During the course of one's life, one encounters literally thousands of incidents that slow the flow of life around; and through the individual we hinder the develop1ent of an efficient life style. In many cases, it seems that we, "hurry up and wait." In others, we are slowed to the point of standstill, and then must rush to be on time for other things. These incidents seem to be a byproduct of modern society. As a society grows larger and more complex, one must make many concessions to others that are not needed in a hermit-type of life or in a much smaller societal grouping. Instead of dealing in goods and trade alone, our society now deals more in services. These services are people-oriented and therefore should be at the disposal of the client or customer. Instead, they are often at the convenience of the organization which provides the services. For example, bank hours are typically from 9 am to 5 pm. In some places, like at my bank, the hours are from 9am to 3 pm, only staying open till 6 pm one day a week. For people who work during those hours, these short hours preclude their use of the facilities, unless one is able to leave the place of employment during those hours. This is not possible for a good number of people. Some banks, in an effort to increase their business, have begun staying open till 9 pm. Even so, this is only one branch of the facility, and people must drive many miles to find the open branch. Another solution would be to offer limited services at each branch, perhaps at a drive-in window, such as deposits and withdrawals, to accommodate those who work late. I was previously employed under such conditions, with my job requiring me to work. from 7:30 to 5 to 6 pm, and so had my salary deposited directly in the bank. Then one really gets the feeling that he or she is working for nothing.
This research report will discuss some of the incidents similar to that discussed above, as gathered from personal observations, from discussions with my husband, and from discussions with colleagues.
Incident Number 1.
Date-October 20, 1977. Time- 3 pm.
Situation: I was driving on the H-1 freeway from the UH to Liliha. Construction work was in progress near the Alexander Street on-ramp. Traffic flow was slowed down. The signs indicating merging of traffic away from the obstructed lanes looked terrible. This type of a sign does not indicate merging of traffic, only loss of an intermediate lane. To indicate merging of a lane, the traffic signs should look more suitable. This would show a motorist that the lane would be closed.
Incident 2. Date- 10/25/77. Time- 2:30 pm.
Situation: I was driving mauka on Piikoi Street. Traffic was obstructed from the freeway on-ramp beyond Kinau Street to nearly Kapiolani Boulevard. The problem area seemed to be on the corner of Piikoi and Beretania, where a building for "Church's Fried Chicken" was being erected. Large trucks were entering and exiting from a driveway on Piikoi St. For this two lanes of traffic had been blocked off, but no signs were erected to show that traffic flow would be reduced. An off-duty policeman was on duty directing traffic at the site of the construction area, but no one was on the other side of the street. Because there is normally quite a pile-up of traffic in lane 2, since it leads to the west-bound on-ramp to the H-1, traffic was backed up as previously indicated. I felt, apparently along with many other motorists, that there should have been signs to indicate traffic changes, and there should have been an alternative entry into the construction area, such as from Beretania Street, rather than from the already crowded Piikoi Street.
Incident 3. Date- 10/26/77. Time- 1:45 pm.
Situation: I was at the Bank of Hawaii, Ala Moana branch. Even though it was long past lunch hour, only 10 out of 30 windows were open for customers There were 24 people in line ahead of me, and in another line, there were 30 people. Each person took one to four minutes to complete transactions. They should have more than one-third of The windows active on a weekday at that time of day.
Incident 4. Date- 10/26/77. Time- 1:45 pm.
Situation. Also at the Bank of Hawaii, Ala Moana Branch. I have an automatic deposit, which they transfer funds directly from my checking account into my savings account on the first of every Month. Since customers are not allowed to write these deposits into their passbooks, one is never quite sure of one's balance in the book. A separate page should be provided in the passbook for customers to enter such transactions, which could later be verified by the bank's tellers.
Incident 5. Date- 11/3/1977. Time- 1 pm.
Situation: I have observed the length of time it takes to prepare for each lecture in Psy 222. From the selection of orthographies designed to illuminate each lecture, I am not always able to easily focus on the topic, as it is not clear what the topic focus is. I and other class members have also noticed that the lectures do not clearly specify the topic focus, making it additionally difficult to follow the topic. Perhaps the specification of each lecture's topic focus would reduce much of the dissonance felt in preparing for and listening to each lecture.
