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).


  1. Our hospital, as part of an extensive renovation project, built us a new surgery unit. Handwashing stations abound. Problem is, each sink is at about knee level, and each is outfitted with an automatic-shut-off spigot which, once you have coaxed it to turn on by touching the underside of the spout, emits a brief blast of ice water.

    I conclude that these were provided for extremely short folks who can sing “Happy Birthday” extremely fast.

    The money saved by conserving water must have gone into salaries for the gloating “Gotcha” types.

  2. Rae the Tech says:

    Even more disturbing to me than the lack of handwashing by the general public, is the lack of handwashing I’ve observed by some EMS personnel. I have witnessed the flush-nanosecond-door open maneuver by some of them many times. Disturbing…and they definitely know better!

  3. I hate busy-bodies… there’s practically nothing worse.

  4. Thanks for this post. What you’re saying, if I understand it, extends far beyond hand-washing and safety monitoring in hospitals: When a person or group of people “wants” to see or find something to prove a point, it’s not unlikely that they will.

  5. Wait, what? You’ve got people who are paid to follow you around to see if you washed your hands? I think I’ve just solved the healthcare funding problem….