Doctors Orders

When my brother went into the hospital with pneumonia, he quickly contracted four other infections in the intensive care unit. Anguished, I asked a young doctor why this was happening. Wearing a white lab coat and a blue tie, he did a show-and-tell. He leaned over Michael and let his tie brush my sedated brother's hospital gown. "It could be anything," he said. "It could be my tie spreading germs." I was dumbfounded. "Then why do you wear a tie?" I asked. He shrugged and left for rounds.

Michael died in that I.C.U. A couple years later, I read reports about how neckties and lab coats worn by doctors and clinical workers were suspected as carriers of deadly germs. Infections kill 100,000 patients in hospitals and other clinics in the U.S. every year. A 2004 study of New York City doctors and clinicians discovered that their ties were contagious with at least one type of infectious microbe. Four years ago, the British National Health System initiated a "bare below the elbow" dress code barring ties, lab coats, jewelry on the hands and wrists, and long fingernails.

The Centers for Disease Control and Prevention says that health care workers, even doctors and nurses, have a "poor" record of obeying hand-washing rules. A report in the April issue of Health Affairs indicated that one out of every three people suffer a mistake during a hospital stay. I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses, and orderlies, irrationally hoping that they'd treat my brother better if they liked us.

Commenting on the new report on hospital errors, CNN's senior medical correspondent, Elizabeth Cohen, instructed viewers to "ask doctors and nurses to wash their hands" if they haven't. "They sometimes will actually give you a hard time, believe it or not," she said, "and they say, 'My gloves are on. I'm clean.' 'Well, I didn't see you put those gloves on. What if you put those on with dirty hands?' "

I called Cohen, the author of "The Empowered Patient," to ask her the best way to confront those taking care of you or family members. She said that you have to get over the "waiter spitting in your soup scenario," that the medical professionals will somehow avenge themselves, by giving less attention, if you insult them. "There are all sorts of reasons we default to being quiet," she said. "It is general etiquette not to correct another adult, especially when this is their profession. But when the consequences are so grave, you have to summon up your courage." You could say that you are a germaphobe, she suggested, and ask if they could please just indulge you?

This is an excerpt from a recent article in the New York Times written by Maureen Dowd. It's not my story, but I have a similar one. Someone near and dear to me died in a hospital I.C.U. of an infection from unknown origins.

My parents' generation almost never questions a physician or other clinician. Whatever he says, goes.

My generation rarely questions a physician or other clinician. Whatever he/she says, usually goes.

My children's generation will question a physician and other clinicians. And they should. Yeah, they're smarter than the average bear, but they can't know and do everything and sometimes . . . they don't wash their hands.

Proven to be the single most important way to prevent the spread of germs, it's also the easiest. I worked in two different hospitals. In the administrative area - not the clinical. I was very careful to wash my hands after venturing out of my office. One hospital I worked in had a strict dress code for non-clinical workers. These are the ones I remember most:

No open-toed shoes

No sleeveless shirts

Perhaps both of these should be a general rule for all the public. Some toes are more attractive than others and I know my triceps have never lent themselves to being bared in public.

The other hospital I worked in had no dress code for non-clinical workers. That always bothered me. I even tried to appeal to my boss to do something about it, but it never happened while I was there.

Here in Belgium, we've had a couple of experiences in the local hospital. From what I can see, hand-washing is not at the top of the list and open-toed shoes may actually be mandatory in good weather.

I'm not suggesting that disgusting feet and exposed armpits are causing infections to rise in hospitals, but I am suggesting it's more civilized to cover those things. Not all toes and armpits are equal. That's all I'm saying.

One in three hospitalized patients suffer from a mistake and 100,000 hospitalized patients die every year of infection. One could also say with over 35 million admissions, those odds are pretty good, I guess. However, it can't hurt to be more vigilant. Improvements in healthcare are phenomenal, but it's not all up to them to improve. We have a significant role to play.

Like those people who send their child to school expecting the teacher to teach readin', 'ritin' and 'rithmetic, we also expect them to convey morality and good behavior too.

Our neighbor said to me once that her cleaning lady doesn't do a very good job. I've never had a cleaning lady or a nanny or an assistant, but I do know that no one will clean your house, run your business, or care for your children like you do.

Healthcare workers do a very good job, but often overworked, they need help. No one will attend to your loved one like you will.

Don't let that story up there be yours. It's okay to ask questions.