Unpublished research suggests that a stay in hospital weakens us so much that, far from restoring us to health, we are more likely to get sick again after discharge. A professor at Yale says enough is enough - it's time to completely rethink patient care.
When a hospital discharges someone, both patient and doctor are usually united in a hope that they will not see one another again soon.
But for some time it's been known that about a fifth of patients who leave US hospitals are back within a month. In England the number is lower - about 7% - but readmissions still cost the NHS £2.4bn in the 2012-2013 financial year.
In both countries, and many others, re-admission rates are taken as a measure of the quality of care a hospital provides. However when Dr Harlan Krumholz at the Center for Outcomes Research and Evaluation at Yale School of Medicine asked doctors about re-admissions, he got a rather curious response.
"They would say, 'How can you blame me when they come back with pneumonia after they were in for heart failure? We took care of the heart failure, it's not our fault that they came back with pneumonia!'" Krumholz recalls. "Or they would say, 'Why are you blaming us when they fall over - it's not our fault.'"
Krumholz learned that only about a third of patient readmissions were related to the original cause of hospitalisation. Patients' reasons for returning to hospital were diverse and linked to their immune systems, balance, cognitive functioning, strength, metabolism and respiratory systems. It was as though they were mentally and physically below par, off-kilter, out of whack.
Could it be, Krumholz wondered, that the very experience of going to hospital had made patients more vulnerable to disease and accidents?
In a series of opinion pieces in top medical journals, he has developed the concept of "post-hospital syndrome" (PHS), which he defines as "an acquired, transient period of generalised risk".
"My premise is it's the cumulative effect of a lot of insults to the body, of all the stress coming from all different directions," he says.
