Archives for February 2011

The trouble with observation in medical settings

I have experience with this, from both sides. Both involve hand-washing. Still, a clean story.

Washing of hands is the right thing to do for health-care providers, between seeing patients, for infection control reasons. And, I’ve gotten ‘the letter’ from a VP charged with signing them, citing me for not washing my hands between patients.

Except, I did. This is the problem with observational medicine.

Several years ago I saw a patient at the end of an irregularly-shaped hall, which has an alcove area at the end. There are alcohol dispensers there, I used them on the way in and out of a patient interaction there. That wasn’t enough for the observer: she veritably gloated ‘I got you’, meaning she got me not washing my hands into/out of a patients’ room. (I’m not perfect, nobody is, and I’ve probably botched this somewhere, but not here; I knew she was there, but didn’t think she was dense. I was wrong). I pointed out there are dispensers out of her vision, to no avail. I got the letter from the VP who hasn’t touched a patient in a decade, and oh well.

I think of this sometimes, as my ED’s Fast Track was not designed, more just cobbled together from available space and good intentions. The resulting arrangement has the doc station less than an arms’ breadth from the primary patient restroom. To say this affords ample opportunity for totally unavoidable observational medicine is an understatement. Trust me, we’d love to avoid it, but that’s not an option.

We’d love for the count from fully audible flush to door opening ot be, oh, a 6 count: long enough to reach the sink, run some water over the hands, then hit the door. (Problem: we cannot hear the water run in the sink, or it’s never happened, so we prefer to think we cannot hear it). Yeah, it’s Usain Bolt speed, but that’s preferable to the alternative, no washing. And yet, speed like that is hard to believe from the general ED public.  It doesn’t happen. Flush, door open within a 4 count. Nobody dries their hands on their pants, like, you know…people in a hurry.

So, given my experience, I’m forced to accept the alternative: people clearly wash their hands, then flush, then exit the bathroom with super-dry hands. Yes, it goes against everything I know about humans and the behavior, but then so does the majority of the ED population.

It’s the trouble with observation in medicine.  It’s unreliable.

(In case you’re slow, this isn’t an indictment of my patients, it’s about hand washing observation and its limitations). (I might not be the clever writer I imagine).

FY11 Team Run & Remember Rock ‘N Roll Dallas Half Marathon – General Donation

Welcome to the Donation Page of

Kate Schickedanz

Join me in my efforts to support Tragedy Assistance Program for Survivors (TAPS)!

On March 27, 2011, I will be participating in the Dallas Rock ‘N Roll Half Marathon in support of the Tragedy Assistance Program for Survivors (TAPS). TAPS provides direct support to families who have been impacted by a death in the military regardless of geography or circumstance.

via FY11 Team Run & Remember Rock ‘N Roll Dallas Half Marathon – General Donation.

I wrote about her late husband, an ED Nurse colleague, after his untimely death here. I’m glad Kate is helping others, and TAPS sounds like a terrific program.

I gave to her goal, and hope you’ll consider doing the same.

Polls Are Open in The 2010 Medical Weblog Awards Sponsored by Epocrates and Lenovo

The polls are now open in the Seventh Annual Medical Weblog Awards Sponsored by Epocrates and Lenovo!

The 2010 Medical Blog Awards

Voting will close 23:59:59 on Sunday, February 13, 2011 (EST).

via Polls Are Open in The 2010 Medical Weblog Awards Sponsored by Epocrates and Lenovo.

Many thanks to MedGadget for continuing this yearly award.  They don’t get rich doing it, but they keep on anyway.

There are a lot of terrific blogs in there, please go vote early and often, the Chicago way.

Bill Lohmann: Last U.S. WWI vet approaches 110 | Richmond Times-Dispatch

Frank Woodruff Buckles, America’s last living veteran from World War I, celebrated his 110th birthday at his West Virginia farm on Tuesday, reading hundreds of birthday cards from around the world.

via Bill Lohmann: Last U.S. WWI vet approaches 110 | Richmond Times-Dispatch.

Thanks for your service, Mr. Buckles. May you live as long as you wish.

via In From The Cold, where I agree with the first commenter.  That, via Ace.