Entries for October 2008

Like people generally, most patients are not statistics whizzes, but we rightly expect physicians to understand and to be able to place in perspective any numbers that reflect on their patients' health and medical decisions. A distressing report in the journal Psychological Science in the Public Interest argues persuasively that many doctors simply don't, and that anxious patients who make bad healthcare decisions are among the consequences.

An example drawn from the report: a woman who has had a routine mammogram and is told the result is positive. "What does that mean?" she asks her physician. "What are the chances that I have breast cancer?" Her emotional reaction to a high percentage will surely be different than to a low one. In a study of women who had received a false positive on a mammogram, 1 in 8 said the anxiety it created affected their mood and ability to function months later.

I'll be curious to hear about the weapons that will be rolled out tomorrow at a press conference on combating healthcare-acquired infections. It has been billed as a first-ever event, with five leading healthcare organizations linking hands to announce a unified approach to reduce, ideally wipe out, infections in healthcare facilities. The five groups—the American Hospital Association, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Joint Commission, and Society for Healthcare Epidemiology of America—have undeniable clout.

But how much of an answer can institutional muscle provide, really? Many of the tactics that will defeat HAIs are well known and at least in theory not difficult to put into practice. Everyone who walks into a patient room—that includes family and friends as well as caregivers—can and should faithfully sanitize his hands. Insertion and maintenance of central venous line catheters can and should follow established procedures, called a central line bundle, that minimize the chance of infection. Antibiotics can and should be administered before and after surgery based on timing that both reduces the possibility the surgical wound will become infected and minimizes the growth of antibiotic-resistant bacteria. I could go on.