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For want of a four-cent pull chain
  1. Michel Villette
  1. Correspondence to Professor Michel Villette, Professor of Sociology, AgroParisTech and Researcher, Centre Maurice Halbwachs ENS/EHESS/CNRS Paris, 63 quai de Seine 75019 Paris France; michel.villette{at}

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A noted French ethnographer describes his care in a French private hospital for a hip replacement. He recounts a number of events that are probably typical of many patients' hospital experiences, but which clinicians often do not perceive. The observations are probably similar to those patients might make after exposure to any modern healthcare system, except that they offer a level of detail few would provide. The account focuses on the contradiction between excellent technical operations and the absence of compassionate patient care, basic civility and the needs of patient safety. It addresses marketing of hospital services, staffing levels, conflicts between private enterprise and medical need, fragmented billing, disconnected after-care, and the absence of a coherent view of a patient's experience—the non-coordination of care. The author is not an expert in healthcare, and so refrains from offering specific recommendations, but hopes that his experience will stimulate professionals and researchers involved in improving healthcare to reflect on the many seemingly minor ways modern care causes distress or even harm. While minor from a technical point of view, these distressing incidents powerfully shape patients' experience of the care they receive.

I recount the events of my hospitalisation for a hip replacement. Each of the events may appear as a minor incident, a little nothing, in a large professional operation. From the point of view of the patient, however, each of these ‘little nothings’ cause unnecessary suffering, anxiety or discomfort at a minimum, but sometimes significant dangers for the patient, whether he or she is conscious of them or not. Moreover, these incidents, minor as each may appear to workers in the system, can cohere into a story that shapes a patient's overall image of the healthcare system. In my case, the story seemed to be one in which nobody on the hospital …

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