Giving Doctors Orders
Published: April 12, 2011
Fred R. Conrad/The New York Times
When my brother went into the hospital with pneumonia, he quickly contracted four other infections in the intensive care unit.
Anguished, I asked a young doctor why this was happening. Wearing a white lab coat and blue tie, he did a show-and-tell. He leaned over Michael and let his tie brush my sedated brother’s hospital gown.
“It could be anything,” he said. “It could be my tie spreading germs.”
I was dumbfounded. “Then why do you wear a tie?” I asked. He shrugged and left for rounds.
Michael died in that I.C.U. A couple years later, I read reports about how neckties and lab coats worn by doctors and clinical workers were suspected as carriers of deadly germs. Infections kill 100,000 patients in hospitals and other clinics in the U.S. every year.
A 2004 study of New York City doctors and clinicians discovered that their ties were contagious with at least one type of infectious microbe. Four years ago, the British National health system initiated a “bare below the elbow” dress code barring ties, lab coats, jewelry on the hands and wrists, and long fingernails.
The Centers for Disease Control and Prevention says that health care workers, even doctors and nurses, have a “poor” record of obeying hand-washing rules.
A report in the April issue of Health Affairs indicated that one out of every three people suffer a mistake during a hospital stay.
I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us.
Commenting on the new report on hospital errors, CNN’s senior medical correspondent, Elizabeth Cohen, instructed viewers to “ask doctors and nurses to wash their hands” if they haven’t.
“They sometimes will actually give you a hard time, believe it or not,” she said, “and they say, ‘My gloves are on. I’m clean.’ ‘Well, I didn’t see you put those gloves on. What if you put those on with dirty hands?’ ”
I called Cohen, the author of “The Empowered Patient,” to ask her the best way to confront those taking care of you or family members. She said that you have to get over the “waiter spitting in your soup scenario,” that the medical professionals will somehow avenge themselves, by giving less attention, if you insult them.
“There are all sorts of reasons we default to being quiet,” she said. “It is general etiquette not to correct another adult, especially when this is their profession. But when the consequences are so grave, you have to summon up your courage.” You could say that you are a germaphobe, she suggested, and ask if they could please just indulge you?
Dr. Peter Pronovost of Johns Hopkins has been able to prove in a national program that you can curb infections and reduce mortality rates in I.C.U.’s by adhering to checklists, creating accountability and fostering a culture where patients, their families and even nurses and residents feel freer to challenge doctors.
“There’s no doubt that it’s really difficult to question physicians,” Dr. Pronovost says. “It’s hard even for me when my wife or my kids are ill. Many clinicians aren’t the most welcoming. They give verbal or nonverbal clues to say, ‘Hey, I have the answer.’ We just need to change the culture. The patient really is the North Star.”
I decided to work up my courage to give orders to unmindful doctors by starting with another group that has you at their mercy: cabdrivers.
They, too, can put our lives at risk by being heedless. Their constant yammering on cellphones can be just as dangerous as drunken driving, whether the calls are on hand-held or hands-free devices.
As Jane E. Brody noted in The Times, the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association has started a campaign against distracted driving. “Orthopedists would do very well, thank you,” she wrote, “without the business generated by the 307,369 crashes that have occurred so far this year.”
The other day, I finally asked a driver who was absorbed in animated conversation to hang up. But on my next cab ride when the same thing happened, I lost my nerve. I had read that Alec Baldwin was, not surprisingly, a master at demanding that cabdrivers get off their phones. I called and asked for some pointers.
“I tell them to shut off the radio, get off the phone and post their license, because very often the man driving the cab is not the guy on the license,” he said. “If you get in a cab you don’t feel comfortable in, get out of that cab.”
I told Baldwin that I would start giving orders, when necessary, to cabdrivers and clinicians, even though I feared their wrath.
“Of course,” mused the actor who so memorably played an evil doctor in “Malice,” “cabdrivers don’t put you under anesthesia.”
A version of this op-ed appeared in print on April 13, 2011, on page A25 of the New York edition.
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