One of the greatest figures in the history of British hospitals in the twentieth century was not a doctor, but a former steelworker from Glasgow who later became a social worker and then a film maker. His name was James Robertson.
Robertson started his researches into paediatric wards in Britain in 1948. At that time, sick children were routinely separated from their parents for long periods of time. Having parents in hospital was regarded as disruptive, and staff were upset hearing children cry when mothers arrived or left. Visits were restricted and in some cases forbidden. Here, for example, is a list of the visiting times in some of London’s main hospitals from around that time, published in a survey in the Spectator:
Guys Hospital, Sundays 2–4 p.m.; St Bartholomew’s, Wednesdays 2–3.30 p.m.; St Thomas’s, first month no visits, but parents could see their children asleep 7–8 p.m.; Westminster, Wednesdays, 2–3 p.m.; West London, no visiting; Charing Cross, Sundays, 2–3 p.m.; London Hospital, under three years old, no visits but parents could see through partitions, over three years old, twice weekly.
The story of Robertson’s campaign to change this state of affairs sheds no glory on hospitals, doctors or the British establishment. His meticulous researches into the effects of separation on children – distrust, rejection, bed-wetting, soiling, anxiety and rages – were dismissed as sensational. The film he made with his wife Joyce to demonstrate these effects was shown at the Royal Society of Medicine in 1952 to unanimous derision, and to accusations of rigging. BBC producers blocked his attempts to present it on television. When they finally relented in 1961 and allowed him to show some excerpts, Robertson defied their orders by turning to the live camera to explain that parents had a legal right to stay with their children regardless of any ‘official’ rules. His courage inspired a group of mothers to form the National Association for the Welfare of Children in Hospital, one of the most effective pressure groups ever. As a result of their work, there are probably no paediatric wards in Britain nowadays with restrictions on parental visiting.
I find Robertson’s story inspiring but I am also outraged by it. The list of hospital visiting times, in particular, is heartbreaking. It makes me go hot and cold with anger, misery and a retrospective sense of helplessness. The emotional effects of such institutionalised brutality are too painful to hold in the imagination. How on earth can it have happened? How can people have ever believed that it was a good thing? How could doctors and nurses have been so blind to the distress they were causing, and so uncritical of themselves?
The answer, of course, is that the rules were familiar, and familiarity breeds conformism. As Robertson found, protests against convention can invite ridicule, particularly from the medical profession. We also need to remind ourselves of innumerable other examples of social practices that were considered humane for considerable periods of time, but that now fill us with horror – including slavery, workhouses, and large mental asylums in remote rural locations.
Which brings us, somewhat uncomfortably, to the question of whether there are any current practices that doctors now accept with complacency, but ought to regard as similarly grotesque. My own nomination for such a practice would be the ward round.
Before you accuse me of descending from the sublime to the ridiculous, let me explain that I have been a hospital in-patient myself several times, so I know from experience what it feels like to lie horizontally, in ill-fitting hospital pyjamas, while small groups of fully dressed and vertical doctors (some of whom have never introduced themselves) stand over you briefly to conduct a consultation about matters of life and death, within earshot of patients in neighbouring beds. More distressingly, I have seen my wife subjected to the same humiliation by groups of mainly male colleagues, while I was dismissed from her bedside. And when my parents were alive, I observed each of them reduced to a state of humiliation, bewilderment, and more or less utter disempowerment each time they were in hospital and were victims of this uncaring but unchallengeable ritual.
In all these situations, I have wondered how it could still be permissible for patients to pass through their entire admission to hospital without ever having the basic human dignity of one-to-one meetings with their doctors, sitting in a private space such as a ward office or day room, properly clothed if possible, and with family members present if they wished. I also find it dispiriting that some consultants manage to complete their entire careers without ever engaging in a single medical encounter of this kind with an in-patient (except possibly in their private practices). I am puzzled as to why hospital teams cannot allocate one main doctor to each in-patient so that this can happen.
From the perspective of general practice, confidential encounters between a single doctor and a patient or family are the cornerstone of good medical and emotional care. There seems no reason, beyond professional convention and convenience, why this cannot happen in hospitals too. Even frail and elderly patients can in most cases be helped to dress properly and to come alone into an office – with the help of a wheelchair if necessary – so that they can disclose their fears and articulate their questions in relative dignity. For the few who cannot, it is perfectly possible for any doctor to draw up a chair to the bedside on each visit. The medical team can of course still meet, as some already do, to discuss the ‘case’ quite separately from arranging for one sole doctor to meet the actual person face to face.
I wonder if we will have to wait for a latter-day James Robertson so that this happens, or whether our own profession could seize the initiative in bringing the time-honoured but demeaning practice of ward rounds to an end.