Entries for January 2008

Corrected on 1/24/08: An earlier version of this blog misspelled Mark Rupp's name.

If only those doctors and nurses would wash their hands...

Hand washing is one of those perpetual skeletons in medicine's closet. Infections acquired in U.S. hospitals kill an estimated 100,000 patients annually—yet only about 40 percent of doctors, nurses, and other hospital caregivers clean their hands before touching patients. It's not as if hospitals aren't trying. Posters are displayed. Briefings are conducted. Dispensers of germicidal hand gels have sprouted on walls outside (often inside) patient rooms so caregivers don't have to scrub at a sink (to be rewarded at the end of the day with chapped hands). Don't they get it? That clean hands would lower the rate of infection and lead to fewer deaths?

Good morning, passengers—this is your captain speaking. There will be a brief delay before we leave the gate. For your comfort and safety, we've added a couple of extra steps to the preflight checklist. The flight attendants will be handing out consent forms to make sure that's OK with you. Please read your copy carefully, and if you're satisfied that none of your rights are being violated, sign it and turn it in so we can get you to your destination. Thanks for your cooperation.

Think you'll hear that announcement anytime soon?

It almost would be less surprising, at least to me, than a federal agency's recent disruption of a study meant to see if following a five-step checklist—simple things like cleaning the skin with a disinfectant soap before inserting a catheter—could reduce infections and deaths in intensive-care units. It could and did. In the first 18 months, the infection rate in 108 ICUs at 67 Michigan hospitals was slashed by two thirds. It was reported in the New England Journal of Medicine at the end of 2006.

We all screw up. Me. You. Doctors and nurses. Mistakes happen. But the damage spreads like spilled acid when those who make mistakes don't learn from them. Or, worse, when they act as if nothing happened or even lie to cover up their error or incompetence. Being a patient is an act of trust; eat away at that trust, and patients who need care may begin to hesitate to ask for it.

Three new videos posted at Health Care for All, a Massachusetts nonprofit trying to improve the quality of and access to healthcare, are reminders of our vulnerabilities, whether we're patients or caregivers.

Last week, after my story on complementary and alternative medicine (CAM) went up on our website, I did a bit of keyboard out-loud thinking—can I call it blogmusing?—on the topic. The volume of comments has been unusually heavy, with the expected bright line separating those who castigate me for publishing nonsense from those receptive to CAM. It has been a useful discussion, but I'd like to clarify a couple of points.

I did not state in the story or argue in my blog post that CAM can cure—that it can address the underlying cause of an illness and treat it effectively. I did not write that the explanations put forward by CAM proponents and practitioners for the supposed mechanisms powering their techniques are logical. And I did not say that CAM studies have been well designed and executed or have produced noteworthy findings.

I'm sorry—I really didn't intend for the blogless days to pile up like this. The holidays... A day off here and there... And, in particular, a difficult story to write about alternative medicine now up on our website. Blogging chores just had to wait.