Wednesday, March 9, 2011

NEGLIGENT HOMICIDE: Doctor, please take your filthy hands off of me!

Doctors deserve the claps. Plain folks merit applause.

     (march 29, 2015) A new study of 4,000  hospital personnel at 37 hospitals found more than 14 million instances where a caregiver had contact with a patient and should have washed his or her hands and did not, according a report on NPR last week. "Thousands of patient deaths and millions of infections occur,  and tens of billions of unnecessary dollars are spent" as a result of medical personnel's failure to wash their hands, the study authors concluded.
    This is important: In a study published in the journal Clinical Infectious Diseases, hospital workers who were not aware they were being monitored washed their hands less than 10 percent of the time. 
    If a doctor won't wash his hands between patients, he should be fired -- not seduced with the promise of free pizza if he'll change his ways. On May 28, 2013, the New York Times described the extraordinary -- and truly pathetic -- lengths to which hospitals are going in order to entice doctors, and other front-line personnel, to practice basic hygiene.
    Some hospitals are handing out gold stars (I'm serious) when medical personnel comply with this fundamental imperative (yay! back to kindergarten!), but they're awarding dining-out coupons and other prizes as well. Some turn it into a contest, with an Honor Roll, a big jackpot and a buffet dinner party.
    This got me thinking: Why should these overpaid hotshots be the only people in the workforce who are given gifts simply for doing the basics of their jobs? I propose that the dear ladies in that same hospital who diligently and thoroughly scrub toilets, cope with fecal incontinence, and clean up vomit be treated to a Hawaiian cruise.

     The sweet, shy checkout girl at the grocery store deserves pearl earrings and a pair of super-cool shoes (and/or a tuition waiver, if she wants to go to college) for ringing up my big heap of fresh produce accurately. The same goes for  the tattooed dental hygienist with purple-streaked hair, who peers so conscientiously at every teensy millimeter of my gum line and painstakingly probes each tooth to be POSITIVE that it's okay. 
    I propose that the gentle Iraqi refugee (thanks, America, for making Baghdad unlivable), who offers $10 haircuts in my neighborhood, be given an iPad and a pair of Dolce & Gabanna "Elite" sunglasses simply for not severing my jugular vein while giving me a perfect trim.  The waitress who gets the orders right and remains polite, despite being treated as a nonentity (and being paid the federally sanctioned $2.13 per hour), should be presented with a once-a-week luxury day-spa pass, entitling her to the full treatment. Give her a cashmere bathrobe, too -- my doctor loves his. At less than $1,000, it was well worth the price, he told me.
A Neiman Marcus exclusive.
     Why do we have to pay doctors more for doing the basics than we're already paying them? Isn't a thorough sudsing as fundamental as showing up, when you are caring for vulnerable people in a disease-ridden environment? Are they waiting for us to give them a hand?
Some people need constant applause to keep them on the right track.
    Why are we spending additional money, in the most expensive and bloated health-care system in the world, to baby these Masters of the Universe, who apparently think the rules (and Scientific Verities) don't apply to them?
    UPDATE: A University of California, San Francisco, program has resorted to bribing residents with a $400 reward if they discuss and record end-of-life preferences with their patients. Compliance rose from 22 percent before the incentive program to 90 percent. If doctors get payoffs for doing the right thing, why don't the rest of us? Bribery is delightful for everyone involved. I think someone should slip me an envelope filled with $20 bills for updating my blog posts. (
    It has been proven that diligent hand-washing by medical staffers would save tens of thousands of lives every year in the nation's hospitals. (In a pilot program in Miami, patient deaths from hospital-borne infections plunged 89.9 percent.) 
    So why are we playing games, and saying "pretty please"? Did you know that some hospitals have installed cameras in every room, and that people in INDIA are watching, waiting to pounce on anyone who tries to slip past the sink? (This program was adapted from the meat industry by Arrowsight, developer of the motion-sensor camera system.) The Indian workers probably get bonuses for every "catch," adding even more to  your hospital bill. They must think we are a hilariously primitive country to have such clueless baboons manhandling sick people.
    Excuse me. It was incredibly careless of me to imply disparagement of baboons.
I apologize. I am very fond of your tribe.
    Imagine what our country would be like if all of us were as  suspect as doctors! (Well, I guess it would be just like it is: people spying on everything we do.)
    An entire new industry has been created that is developing technologies to monitor hand-washing compliance. It involves sensors, lasers, radio-frequency ID chips, eagle-eyed loiterers (sort of like "secret shoppers" or undercover intelligence agents), blasts of music or hissing air, microbe-alert bracelets, hand "scanners," high-tech "sniffers," and a whole bunch of new stuff that was probably invented while I was writing this. It's exciting to watch as great minds tackle this challenge.
    For those doctors who need a more "human touch" to alter their habits, "hand-washing coaches" have been deployed. Perhaps this new career path will put a dent in our unemployment statistics. I wonder if the coaches actually get to mingle fingers in the suds with those heroic Healers of Mankind as they perform their "coaching" duties.
    All of this infantile hullabaloo over a simple task is because our doctors can't seem to do what all of us learned as toddlers (can you hear your mother?): "WASH THOSE HANDS RIGHT THIS MINUTE!"

