The entire medical system is built around the assumption that patients have families. Hospitals assume someone will sit with us around the clock. They assume someone can pick us up from the hospital on an hour’s notice. They assume someone can take a day off from work to wait during a procedure.

The reality is very different.

Patients skip important procedures because they cannot satisfy these requirements. Some ask strangers to pose as relatives. Some sneak out quietly to avoid the discussion altogether. In some places patients can hire medical transport or private aides, but that can be expensive even when it is available. The quality is not necessarily better than a taxi. Background checks for medical transport workers can be sporadic and sketchy.

Even worse, the requirement is not always medically necessary.

Some hospitals classify patients as “impaired” after a local anesthetic or after a mild sedative that would still allow the President of the United States to resume office. Running the country seems slightly more complicated than calling a taxi or a rideshare.

And why must someone sit in the waiting room during the procedure itself? What exactly are they supposed to do if there is a crisis?

Employers will often encourage workers to take time off for a spouse or child undergoing a procedure. In the United States, the Family Medical Leave Act applies to families, not friends.

Once a surgical coordinator was giving me a hard time about scheduling outpatient surgery. Finally I asked her a simple question.“Could you take time off work to give a friend a ride to a medical procedure?”

She thought for a moment and said, “No, I have to work.”

Then a light went on.

She scheduled my procedure early in the morning so it would be easier for the person picking me up.

What still boggles my mind is how difficult it can be to get post surgery instructions in advance.

The same staff who assume you are too groggy to get home alone often expect you to absorb complicated instructions afterward.

I have had to explain more than once that if I need to buy anything, I must do it in advance. I cannot send someone out at the last minute.

Medical staff sometimes ask invasive questions about how a single person will manage after surgery.

They rarely offer solutions. I have heard of patients being denied procedures because doctors decided they lacked sufficient “support.”

The irony is that single people are extremely good at finding creative solutions when help is needed.

Coupled people often do not even know what options exist. Once a doctor asked me anxiously how I would manage groceries after surgery. She seemed surprised to learn that a city like Philadelphia offers endless delivery services that are affordable and easy to book.

The casual comments by medical staff can also be shockingly insensitive.

A technician once said to me, “It’s too bad you don’t have children to help you with this.” Would she say to a gay man, “It’s too bad you have a husband instead of a wife”?

People have been asked similar questions in the middle of examinations or procedures.

Meanwhile hospitals invest real money in making their facilities more comfortable for families. They spend almost nothing making the experience better for single patients, even though we are a rapidly growing part of the population.

Half of all single people say they want to remain single, according to a Pew survey. They are not waiting for marriage or long term partnership. Online communities devoted to single life now have thousands of members who are not interested in dating. Universities have begun offering courses in Single Studies alongside Women’s Studies and Queer Studies.

Only the medical world seems determined not to notice.

Second, many patients today live alone.

When hospitals first began placing patients in shared rooms and installing televisions everywhere, society looked very different. Most people lived in families, often large families with several generations under one roof. Living alone was relatively rare.

As recently as the 1970s it could be difficult to book a single room in some European hotels.

Today the landscape has changed dramatically.

In Philadelphia, where I live, one out of every three households consists of a single person. In some places the number approaches fifty percent. Single people no longer wait for marriage to buy a home. That idea is as outdated as a rotary phone.

Not all single people live alone, but many do. And when someone who has lived alone for years suddenly finds themselves in a hospital environment, certain experiences can be excruciating.

At some hospitals, including excellent institutions like Penn Medicine, patients cannot reserve a private room even if they are willing to pay for one. For someone with five children at home, sharing a room may be mildly annoying. For someone who has lived alone for ten, twenty, or fifty years, it can be unbearable.

If the noise becomes overwhelming, staff may suggest wearing headphones. But headphones block the environmental awareness that many people who live alone develop over time. We learn to monitor our surroundings. That radar does not turn off easily.

I have met people who delay or avoid medical care because they dread the chaotic environments hospitals often create.

You can see similar behavior elsewhere. Online communities for women traveling alone frequently discuss the importance of private rooms. Many solo travelers resent paying extra for them, but they still do it to preserve a sense of control and calm.

