Why Most Doctors Don’t Wash Their Hands

by Godfrey Onime

Image of handwashing

At the hospital a couple of years ago, a nurse walked up to me to report that one of my patients was “hysterical.”

“She says to make sure Dr. X never returns to her room,” the nurse explained. I was the patient’s internist and Dr. X the surgeon who had operated on her. Apparently, the surgeon had not washed his hands — before and after touching the dressing on her wound.

I braced myself as I went to see the patient in hopes of placating her. I knew it can be difficult persuading another surgeon to take over the case of a patient they had not operated on, as they may think such patient was a troublemaker.

The patient was laying in bed and talking angrily on the phone. I had seen her the previous day, before her surgery, but not yet on that morning.  In her early 70s, she looked younger and fit. I introduced myself again, more out of habit than her not remembering who I was. I asked what the matter was, and she recounted essentially what the nurse had said.

“I kept watching him and flinching as he examined me and then lifted the bloody dressing on my wound to take a look.  I wanted so bad to say something, but I was afraid he might get mad and do something crazy to me, like purposely infecting my wound. Now that I think about it, I should have told him right to his face.”

Wanting to give the surgeon the benefit of the doubt, I reasoned, “Could he have used the disinfectant hand-rub solution outside the room?” Read more »

The Kidney Dialysis Puzzle

by Godfrey Onime

Arm hooked up to dialysis tubing
Arm hooked up to dialysis tubing – from Wikipedia

“Dr. Onime, your patient in room 607 is throwing a fit,” read the nurse’s message on my iPhone. “He wants to leave. What should I do?”

I was half-way through lunch. I placed a call to the nurse and asked her to try and convince the patient to stay until I got there. “I have called security,” she said, “but we can’t continue to hold him if he doesn’t want to wait.” Gobbling down the rest of my meal, I clutched my drink and dashed to the elevator.

I’ll call the patient Mr. Freeman. He had irreversible kidney failure, or End Stage Renal Disease (ESRD). He often missed outpatient dialysis. He would end up in the emergency room huffing and puffing from volume-overload, his lungs bathed in fluids, and his potassium level dangerously elevated.

This time, Mr. Freeman had also suffered a heart attack and had been admitted to the ICU. He had received urgent hemodialysis, the on-call kidney specialist physician, or nephrologist, and nurse dashing to the hospital in the middle of the night for the task. Mr. Freeman had only been transferred out of the ICU to a monitored bed earlier today, the plan being for him to be observed for one more day and to receive another dialysis session tomorrow. Read more »