Why are there vending machines in hospitals? This seems like an odd question to ponder, and it certainly would seem to have nothing to do with the current state of medicine and health care in our country. But it is a question that I am having a hard time wrapping my brain around. Certainly, most hospitals do have vending machines that sell snacks and soda, and they are by no means hidden in the basement. On the contrary, vending machines are positioned close to as much foot traffic as possible, advertised without shame. Less common but more reprehensible are hospitals that have a McDonald’s in them. If you Google “fast food in hospitals,” you can find the locations of such facilities. We hospitalists (my current occupation) are certainly on the front lines of battling chronic disease at its end stage. We still counsel our patients about the dangers of excess, and how these dangers contribute to their chronic diseases, likely well past when this information might have had an impact. The theory of such counseling is that, by teaching patients the skills to change their bad habits, and patients following through on such changes, that excess can be reduced, and the burden of chronic disease can be eased. Physicians, as a majority I would imagine, would agree that this is a theory that has been researched, tested, seen to be effective, and worth pursuing. There is much talk about an individual’s right to health care, but there is little to no talk about her/his responsibility to take care of her/his self. Shouldn’t rights and responsibilities go hand in hand? If your medical ailments are self-inflicted, and most adulthood chronic diseases are absolutely self-inflicted, do you not have the responsibility as an individual to straighten yourself out? Must the health care profession be responsible for all the burdens that individual patients place on themselves? The answer to this question is no, not all the responsibility; but we do bear some responsibility, and that gets back to the title of this article. Why are there vending machines in hospitals? Why would we ever allow a McDonald’s to be built into a hospital? How is this not the absolute epitome of hypocrisy? It is very hard for an individual to change a habit. How are our patients to have any chance of changing their bad habits when we are not showing them by example what it means to be healthy? It is our responsibility as physicians to give our patients the tools for success. It is our patients’ responsibility to take those tools and apply them to their lives. We hospitalists moan about readmissions, but when our patients with coronary artery disease and heart failure get wheeled by a McDonald’s on their discharge from the hospital, what did we expect to happen? We might as well offer to light their cigarette while we’re at it. In my opinion, if you want to improve health care, you have to talk about responsibilities in the same breath you talk about rights. HCAHPS and similar surveys are an absolute joke. Hospitals are not supposed to be restaurants or hotels; they are supposed to be hospitals. Why would you not instead have a survey that asked questions like: “Did the hospital teach me how to change my bad habits?” “Did the hospital teach me about good health, nutrition, and exercise?” “Did the hospital impress upon me a responsibility to take better care of my own health and well-being?”. How are these not the most important questions to ask a patient and to which we as health care professionals would be better held accountable? How are our patients supposed to take their own health seriously when we cater to their bad habits in every possible way? How do you hold an individual responsible for her/his health care? That is a tough question. The federal government tried its individual mandate for health insurance, which no longer exists. All else being equal, when the total number of insured goes down, the cost for the remaining insured goes up, which is the very nature of insurance. And the cost of health care in America is indeed going up, with no signs of stopping for air. What can individual consumers of health care actually do on their own, faced with high insurance premiums, to improve their financial situation? They are left with two options: either convince the rest of the country to buy health insurance or, to the best of their ability, reduce their own chronic disease burden that necessitates such a high cost. The latter, of course, is the only realistic option, and it is the only option that actually improves their health in general. We on the health care profession side of things need to recognize our responsibility to show our patients a better way. We need to be better examples of the lessons we preach, and we can start by removing the hypocrisy that exists in our health care facilities. Our hospitals should only allow for the most nutritious foods to be served, and our hospitals should be able to weather the complaints of patients who might not like how that food tastes. We need to remove any ambiguity that good eating and exercise are just passive suggestions, but that they are absolutely necessary for the health and well being of every individual. We physicians need to stop passively throwing pills at every problem we see without addressing the cause or bad habits of the individual, and we need to resist our patients’ demands to behave in such a manner. Our administrators need to stop treating hospitals like hotels, patients like customers, and doctors like waiters. They need to start asking the right questions. Lastly, and probably most controversial of all, is that we as health care professionals, and indeed society as a whole, need to address how we are to hold patients accountable for their own behavior as it relates to chronic disease. We cannot ignore the elephant in the room anymore. Any successful implementation of socialized medicine will bankrupt this country, if the current course of chronic disease is allowed to continue. Health care for all will only succeed as a right when it is treated as a responsibility as well. Source
