Hospitals struggle to get doctors and nurses to wash their hands. That's a serious problem, since hand-washing is one of the keys to reducing health care acquired infections that afflict more than a million patients a year and kill over 100,000. And it's one of the reasons you should try your best to stay out of the hospital.
For the past few years I've heard suggestions that patients should take a more active role, and in fact have the responsibility to speak up. The Wall Street Journal (Why Hospitals Want Patients to Ask Doctors, 'Have You Washed Your Hands?') covers the topic again, with a pretty strong message that patients need to take charge.
I strongly disagree.
Here's one excerpt from the article:
The CDC has provided 16,000 copies of a video, titled "Hand Hygiene Saves Lives," to be shown to patients at admission. In one scenario, a doctor comes into a room and the patient's wife says, "Doctor, I'm embarrassed to even ask you this, but would you mind cleansing your hands before you begin?" The doctor replies, "Oh, I washed them right before I came in the room." The wife says, "If you wouldn't mind, I'd like you to do it again, in front of me."
And here's another:
"We've been focusing on intensive interventions to improve hand hygiene among health care workers for decades, yet we've really shown very little progress," says Carol McLay, a Lexington, Ky., infection prevention consultant and chair of the committee that designed the campaign [to get patients to speak up]. "We are trying to empower patients and families to speak up and understand their role."
Am I the only one that thinks the situations described above are absurd?
Here's how I see it:
- If infection control specialists have been failing to make progress with health care workers for decades then they need to figure out what's wrong and fix it, not throw the problem onto patients. Here are some ideas: education to get more buy-in from clinicians on the idea of frequent hand-washing, technology to track whether hand-washing is occurring, harsh penalties for lack of compliance — like closing down a hospital floor, or firing or suspending staff, or making lack of hand-washing subject to malpractice claims. If you believe the conventional wisdom (which I don't — but that's another story) then physicians will be so focused on avoiding lawsuits through defensive medicine that they'll instantly get to 100% compliance on hand-washing.
- The scenario in the video of first asking a doc if he washed his hands – and then not accepting his answer that he just did it but instead wanting to see him "cleanse" his hands again — is ridiculous. That's not my vision of patient engagement.
- Lack of hand-washing is reasonably visible to the patient, but what about all the other things that occur? Is it practical to verify that my doctor performed all the correct diagnostic tests, interpreted the results correctly, made the right differential diagnosis, prescribed the most appropriate antibiotic and dosing level, that the hospital stored the medications properly and disinfected their equipment, that the nurses didn't fake their credentials and that their immunizations are up to date, that I was referred to the right specialists, etc.? All of these things — and many, many others — are important, but I count on the hospital to deal with it and the regulators to oversee that it's done. I want quality ratings that take into account these issues and I don't mind payment incentives that reward certain behaviors and penalize others.
Don't get me wrong. I hate the idea of doctors and nurses not washing their hands. If I'm in the hospital and I see something I'm unsure of I do speak up. I bring an advocate when I'm a patient and act as one for others. I would even bring up hand-washing in certain circumstances.
But I really resent the idea that I'm supposed to be the hand-washing police. Hire someone else to do the job.
This post originally appeared on Kevin MD on October 12, 2013.