When it comes to asking doctors if they’ve washed their hands, most patients are washouts.
In my doctor’s waiting room hangs a cloud, ominous, but invisible. More accurately known as the microbiome, it consists of our unique fog of germs, the combination of all our microbial interactions that follow us wherever we go. What concerns me is the state of the germ-cloud of the patient coughing next to me. Listening to his guttural hacks, I imagine it thickening with droplets of ever-virulent microbes, becoming a storm cloud of contagion. When my doctor in Toronto calls him into his examination room, my anxiety rises. How quickly will those microbes settle into his palms? And dare I ask my doctor if he’s washed his hands before examining me?
Asking the hard question isn’t easy.
Apparently a large majority of people share my trepidation about my doctor’s reaction to the hand-washing question. Although most of us know that frequent hand-washing is the best way to prevent infection, two new studies show that we aren’t any more comfortable now than a decade ago with the idea of asking doctors to lather up or reach for the hand sanitizer.
For elderly people—especially women raised in the docile June Cleaver 1950s— questioning a doctor is not just awkward, but inconceivable. But nearly 100,000 deaths a year are linked to infections picked up in doctor’s offices, nursing homes and hospitals, and most of those fatalities are likely to be the elderly.
One reason healthcare workers only wash their hands about 40 to 50 percent of the time, is that they’re overwhelmed by other tasks, and simply forget. To that end, the CDC (Centres for Disease Control and Prevention) is encouraging patients and their loved ones to take matters into their own hands, with a video titled “Hand Hygiene Saves Lives” showing them how to tactfully broach the subject.
In one scenario, a doctor comes into a room, and the patient says, “Doctor. I’m embarrassed to even ask you this, but would you mind cleansing your hands before you begin?” When the doctor replies that she has already washed them, the patient persists, asking if she could wash her hands in front of her.
Fortunately, I don’t need video instructions for asking my doctor, as he too encourages patients to be assertive in this area. Addressing patient concerns is part of his job he explains, going on to admit that a couple of his patients have asked him to wash his hands—one even insisting he use soap and water rather than the antibacterial gel! How to approach your doctor? My doctor recommends stating your request clearly and politely.
“Simply say, would you mind washing your hands before examining me? If the doctor keeps in mind that hand hygiene is our goal, hopefully he or she will not take it the wrong way.”
But what if your doctor does take it the wrong way, and becomes defensive, or even hostile? Understandably a lofty surgeon with years of medical school may not take kindly to a Dr. Google graduate telling him what to do. And on a practical note, over-washing could leave hands red and cracked, and vulnerable to infection. Michael Gardam, Director of Infection, Prevention and Control at Toronto’s University Health Network says he has seen healthcare providers scream at patients for daring to challenge their authority.
“It’s obviously not acceptable to scream at patients,” my doctor says. “If your doctor gets upset over being asked to wash his or her hands, remain calm, and say that I’m sure we both think hand hygiene is important—especially in healthcare environments. Hopefully it would defuse the situation and again remind the doctor that hand hygiene is in everyone's best interest.”
And if that tactic is a washout? You might want to consider finding another doctor.
You can find the “Hand Hygiene Saves Lives” video and other patient empowerment materials here.
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