Despite national campaigns encouraging patients to take an active role in improving hospital safety, many patients aren’t comfortable asking doctors challenging questions about their care, a new report shows.
(Jeff Swensen)British researchers gave surveys to about 80 surgical patients asking them how they would feel about asking doctors or nurses various questions. The questions ranged from simple factual questions like, “How long will I be in the hospital?” to more challenging questions such as, “Have you washed your hands?” The patients were asked to rate their level of willingness to ask the questions on a scale of 1 to 4, with 4 indicating they would be very willing to pose the question to their doctor or nurse.
Basic questions to doctors about length of hospital stay, time off work and details about the procedure were easy for patients to ask and received high marks, scoring on average 3.4 points, according to the report, which appeared in the journal Quality & Safety in Health Care.
But questions aimed at improving patient safety and reducing medical errors were far more difficult for patients to ask, receiving an average score of just 2.4 points. Questions that received low marks included:
- “Who are you, and what is your job?”
- “I don’t think that is the medication I am on. Can you check please?”
- “Have you washed your hands?”
- “How many times have you done this operation?”
Although patients were slightly more willing to ask challenging questions of nurses, scores remained low. However, the survey suggested that if a doctor instructs a surgical patient to be sure and ask about safety issues like hand washing and medication, patients found it far easier to ask challenging questions. Women also were more likely to ask challenging questions than men, the study showed.
The study authors said the findings suggest patients are worried about insulting their doctors by asking safety-oriented questions. For patient safety programs to be effective, doctors and nurses need to communicate to patients that challenging questions are a good thing.
“Patients need to feel they can ask questions that may be perceived as challenging without causing offense to those involved in their health care treatment,” the study authors wrote.
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Hands washing in medical setting is paramount to patient safety, but airborne and topical bacteria make that effort less than useful, particularly outside of ICU or surgical box.
Another (almost universally ignored) factor behind primary and secondary bacterial infections is hypothermia, or low body temperature, exacerbated by medication, anesthetics, and intense air conditioning.
Just by keeping yourself warm with heat packs wrapped around your neck, wrists, and ankles (particularly before, during, and after surgery), you can bring down infection rates from dirty hands, skin and environment even more effectively than just questioning your doctor about his “professional” hygiene.
Konstantin Monastyrsky, author of Fiber Menace
— Konstantin Monastyrskyhttp://www.FiberMance.com
The real question is why don’t MD’s want this to occur rather then allow massive numbers of deaths (over 100,000 in the US alone!)? IAccepting the mantra ‘I’m part of the problem?’ worth the social, human and economic costs? The answer, tragicly, is as far as MD’s are really concerned, simply no. The facts prove this.
— DBrownDon’t worry about insulting me with intelligent questions. There are some basic rules of the doctor/patient interaction:
Your doctor should introduce himself/herself to you by name, listen to you without interruption, wash his or her hands before and after examining you, return your calls within a reasonable period of time, be available (or have a covering doctor be available) for your emergency calls, offer a diagnosis, treatment plan and testing to you in words you understand. If your doctor fails on any of these counts, find a new doctor.
As a patient, you should make an appointment, be on time for your appointment, present your problem in an organized, succinct manner (writing some notes in advance of your visit would be helpful), you should understand your insurance and its limits and make any payments for fees, deductibles and copayments at the time of your visit and you should ask questions if there is anything your doctor has said that you don’t understand.
— famdocas a medical student, i am appalled that so many doctors are lax about hand-washing. in our practical exams (patients are hired actors, and the encounters are videotaped by a security camera for feedback and evaluation), we are required to follow a strict set of guidelines. You don’t get any points at all if you don’t wash your hands before beginning the physical exam. when my classmates and i shadowed physicians in practice, we were all disgusted at the lack of concern for handwashing. i also only saw one doctor wipe down his stethoscope with an alcohol pad between patients. (if i touched a patient, i made sure to use hand gel before and after, especially if i touched their feet.) my feeling is, this is one of those bad habits that will never be eradicated. it will only phased out as younger doctors enter the field, acutely aware of the risks of transferring viruses and antibiotic-resistant bacteria to vulnerable patients.
— SangeethaSounds like a great opportunity for a doctor, hospital or medical society to create a list of questions patients should ask and giving that list to each patient admitted. Then it can be a bit of an inside joke (”don’t you have something to ask me?”) and can also give the caregivers an extra incentive to follow procedures because they know they will more likely be checked. I’d feel much more comfortable reading “did you wash your hands” off a sheet of paper in a voice that made clear I was asking what was listed. Then I might even feel more comfortable improvising my own questions (”onions for lunch, huh?”).
— JesseI may well have to have a delicate partial corneal transplant at some point for Fuch’s endothelial dystrophy. The operation is quite new. You can bet I looked for an ophthalmologist specifically trained in this operation and have discussed it with him, including how many he’s done and what the results were.
He’s a nice guy and was completely open about it. I feel very comfortable with him because of how he handled that discussion.