Incident 6. Date- Nov. 3, 1977. Time- 12pm.
Situation. In the rear of the auditorium in which Psy 222 classes are held, students often talk and distract other students from the lecture. The professor mentions this situation at the beginning of class, and many members or the class (including myself) feel that valuable class time is wasted by repeating what the students should have heard at each previous lecture. A system should be devised that the students guilty of the interruption would suffer some kind of penalty. This could take the form Or reduction in points towards the final grade, or having the T.A.'s hand the offending students a slip of paper warning them of the disturbance they create in the class. This has seemed to be a problem in any large class, and I have never seen it solved satisfactorily yet.
Incident 7. Date- Oct. 25, 1977. I1ime- 10 am.
Situation. In the clinic of a local hospital, the patients come in at 9 am, have blood work drawn, and then must wait for an hour while the lab processes their blood. Then, depending on the level of the white blood cell count and various other indices, the nurse decides to either give an anti-cancerous drug or withhold it. During that hour, there is nothing for the patient to do but wait. This situation was observed by four nurses I interviewed, and by myself as well, when I was in their position. My suggestion is to have two or three rooms for the patients to congregate in during their waiting period, as there is no way to reduce this time. One room would be used as a coffee room combined with socializing room, where patients could give each other mutual support. A second room could be used by a nurse or psychologist to counsel patients during this time, either in group therapy or in individual sessions. Or a third room could be used for a Fairchild projector (a small cassette operated projector with a self contained screen) for educational films, especially those pertaining to health and the medications a patient received, or to potential side effects of the drugs. Another alternative would be to invent a faster way to do the blood count so the results would be available in 5 minutes, for often the counts are too low for the drug to be given that day.
Incident 8, Date- Oct. 25, 1977. Time- 10 am
Situation: A nurse I interviewed operates a cell separator, a machine that removes the white blood cells from a unit of blood that is withdrawn from a donor and then returns the rest of the unit to the donor. The nurse had noted the institution retained her part time, yet she was called on her off-duty time to run the cell separator. She noted other institutions were in the process of buying their own cell separators. She was upset by the practices of the institution in calling her on her off time, when if she was retained full time, this type of call-in would be reduced to almost nothing, except an occasional weekend call. I feel the community needs a group of specialty prepared nurses. These nurses could be in joint practice, and receive contracts from various institutions to provide such services as cell separation, administration of chemotherapy (anticancer) drugs, teaching nurses, patients, and their families postoperative care and how to live with their new body images and new body functions after a colostomy, breast removal, or removal of the bladder or kidneys. As it is, there is a lack in the health care system in consistent teaching and home care of most types of illnesses. This system could include teaching of diabetics, those with gout, arthritis, or other types of problems that require changes in nutrition. Some of this need is set by the Honolulu Home Care nurse system, but it is based at St. Francis Hospital and is not designed for the community use. I only wish I had time to start such an organization; it would be very well accepted by the community.
Incident 9. Date- Oct. 13, 1977.
Situation: I interviewed my husband and his only large unsettling problem had to do with the inability to understand how the medical profession could police its members and their behaviors. In the last year, five members of the profession have come to his attention because of aberrant behavior. One drinks heavily; one is a manic-depressive who refuses to take lithium, supposedly because of his high productivity in the manic phase; one is known to commit unprovoked acts of aggression towards colleagues, knocking one down in the corridor near an operating room; one falls asleep in front of patients and is suspected of being a drug addict; one has caused 4 deaths during surgery over the last 4 years because of the careless way anesthesia is handled by him. The latter was reviewed by the board and was told to return for additional classes or his license would be revoked. He has attended classes on the mainland, but his attitude is unchanged. When one is employed by an institution, one is liable to the institution for behaviors while on the job, but in the case of one who has his or her own business, it is nearly impossible to know what goes on behind the closed doors, and there is no current way to regulate the professionalism of any profession's individual members. My husband, who has been in private practice as an M.D. for 25 years, has been very much against government control of medicine, but now feels that perhaps this is the only way to help control such behavior. The majority of the members of the medical profession are good, but those few who are not, he says, need more close supervision. He feels that those who practice as described above way lead the entire profession to change its stand on government control of medicine.
Incident 10. Date- Oct. 4, 1977. Time- 3 pm.
