Just What the Doctor Ordered: Health and Architecture
February 7, 2019
A: Yo why does hospital architecture suck?
I feel like the hospitals are always the worst designed building in the city.
Just below architecture schools.
B: Wow, ok.
I thought you liked Rudolph Hall.
A: Yeah, that’s true.
The outside is a little… imposing.
B: You can’t blame the architects for “bad” design.
When all we can do is squirm in the tight gap between money and regulations.
A: I do notice how a lot of the prime real estate within a hospital doesn’t get spent on house staff at all.
If you go to a lot of the resident rooms, they either don’t have windows, or are super cramped.
But I think it’s getting better.
B: Oh yeah?
A: I think we’re starting to recognize as a field (medicine that is) that beauty matters.
That space matters.
Not just for their own sake, but for mental and bodily health.
I’m gonna sound like this Silicon Valley crunchy granola person, but I ran into this thing called “shinrin yoku” which is Japanese for “forest bathing,” as in immersing yourself in a forest.
B: I mean you already started buying hipster sweaters from Goodwill.
But anyway, Japanese scientists and doctors are actually doing legit research, and so far they’ve actually been able to show that forest bathing can do a lot for a person’s health.
I feel like a lot of the hospitals I’ve seen on the interview trail that were newer paid a lot more attention to natural elements like light, water, and plants…
A: But I think the real question is: why make hospitals better in the first place, when we should be moving away from hospital-based care anyway?
Have you heard of Ezekiel Emanuel? He drafted the legislation that became Obamacare. He basically said hospitals have been seeing lower patient volume for a couple of decades now, so it’s been harder to make money as a hospital.
Which is why all of these hospitals are consolidating around the country as one large system.
He thinks we’re gonna transition more care out of the hospitals and into outpatient settings.
B: I’m telling you.
The next big thing is gonna be Whole Health: Whole Foods + Pharmacy + Equinox.
Also, what is Equinox.
B: The super expensive gym that people go to in NYC.
As in, a large health food chain, fitness club, and pharmacy/light procedure center will merge as a mixed health-related conglomerate.
So that you can have your food, meds, and body improvement all in one.
A: But what about when you’re actually sick?
So there are doctors off to the corner?
Next to the carrots section?
B: …Not literally, but yeah.
A: I wonder if that’s happening already.
Like I wonder if CVS will get into the urgent care game.
It just merged with Aetna, the insurance company.
Maybe you’ll be able to go to CVS, schedule an appointment with an app, and get your basic stuff anywhere and everywhere.
B: But maybe that also means that all we’ll see everywhere are CVS’s.
A: It’ll definitely fill a need, but I don’t think that we’re going to fix this broken system by commoditizing it even more.
I mean, being in the hospital has convinced me more and more of this.
Health is something totally transcendent.
Some people have it some people don’t.
But I noticed it has a lot to do with self-understanding, social context.
Whether or not you’re lonely.
Whether or not you have a hope for
B: Hmm. Doesn’t that put you in an existential crisis though?
A: Yeah, I think health is a very existential crisis.
Or it can be a sign of one.
Even if we have the perfect “system,” whatever that means.
We’ll still have a very unhealthy population.
America is lonely, it’s hopeless, it’s divided, and so many people are poor.
The way we treat, produce, consume our food is shit.
The way we treat our land and each other is shit.
And in some big mega way the fact that we have one of the unhealthiest populations in the developed world is a reflection of that.
B: It’s like we’re imploding.
A: I think Wendell Berry is right on this one.
I think community is the smallest unit of health, not the individual.
Like you can’t take an isolated single individual and say, “I’m gonna make that thing healthy!”
Because we don’t even know what health would mean for that person outside of their community/context/life.
I wonder if we can change the delivery of healthcare so that it’s centered on community (not the idea but real communities that exist).
B: Damnnnnnnnnnn now I feel like I’m having a existential crisis.
What’s the point of designing and building a bunch of individual buildings when I don’t even know if it needs to exist in the first place?
Like Trump Tower, you know?
At the end of the day it’s Trump Tower.
Architecture tells you how to design a building presuming it’s gonna get built.
It says nothing about what structures/spaces are truly required.
So how does architecture start changing that?
B: I don’t know.
I don’t think it’s a one-liner.
But I keep coming back to this idea of home.
As in, having family across walls.
Maybe for one community, what they need is a large shared kitchen.
For another, an indoor basketball court.
Another, a daycare center.
I wouldn’t know unless I’m there, you know?
I wouldn’t know where to start or what to look for unless I’m part of the community.
B: TBH, I think I’m less concerned now about making pure architecture than to live in a place that I can build memories with.
Life itself is beautiful.
I think we forget that as architects.
You can see it in the photos of our projects because most of them don’t want people and messy stuff in there.
And we think that that’s the most perfect state that the building will ever be in.
Yea that makes a lot of sense.
We all talk about the SFs, the NYCs, the Bostons…
But what would it look like to love what is hidden from plain sight, you know?
And not to go for the BANG, but for what simmers.
Simmers for years and years and years.
I think for doctors and architects that’s probably the most important skill.
I think it’s about love.
To be a true human who loves other humans.
And to hone your eye for the hidden things.
So that you can do truly what is good and what is required.
Not just what is flashy or gets noticed.
B: True, but it’s hard.
Maybe I should just be like Robert Moses.
B: I kid.