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Offering Welcome in the Kingdom of the Sick: A Physician Guide to Hospitality
  • Brett Schrewe,
  • Claudia Ruitenberg
Brett Schrewe
The University of British Columbia Faculty of Medicine
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Claudia Ruitenberg
The University of British Columbia Faculty of Education
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Peer review status:ACCEPTED

15 Dec 2019Submitted to Journal of Evaluation in Clinical Practice
16 Dec 2019Submission Checks Completed
16 Dec 2019Assigned to Editor
17 Dec 2019Reviewer(s) Assigned
28 Jan 2020Review(s) Completed, Editorial Evaluation Pending
28 Jan 2020Editorial Decision: Revise Major
07 Apr 20201st Revision Received
08 Apr 2020Submission Checks Completed
08 Apr 2020Assigned to Editor
08 Apr 2020Reviewer(s) Assigned
20 Apr 2020Review(s) Completed, Editorial Evaluation Pending
20 Apr 2020Editorial Decision: Accept

Abstract

The onset of acute illness may be accompanied by a profound sense of disorientation for patients. Addressing this vulnerability is a key part of a physician’s purview, yet well-intended efforts to do so may be impeded by myriad competing tasks in clinical practice. Resolving this dilemma goes beyond appealing to altruism, as its limitless demands may lead to physician burnout, disillusionment, and a narrowed focus on the biomedical aspects of care in the interest of self-preservation. The authors propose an ethic of hospitality that may better guide physicians in attending to the comprehensive needs of patients that have entered “the kingdom of the sick”. Using philosophical methods, the authors explore what compels people to present to emergent medical attention and why altruism may not offer physicians a sustainable way to address the vulnerabilities that occur in such situations. They then present the concept of hospitality from a Derridean perspective and use it to interpret a narrative case of an on-call paediatrician caring for an infant with bronchiolitis to demonstrate how this approach may be practically implemented in the acute care hospital context. Hospitality allows physicians to acknowledge that clinical presentations that are routine in their world may be disorienting and frightening to patients experiencing them acutely. Further, it recognizes that the vulnerability that accompanies acute illness may be compounded by the unfamiliarity of the hospital environment in which patients have sought support. While it is unlikely that anything physicians do will make the hospital a place where patients and caregivers will desire to be, hospitality may focus their efforts upon making it less unwelcoming. Specifically, it offers an orientation that supports patients in navigating the disorienting and unfamiliar terrains of acute illness, the hospital setting in which help is sought, and engagement with the health care system writ large.