I would have felt odd asking a doctor if he’d washed his hands, and I probably still would, but having gotten a staph infection at a doctor’s office (not the doc above), I would for sure ask this before any procedure now. I’m still too inhibited to ask before regular office stuff.
I always check medicine I get from the pharmacist, and once caught an error.
— janetI would be interested in a complementary study researching the reactions of doctors to patients who pose such questions.
One reason for the patients’ timidity may be the deference to a trained and educated health care professional, but I’d wager that those surveyed have had previous negative experiences asking questions of health care workers.
— Sara JaneWhen I’ve asked doctors these kinds of questions they always got offended. It is no wonder people are hesitant to ask.
— AndyAs a pediatrician, I move in and out of approximately 30 exam rooms per day, as is the case with most primary care physicians. It is far easier to feel compelled to wash my hands before AND after each exam as the patient (and parent) is usually watching me. The temptation to skip this little detail is greater when the patient is in another room, or is in no position to observe the washing process. My advice to patients is to look at your physicians’ (or nurses’) hands. If they are wet - good. If they are dry and cracked (from so much washing) - good. If they are nice and smooth - ASK ABOUT THAT WASHING.
— Gregory LawtonThis was an issue for me just a few days ago. A physician was going to examine my husband, after a recent minor surgery. He put a glove on his right hand, used that hand to turn on more lights in the room, then proceeded to glove his left hand and do the exam. My head was swimming; I was trying to figure out what to say. Or whether to say anything. I was angry and didn’t really trust myself to word my objection appropriately. And it was just a few seconds between the light switch and the exam. I didn’t think fast enough and didn’t say anything. Other than that, this surgeon has given my husband excellent care.
What’s the incubation period on staph, anyway?
— JenHere’s how most Health Care Providers would pleasantly answer these questions.
— Tony1. I just washed my hands.
2. I’ve done thousands of that operation and never had a complication.
3. Of course we’ll check your medicines.
You’ve got your answers.
Now what?
I’m a “standardized patient” who works to train medical students in proper procedures for performing examinations. We stress handwashing a lot and remind them that antibacterial foams and gels are not effective substitutes for good handwashing, especially since the dispensers for such things are usually outside the exam rooms and are often used before the doctor or student turns the handle to enter a room.
— MantelliMy kids’ pediatrician’s office does not have a sink in each exam room. Instead, the doctors and PAs use this antibacterial gel before and after each exam, which is nice and all, but insufficient, I believe. I’ve never said anything, b/c there’s simply no sink in the room, and the doctor would have to go out and down the hall to the nearest sink. But, it’s a problem. What does everyone think about the value of these gels instead of actual hand-washing with soap? What does the literature say?
— BklynGirl#9 Gregory - it has been my understanding that not properly drying (on a clean disposable towel then disposed off without touching other breeding bacteria - so a footpedal bin) makes the washing itself much less effective. Since the loosening of the bacterial cells from the skin is one thing (thanks soap!) the rinsing hopefully is another (thanks running water) and the drying completes the process.
I wouldn’t be comforted at all by shaking a Dr’s wet hand. On the other hand a Dr with nice smooth hands could simply be diligent about washing and drying properly. Skin is much more likely to get cracked if its never properly dried after washing.
Do you disagree?
— JillyFlowerI am anticipating hip surgery and have been making many mandatory, preliminary visits to individual doctors as well as to the hospital where I will be having the procedure in order to undergo “pre-operation” exams. Everywhere I’ve gone, I’ve noticed cylindrical plastic tubes of liquid antiseptic soap mounted on the walls:in patient waiting areas as well as in exam rooms. It occurs to me that the medical profession has become quite concerned about “hand washing” for both doctors, PA’s, nurses and patients.
— VovAll of these questions are reasonable. If the physician takes offense, get another physician. If you are undergoing a sophisticated procedure and the doctor can not tell you how many total and how many in the past 3-4 months they have done, leave immediately. No physician with a reasonable experience would be embarrassed to address those questions at all.
— NYCAnesthesiologistI just completed a blog post on this topic at
http://medicalcrises.blogspot.com
Generally I say in my post that this is yet another one of those good basic ideas now taken to irrational excess.
Thanks
— Dr. Rick LippinI have found that many doctors are WORSE than the average population at observing careful hygiene practices.
It’s almost as many of them feel they are “above it.”
— LorneI have constantly found most physicians do NOT wash their hands before exams; some do after exams.
My present primary care physician is in her early thirties and is the first doctor in a long time who does not need to be asked to do this.
In the past, depending on the procedure, I will watch like a hawk, and have had to ‘mention’ this politely many times.
My strategy is: go in with a list; when you get to the point where the exam is going to start, I look-up from my list and say “I’ll wait before we go on. Just take your time to wash your hands.” Then I may resume my list discussion during the hand-washing time, just so the time is not lost, but it gave me a way to break-through.
Sometimes the docs look surprised, but they all go do it.