People who live alone are simply not accustomed to sleeping through the sounds of other humans nearby. We stay alert at night unless we have a very reliable guard dog. I had one for many years and it made a remarkable difference.

Over time I have learned which noises in my home mean nothing more than  “It’s just the cat.”  I do not want to lose that instinctive awareness.

Third, some people enjoy a healing relaxation experience with television. Others need silence.

Some single people keep a television or radio running all day. Many of us do the opposite. When we are not actively watching or listening, we turn everything off.

Music is easier to control because it can be blocked with headphones. Television noise is far harder to escape.

Whenever I walk into a waiting room with a television blaring, I think to myself, “These doctors cannot possibly care about anyone’s blood pressure.”

If they wanted accurate readings, or even a calmer environment, waiting rooms would resemble the quiet car on Amtrak. People would use headphones and avoid phone conversations. I wrote about this in another article.

Modern television is also highly segmented. Programs target narrow slices of the population. It can be almost impossible to find a show that appeals to everyone in a waiting room.

Shows about home renovation or cooking leave me cold. I live in a small urban condo and rarely cook. Even if I did cook, I am not sure why a doctor’s office would encourage patients to watch chefs prepare elaborate desserts that contribute to heart disease and diabetes.

And even if you enjoy a particular show, who wants to watch the middle of an episode and leave before the ending?

In an era of inexpensive portable devices, why not let people bring their own audio with their own headphones?

A doctor I know socially once suggested I bring earplugs to the waiting room. Even if they worked, and they rarely block out television noise completely, I would not be able to hear my name called. When I ask to be called, receptionists often respond bluntly that it was my problem.

Medical facilities effectively subsidize patients who enjoy noise and television. Those of us who need quiet to think are expected to bring our own equipment, tolerate the sore ears associated with noise cancelling headphones, and accept being treated as difficult.

Noise sensitivity also tends to increase with age. I have not seen formal studies, but informal discussions online suggest it is common. Constant noise interferes with concentration, with conversation, and potentially with accurate medical assessments.

When I raise these concerns, staff often respond with a shrug.

“Most people like television.”

Maybe they do. But no one has actually asked. And even if they have, popularity is not a good medical argument.

Most people also like sugary soda. We do not hand patients cola in the waiting room. Television can function like the sugar soda of the mind.

Medical staff often seem genuinely puzzled by requests for quiet. Once, while recovering from surgery in a blissfully silent private room, a nurse could not understand why I did not want the television turned on. She was sincerely baffled.

Receptionists can be surprisingly defensive about it. One technician protested when I declined a blood pressure reading after sitting in a noisy waiting room.

“But that’s a good program,” she insisted.

I had no idea what program she meant.

To make matters worse, I’ve seen waiting rooms are arranged so that only a few seats can actually see the television. Everyone else hears an indistinct roar that is too loud to ignore but too garbled to follow.

The result is the worst of all worlds.

None of these problems are difficult to solve.

I suspect there may even be financial incentives behind the endless televisions. More than one doctor has commented online that administrators insisted on installing televisions despite their objections. In the American medical system, business decisions often override common sense.

Yet I have also seen clinics that take a different approach. Some waiting rooms have no televisions at all. One even posts a large sign asking patients to take phone conversations outside.

No one complains. Staff say it makes their work easier. Why can’t everybody do this?

Imagine a simple alternative. Remove the television. Encourage patients to bring their own audio and headphones if they want entertainment. Provide reading materials the way waiting rooms used to.

Most important of all, the medical world needs to recognize that single people are now a major demographic. They need to know that more of us are living alone.  And staff needs to recognize that noise affects patients differently.

For some people television is soothing background distraction. For others it is the equivalent of a medication that causes agitation and stress.

Medicine already understands that the same drug can calm one patient and enrage another. Why not apply the same principle to the environments where patients receive care?

Hospitals now invest in specialized equipment to protect premature babies from noise. Surely adults deserve at least a fraction of that attention.

Instead we are told, with a shrug, that hospitals are noisy places.

They are noisy because nobody has decided that quiet is worth paying for. And the medical world has underestimated the impact of silence and solitude on health and healing.