Situation: I went to the library to find the article I had written to Xerox a copy for a request for reprint that I had received from Hungary. I was angry to find it had been torn out. If the person had wanted a copy so badly, he or she should have made a Xeroxed copy, as the Xerox machine is nearby. They inspect a library user's personal belongings for books they have not checked out, but there seems to be no way to check for articles torn out.
Incident 11. Date- Oct. 24, 1977. Time- 3 pm.
Situation: I was talking to a neighbor of mine who has cancer and is in the terminal phase. She is aware of her diagnosis and of her prognosis. She talked of her awareness of
her impending death and of the plans she had made for the funeral. She said she planned to be cremated and have her ashes "thrown out to sea." She said her daughter could not accept her resignation to her impending death. I know her physicians, and know one of them is very good with interpersonal relations, and the other seems to act as if he doesn't care about them at all. From her statement about "throwing
(with the word emphasized) the ashes out to sea, and from her attitude, I could see she has a false acceptance of the finality of her condition. I could also see she was not in a position to discuss it. She said if she lived 3 more months, she would then begin to fight her disease. I don't know why she set three more months as her limit, for her condition certainly will not allow/ her to live that long, and I think she is really counting on this. There should be some mechanism by which all cancer patients are counseled as to their feelings about their disease and its treatment. I think all families of cancer victims should also be counseled, so to take the pressure off the ill person. One means that could accomplish this would be to give each patient seen in the clinics or doctors' offices a self administered questionnaire (such as the one I am using to discover ethnic differences in response to disease) to discover their feelings. This should be used as a basis for counseling. I believe doctors and psychologists should work in joint practice, one to care for the body and one for the mind, as no one can meet the needs of the holistic person alone. This would be especially meaningful in a practice where the majority of them are cancer patients and others who have a chronic disease.
Incident 12. Date- Oct. 1, 1977. Time- 4 pm.
Situation: I wanted to contact one of the psychology professors to see if-he would consent to my research questionnaire being run in his section (general psychology). He was not in on the four occasions I went to see him. Finally he told me he was not in on two of the days he is supposed to be there on, and leaves early on the other three days. There should be an easier way to get students to participate in a research project. One way would be to have a center on campus where researchers could take their questionnaires. Students could then go there and take whatever research questionnaire was being given that day. In return for their participation, the student could earn up to 5 points for any undergraduate (or graduate) course that he or she desires. This is effective in situations where all courses are graded on the basis of a 100 point system. one point would be given for each questionnaire completed. To avoid breaching confidentiality, the student could give his ID number to the clerk or secretary when picking up his questionnaire, and could tell her or him which course the point is to be credited to and which semester it is to pertain to. It would be checked off and paper work completed upon return of the completed questionnaire.
There were many more situations which arose, but space does not permit discussion of them all. Of the ten people I interviewed, plus my own observations, these incidents were seen:
| Traffic Concerns | 36 |
| Postal Concerns | 6 |
| Construction Areas Causing Inconvenience | 3 |
| Library Concerns | 14 |
| Banking Concerns | 13 |
| Class Concerns (PSY222) | 10 |
| Health Problems | 4 |
| Concerns About the Medical Profession | 12 |
| Concerns About the Care of the Terminally Ill | 14 |
| Concerns About the Wait for Medical Treatment | 15 |
| Concerns about Reasearch Projects | 12 |
This means the public as a whole has been inconvenienced 139 times in the opinion of the ten people I interviewed in the last month. This is not entirely accurate, as is seen in the statistics of the chemotherapy clinic. They average 140 patient visits each month, with each patient waiting an average of 35 minutes from the time of entry into the unit till the time they leave. This is, on the average, 221.67 hours wait time each month. This is time lost to the community. Many people take time off from their jobs, causing more sick leave to be used and more hours lost to the work force. In the case of the concerns about the medical profession, it may mean a person's life because of poor practice by a few members of the profession, and loss of faith in the profession by the lay public as a whole should these incidents come to light. Thus it is better for the profession to police itself rather than the current non-action type of system.
Another way to view these situations is to look; at "personal" versus "public" type of worries, Concerns about the wait for medical care seem, on the face of it, to be concerns about personal inconvenience. When explored further, however, one can see that private inconvenience, When multiplied many times, becomes a public loss.