And put on a happy face while you're at it!
    Hospitals are desperately trying to lure those stubborn guys to do the right thing, because they'll lose Medicare funds if they don't. They've asked non-medical staffers to give "red cards" surreptitiously to dirty-handed doctors, reminding them  -- in a "respectful, nonconfrontational manner"--  that they are not doing their part. Even so, the program was discontinued, because of the "negative connotation." It was "like getting a traffic ticket."
    Dr. Brian Koll, chief of infection prevention at Beth Israel Hospital in Manhattan, agrees that egos must be carefully tended.
   "You don't want to say to a doctor, 'You did not wash your hands'," he says.
    If you do, lord knows what might ensue.
    Really though, with the right attitude, we can turn this problem into, um, lemonade. There's grant money out there from NIH, so let's get this party started! Pep rallies, slogan contests, adorable badges, silkscreened golf caps ("I'm a Clean Machine!") -- let's hire some team-building consultants and figure out how to "sell" this hygiene concept. It could be fun and creative. It could boost morale if we handle it without hurting anyone's feelings. High fives all around. (Uh oh -- that's germy.) Something akin to school spirit could be created around a "culture of handwashing."
And doctors are people who really need to be "in."
    Brilliant idea number one at a hospital in the Bronx: Hand out coupons for free Caramel Ribbon Crunch Frappuccinos, with crunchy sugar topping, to any doctor caught washing his hands! Doctors love coffee. Especially free coffee! Especially with crunch!
    Brilliant idea number two: The patients' "welcome" packet asks you for a little favor: "Please politely encourage your doctor to wash his hands for the welfare of all involved."
   WTF? Are they kidding? These are very ill people who are paying thousands of dollars A DAY to be here. It's not their job to coddle or supervise the doctor, even if they have the courage to speak up (which I must admit, I wouldn't, if I were the patient. You're totally at their mercy).
    Meanwhile, the real grownups of the world do their jobs with dignity and diligence, no gold stars in sight.
In so many jobs, no one even acknowledges that you're there.
    If we're going to give prizes to doctors, we shouldn't  exclude everyone else from the festivities. Fairness is the American way, right?
    Those who show up day after day (year after year) to do spirit-killing, mind-numbingly repetitive tasks -- whether in some glum bureaucracy, corporate headquarters or factory -- should get the biggest flat-screen TVs available, and all the channels, for free, forever. Or ATVs for them and their kids, if they prefer. Or a backyard swimming pool. Or all of it!

She works hard for the money (so hard for it, honey), will they ever treat her right?
    That bus driver who managed to get us all downtown without causing even one head-on collision should get Super Bowl tickets, hotel accommodations, the works.
    Those heartwarming Mexican people who spend eight to twelve hours a day, bent over in the heat, picking our produce or laying asphalt on our roads, should get a one-hour catered lunch (siesta couches provided) inside a cheerfully decorated, air-conditioned tent every day, and an extra $100 bill at the end of the day, if they performed their duties (as they always do) without whining, spewing exotic-sounding profanities (Spanish is such a beautiful language) or collapsing from heat exhaustion.
You deserve a break today, you honorable people from south of the border!
     The USDA mandates that agricultural workers be "clearly and assertively" educated in hand-washing requirements. If they don't comply, they can be terminated. If doctors do comply, they get a family pass to a fabulous water park. 
    The legions of handymen and plumbers, electricians and installers, masons and roofers, who just keep getting it right every day without so much as a nice pat on the ass should get a four-day weekend escape to a beachfront resort with unlimited Margaritas.
    In fact, come to think of it, everyone who isn't in the Top Ten Percent should get a 100 percent raise. Wouldn't that be the fairest way to handle it? I guess it should be on a sliding scale, with those who are currently being ripped off the most getting the biggest raises. If we made things more equal, the Top Ten Percent might not feel so special, but really: They're not so special.
    There are so many diligent, conscientious people out there in the world -- you know, everywhere you go -- who greet you and fulfill their duties toward you with kindness and good cheer, despite being paid like crap.
    So why is your millionaire doctor enjoying a night on the town just for irritably sudsing his fingers? 
"Is everything satisfactory, sir?"
    As I described two years ago in "Thank You For Your Service"(, we have an economy that bestows the most piddling rewards on those who do work that is the most mind-numbing, spirit-killing, dangerous, exhausting, stressful, demeaning, and boring. They work like hell, and they can still barely make ends meet. 
    They have none of the security, status or lifestyle amenities that are guaranteed to doctors, but I bet they wash their hands! At least they would if someone's life depended on it.
    But they are dispensable. They rarely get any acknowledgement of any kind for a job well done. To most of us, they are invisible. 
    Doctors say they are too busy to be constantly washing their hands for the requisite 15 seconds. Everybody else is busy, too, but they'd better do the basics of their jobs if they want to keep them.
     Doctors say all that cleansing leaves their hands chapped and painful. The workforce is filled with people who are in chronic pain because of their jobs. Deal with it! Since you're so smart, find a way to disinfect your hands that's quick and soothing. Whatever! 
    Many studies over the years have indicated that doctors are "resistant to authority," and won't tolerate being told what to do. The little wearable alarms that some are required to clip on don't make any noise if the doctor doesn't wash his hands -- they vibrate, "so he won't be humiliated in front of the patient."
    This would make for a hilarious sitcom if it weren't for all those dead people. But maybe if doctors got a good dose of humiliation, and humility, they'd gird up their loins and do their duty, like everyone else.
    In the meantime, the rest of us should dedicate ourselves to staying healthy and avoiding those cesspools of disease known euphemistically as "medical centers." If we wash our own hands often enough, that's a good start. 

(A version of this story appeared on this blog June 12, 2011)