The Patient's Friend

The black teen-ager had good reason to be upset. His injured father had been rushed to the emergency room of Chicago's Michael Reese Hospital and Medical Center, and the distraught boy was unable to learn anything about his condition. Harried doctors and nurses were too busy to concern themselves with a frightened kid. Then the boy met Mahon Washington. The avuncular black man ducked into the treatment room to learn the patient's prognosis, returned to assure the youngster that his father would live.

Such service is part of Washington's daily routine. Although he had no medical experience, Washington, 56, was hired in 1969 as the emergency-room "ombudsman" because he could "get on with folks" in Chicago's sprawling South Side ghetto. Working from 4 p.m. to midnight, he handles anywhere from five to 25 patient problems and complaints a day, calming the nervous, interpreting medical instructions and, as he puts it, providing a "human element" in the crisis area of the emergency room.

Consumerism. Washington's presence at Michael Reese underscores a new trend in hospital management. A common criticism of many hospitals, particularly large ones, has been their indifference to an individual's personal problems as distinct from his medical needs. Now an increasing number of institutions are attempting to cope with the whole patient. One important step: some 80 U.S. hospitals have hired staffers to hear patient grievances and to act on them.

Predictably, some of these ombudsman appointments are little more than token responses to the rising spirit of consumerism. Often the individuals are volunteers without any authority to act. But many hospitals are sincerely searching for ways to improve relations with their patients. New York's Mount Sinai Hospital has a staff of five to deal with its patients' nonmedical needs; Presbyterian-St. Luke's Hospital of Chicago has hired a patient representative to deal with the problems of those using its clinic and emergency room. Few institutions, however, have gone as far as New York Hospital, a 1,000-bed facility associated with Cornell University Medical School. New York's Anne Alexis Cote, 26, is a member of the institution's administrative structure and has broad authority to investigate and when necessary do something about patient complaints. She is also singularly qualified for her work. A former nurse, she got a patient's-eye view of hospital operations when a back injury confined her to a hospital bed for two weeks. That experience, plus her understanding of hospital procedures, has helped her in dealing with nearly 1,400 patient complaints in the past year.

Not unexpectedly, most of the gripes arise out of misunderstandings. "Patients often fail to understand the need for hospital routines," says Miss Cote. "They don't always realize that the nurse who seems brusque must take ten more temperatures and half a dozen blood pressures and thus doesn't have time to stop and chat." But, she is quick to add, many complaints about doctors and nurses are justified. "Hospital personnel have to understand that the patient is upset. He's upset by his illness. He's worried about who's going to do his job, take care of his kids, pay his bills. He needs someone to listen to him and explain things to him."

Meat Wagon. At New York Hospital, reports Miss Cote, most patient problems can be solved by a chat with nurses or doctors or a visit to the hospital's billing office. At Chicago's Michael Reese Hospital, on the other hand, more than words were necessary to improve the institution's relations with a distrustful ghetto community. Before Mahon Washington's arrival, for instance, the hospital routinely relied on police cars and paddy wagons to send charity patients to nearby Cook County Hospital. Washington persuaded the hospital to end what he calls "meat-wagon transfers." Now taxis or ambulances are used. He has also sought to reduce long waits for treatment and to interpret unintelligible medical instructions. Says he: "When a patient receives a prescription marked 'take three per day, one before each meal,' and he can only afford two meals a day, you need someone who can explain how to take the medicine."

Most hospitals that have tried ombudsmen are pleased with the results. Dr. David Thompson, director of New York Hospital, believes that Anne Cote's work has greatly improved relations between the hospital and its patients. Officials at Michael Reese are equally enthusiastic about Mahon Washington. Two years ago they had to overrule a hospital accountant to obtain funds for his position. Now they are planning to expand the ombudsman program to the entire hospital.

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