, “This Doctor Says: Take Two Aspirins and I'll Call on You in the Morning,” The Wall Street Journal, January 5, 1984, p. 25. The best available figures indicate that physician house calls dropped to 17 million in 1975 from 60 million in 1960.

      3. Social Security Amendments of 1983, Pub. L No. 98–21, 601–07, 97 Stat. 65, 149–72 (1983). (Prospective payment for Medicare inpatient hospital services based on DRGs.)

      4. F.H. Kerr, “Considering a New Structure: The Health Services Holding Company,” Law, Medicine and Health Care, Vol. 11, No. 5, October 1983, p. 214.

      5. J. Naisbitt, Megatrends. New York: Warner Books, 1982, pp. 39–53.

      6. “Deciding to Forego Life-Sustaining Treatment,” President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, March 1983. (Suite 555, 2000 K Street, N.W., Washington, D.C. 20006.)

      2

       You're an Outsider:

      How Do You Get Inside?

      I write this chapter as a parish minister who spent a year hunting for parking spaces at one hospital before I discovered there was a special permit for ministers. I have visited more empty rooms than I care to mention. I have served in communities where everyone who did not know what denomination they were listed themselves as a member of my denomination when they checked into the hospital. And I have served in other communities where no one had ever heard of my denomination, including the people at the hospital information desk. I have heard the stories of countless other pastors who have struggled with the logistics of hospital visitation.

      People Who Can Help

      When you arrive in a new community, establish a plan to get acquainted with the hospitals and physicians who care for your congregation. Such a plan should begin with the physicians who are members of your congregation. Ask your parishioners for other names of the community's respected doctors as well. Call these key medical people and ask for an opportunity to meet with them at their convenience. Breakfast, lunch, a cup of coffee after rounds at the hospital, are all possible times to introduce yourself. Let these physicians tell you about their community, the current issues at the local and regional hospitals, and the needs they see for visiting and pastoral care. Find out how to share information about patients when necessary. Ask for the names of other health professionals they feel you should meet. Use all these contacts as a time to get to know each other. Specific questions and critical concerns may arise later. These will be much easier to deal with if you have first established a firm base of personal trust.

      Before your first hospital call, find someone who can give you an orientation to the hospital. In a large hospital this might be the chaplain. If there is no chaplain, there are social workers, administrators, and staff with a title such as hospital hostess who can give you a tour, explain that hospital's policies for clergy visits, and even help you find a place to park your car.

      If you cannot find someone within the hospital to help, ask another pastor in the community. Along the way, make sure your guide introduces you to key hospital personnel. You will be spending a lot of time in the hospital. It is important for hospital staff to recognize you and for you to know whom to call when you have special concerns.

      It is clear that many of the logistical elements of hospital visiting are determined by the size of the hospital, community, and church where you work. In Connecticut I was on the staff of a large church, in the largest denomination in the state, in a small town, in a small hospital. There was always someone to see in the hospital, so I just went regularly. I didn't always know everyone I saw, but the hospital personnel got to know me quickly. It was easy to find patients from my church in the visitor's directory. When I moved to Florida, I found myself in a community with four large hospitals, in a small church, of a denomination most people in the South had never heard of. My hospital visiting in Florida is much different. I clearly know everyone I visit, but someone has to let me know they are in the hospital. I have to keep making myself known to the hospital staff.

      We will continue to apply criteria for hospital visiting to the entire range of situations in which hospital visitors find themselves. At this point, clarify your own situation, the setting