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Remodeling Healthcare through Architecture

Diana Andersondianaanderson, M.D., M.Arch, is a “Dochitect®,” or physician-architect who practices internal medicine while exploring architecture’s influence within the hospital walls. She has written for architectural and medical publications such as World Health Design, Healthcare Design Magazine, and the Journal of the American Geriatrics Society. Dr. Anderson received her education in architecture from McGill University, her medical degree from the University of Toronto, and completed her residency at New York-Presbyterian Hospital, Columbia University Medical Center.

Dr. Anderson previously contributed to DWC’s Daily Dose on her experiences as a hybrid professional in “A Dochitect’s Story.” I had the opportunity to speak with Dr. Anderson and to learn more about her path to medicine and her work as a dochitect.

C: What does the term “dochitect” mean for you?

Dr. Anderson: The dochitect serves to bridge the gap between architecture and medicine. There is a quote from the Dutch architect, Herman Hertzberger that states, “The architect is like the physician…he must see to it that what he does makes everyone feel better.” The dochitect is able to see from a different perspective and able to bring both knowledge sets together and promote innovation.

C: Can you tell me about your path to medicine?

Dr. Anderson: My architecture education at McGill University gave me the chance to be creative and think outside the box. Then at the end of undergrad, I had a bit of a turning point that occurred at a visit to the Paimio Sanatorium in Finland. Upon entering the hospital, I had an epiphany where I didn’t feel queasy in this space, but comfortable.

I started thinking about how we can make hospital institutions comfortable for patients. I also started doing research on hospital design and discovered this subspecialty of architecture. I ended up pursuing a Master of Architecture at McGill, with a focus on hospital design, which gave me a lot of interface with clinicians and medicine— all that began to appeal strongly to me. I started to long to be on the other side, rounding with all the doctors and nurses in addition to focusing on the planning and construction details of the spaces I studied. This led to medical school.

During medical school, I maintained my interest in design and design-related research. When I entered residency I found myself missing the role of the architect. In a sense, I have never been able to take off one hat completely to put the other on.

C: Can you elaborate more on some of the challenges you faced when you embarked on your journey as a dochitect?

Dr. Anderson: I found that the hybrid model was questioned. At the time, it was not something that was commonly done. The questions I got most were about the fact that in order to become an expert in something, you needed to dedicate most of your time to it. There were a lot of questions about how I could become a master architect or a seasoned clinician if I had other things that divided my interests. I think that is a fair question, but I also believe that it is possible to combine different things into your career.

C: What issue in healthcare strikes you the most, from a physician-architect standpoint?

Dr. Anderson: The main issue for me in terms of healthcare design is elderly patient mobility. What struck me the most while practicing in the hospital was how quickly elderly patients who were admitted could decline.

A geriatrician colleague once told me an analogy for the process of aging: “When you’re young, it is as if you are standing on this mountain and have a long way to go until you reach the edge-you have a lot of reserve in you. But as you age, that ledge gets narrower and narrower and you end up with a sharp cliff, and it doesn’t take much to push someone over the edge.” Sometimes the hospitalization itself can be that push.

An older person admitted with pneumonia needing a few days of antibiotics will often remain in bed, which decreases their mobility. Consequently, their level of frailty increases so much that they do not return home, and require additional levels of rehabilitation or care.

I am trying to push the boundaries of our notion of the hospital bed as a component of room design. It has been found that (in most instances), there is no therapeutic value to strict bed-rest. In fact, for an older person, bed-rest may be more hazardous than the illness they come in with. I would like to see our designs for patient rooms change, and to see mobility promoted as much as possible in order to prevent this cycle of deconditioning among the elderly.

C: How can one’s environment can enhance their overall physical and mental health?

Dr. Anderson: During Florence Nightingale’s time as a nurse in the 19th century, she recognized the benefit of fresh air and sunlight for patients. It seems that we have come away from that, but are trying to circle back. Aesthetics are quite important including ventilation, views to nature and access to sunlight.
A study which appeared in the Journal of Hospital Medicine in 2014 was done to see if patients can distinguish between positive experiences with their environment versus positive experiences with care. While care was the driving factor, the physical environment was significant enough that it was one of the four metrics looked at in order to determine positive patient experience. Many people say that for architects, the concept of place matters, but I would like to suggest that for everyone, design matters.

C: How do you make time for both professions?

Dr. Anderson: I am very passionate about what I do and I get this question quite often. And I always say that if you love what you do, you will make the time and it will not seem like work!

C: Do you think the bridging of fields will be emphasized within medicine in the coming years?

Dr. Anderson: Yes, without a doubt. When I started this dochitect movement, it was seen as a somewhat crazy idea. Many people told me that I could not combine medicine with something else. Being able to watch medicine change within the past ten years, I have encountered less physicians who have come from very strict science backgrounds. Many clinicians do not necessarily see patients full-time. Many of us do different things alongside clinical practice, such as education, research, consulting, health policy, etc.

I also think that the multidisciplinary-based approach will be the future of not only medicine, but also many other fields. The old architecture image is the expert mason who designs the building and lays the bricks himself, and that is no longer a realistic view for larger building types. It takes a team to design and construct a complex building such as a hospital. The same goes for medicine. You go into it thinking that you can take care of a patient on your own, and very quickly realize that patients are extremely complex and it takes a team to come together and think outside the box for solutions.

C: What has been an important piece of advice you received in your dochitect journey thus far?

Dr. Anderson: I think the best piece of advice that I got during residency was to “write it down.” My hesitation was that I would not have time to write the full story, or to write all my feelings.

But even when you put down a word or sentence and come back, it is amazing what you can remember. I think that the creative side helps to maintain the humanism. And this is becoming an important part of medicine.