Private or personal concerns:
| Traffic | 3 |
| Construction Areas | 3 |
| Health | 14 |
| Wait for Treatment | 5 |
| Research Problems | 5 |
This shows that people were more concerned about the particular area than most other people would be. For example, the problems with construction areas broke down to one concern about male workers' remarks, one about the smell of fumes from the area, and one about the appearance of the dirt on the street. The health concerns were both the one listed above called health problems", and the one called "concerns about the care of the terminally ill." Some were light-hearted but with a note of truth in them. For example, I made the observation to one of my colleagues that the body had a mechanism for waste disposal, but the mind did not, so we end up carrying all kinds of waste products around in our minds for 20 to 70 years. I would like to see such a system developed, but fear it must be more perceptual than actual.
Public Concerns
| Traffic Concerns | 33 |
| Postal Concerns | 6 |
| Library | 14 |
| Banking | 13 |
| Class Concerns | 10 |
| Medical Profession | 12 |
| Terminal Illness | 4 |
| Wait for Therapy | 10 |
| Research Problems | 7 |
Of the above lists, 109 problems were seen as lying in the public domain. This shows that most people I interviewed are aware of the interrelationship of private or personal worries with the public domain they are in agreement that these concerns, when multiplied by the number of people who experience each concern each day, throughout the entire society, would cause large amounts of inconvenience.
The people I interviewed were 3 class members from Psy 222, four nurses, my husband, and two class members from Psy 666. Of these, six, (including myself), are concerned about health care and its delivery. The others were more concerned about the daily flow of life, such as traffic, class, and the bank.
Concerns also flow in a macro- micro-cycle. Some of the micro-concerns were about the care of the terminally ill. For example, when a person is dying, nurses as well as family members tend to withdraw, and the person dies in relative isolation, Usually, the dying person has withdrawn in preparation for the last stage of life, and it may not be perceived by the patient. In some cases, however, the person has not lost the desire to talk to the persons he or she cares for, and when all of those withdraw, there is no one left to talk to about this new and strange, and often frightening experience. I felt this in talking to my neighbor, I, who have counseled hundreds of dying patients, found myself without words in her presence. This led my thoughts to wondering why death is such a closed subject. We all will go through it -- we have hundreds and thousands of books, articles, classes, etc., on birth, but none on death. I realize this is changing, and it is something I have often felt. Yet when I talked to Anna, again I felt the sense of "What do I say now to her?" as acutely as I had felt it when counseling my first patient 15 years ago. I have no answers for this one. Because of the proximity of this concern, I find my thoughts returning to the scene over and over, so if I seem "stuck" on it, I probably am. This woman baby-sat for my son when he was only a few weeks old while I returned to school, and I grew quite fond of her. Attitudes towards death have been a concern, both professional for 15 years, and personal since the death of my cousin of cancer six years ago. I get the feeling, when I talk to people in her situation, that efforts at education, I and others have made, have been like trying to desalinate the ocean. Its a nice try, but the fear is so basic and necessary to our daily survival, that I don't know if it can ever be dealt with rationally.
This research report proved something I was not sure of when I started the project to be true after all; that most people see themselves as part of a larger community.
The needs I saw in the health care system are very basic -- how to insure quality care, and how to educate the public to ensure better results in medical care. The idea of a joint practice between a physician and a psychologist is, I think, an idea of the future which bears close investigation. To enable students to get additional points for any course so desired is a very good idea, if one could overcome all the barriers, such as getting all teachers to agree to it. It would take very little effort to change one's individual grading habits, but to convince all of them that it would be worthwl1ile would be another matter. Each would be screaming "That infringes on my constitutional rights to be different!" The right to vary, here, seems to be just as important as tile right to breathe.
Many of the problem areas could be resolved, it seems, if the people in the position of authority and who do the decision making, would apply their private or personal concerns to their professional abilities to solve them. Instead of just shrugging them off, they should pay attention to them and try to formulate policy to eliminate them, knowing that what affects one person is bound to affect many more in any given period of time.
I was surprised at my own inventiveness in problem solving when I just opened my mind and applied professional attitudes to my own concerns. In previous reports, I had noted that I seem to operate on automatic at home most of the time. This was a good opportunity to see that I can think analytically, even while doing the dishes. go to top of document