Thanks to the reader above, as I realize the stethoscope is also a vector. I’ll ask about alcohol wipes, and that’s another easy way to bring it up.
It’s incredible that we have to discuss this topic, but with rushed-Medicine, this problem is rampant!
And, frankly, I want a good soap, as I don’t want chapped, sore hands being a poor barrier for transmittal of who-knows-what as they do an exam. All the exam rooms I’ve been in have a highly-emolient soap, so that hopefully helps protect the patient and the doctor.
Thanks for bringing up the subject, Tara. For diabetics, skin issues are really important, as diabetic skin is “more easily compromised”, my dermatologist recently confirmed.
Best to all— Em
Please visit me at my blog:
— Emhttp://diabetesdietdialogue.wordpress.com
“Everyone knows someone who needs this information!”(TM)
BklynGirl - when I was a nurse on a pediatric floor of a hospital we washed with soap and water any time we were going to be touching the patient. The antibacterial gel was only for when we were just clearing the IV pump, or hanging meds. I know that C diff is not killed by the gel.
Jillyflower - I agree with you. I was on a pediatric onc/BMT floor, and washed my hands whenever entering a room. I also used a ton of lotion in between rooms, and tons at home. My hands were never cracked with dry skin.
— LizMaybe the following information will motivate patients to ask their treating doctor or nurse a question related to “Doctor, did you wash your hands”. In fact the most likely truthful answer would be ‘no’. Hand washing or use of alcohol rubs to sanitize the bare hands between patient visits is performed at most 40% of the time and usually much less. Healthcare workers and doctors are often too busy to bother. Hand irritation from frequent washing is another inhibitor. Almost certainly the hands of the doctor or healthcare worker when treating the patient are contaminated, even if washed.
To put the question in perspective consider that in the U.S. 8 to 10% of patients, about 3 million a year, acquire infections as a result of spending time in the hospital. They spend on average 21 extra days in the hospital to resolve the infection. About 100,000 die. Worldwide the statistics are similar. As many die worldwide from hospital acquired infections as die from malaria.
However, studies show that increasing the hand sanitation rate between patient visits to 80% has no discernable effect on infection rates because it is not the cause of the problem. The cause is mostly due to the fact that the hand is contaminated whenever it touches a surface, clothing, uniforms, bed linen and railings, instruments, etc. Every surface in the room has pathogens and when touched transfers pathogens to the hand. Consequently, the hand must be sanitized each and every time the patient is about to be touched; many times per patient visit. That requires that the means for sanitation must be fast, just a few seconds to sanitize, located conveniently at bedside, be non-irritating and ideally keeps track of usage. The patient can observe that the hand is being sanitized. As a result, the hand would be sanitary when the patient is touched, virtually ending the chance for infection.
That sounds like a tall order. In fact such equipment would be available to hospitals if they were interested. They are not interested even though the cost would be far less than the cost of alcohol rubs; about $3 billion annually. Soon the hospitals will be under the gun to do something since Medicare and medical insurance companies will reject claims for treating hospital acquired infections. Twenty two states track and publish infection rates.
The right question to ask your doctor in advance is, “What is the infection rate of the hospital where you will be ministering to me?’ and to decline if it is high. In time the hospitals will acquire the proper equipment needed to end the infection problem. To get more information visit http://www.germgardlighting.com
— Dr. Gene GordonBlood pressure cuffs are never washed and rarely sanitized. In the hospital, it’s a good idea to ask for a disposable one that they will leave in your room.
Oximeters aren’t usually washed, either. I’d wash my hands after someone put one on me (from shared equipment). You’d be shocked at where some patients will put their hands and what is under their fingernails and on their fingers.
— readerTo BklynGirl:
The literature is clear on the finding that the alcohol based gels (Purell, etc.)are much more effective in eliminating most bacteria from hands than washing with soap and water. So I’d be glad my doctor is using them.
— Dr. MikeWhat about when the staff person chastises you when you question them? I asked my husband to check the blood transfusion to make sure that it was my own blood that I had donated. I was snapped at by the nurse…”Let me do my job!” Not what you want to hear when you’re recovering from major surgery.
From TPP — I would have complained to the hospital for that kind of behavior. Your example is exactly why people are reluctant to speak up but you were absolutely correct in asking.
— nancyI think it is ludicrous that patients are being asked to take responsibility for something that is so intrinsic and so basic to how health care professionals are supposed to do their jobs.
I mean, what next? The next time I eat out, should I inquire whether the chef and the waitstaff have washed their hands? The next time I fly on a plane, should I inspect all the lug nuts because I can’t trust the mechanics to know what they’re doing?
Sure, patients need to be vigilant. But at some point, it is up to the health care professionals to just suck it up and be, well, professional. And that means washing their hands without needing to be reminded, because washing your hands before touching the patient is what professionals do. Patients and families - who are already in an unfamiliar environment and under stress - should not have to be asked to take on the role of overseers as well.
I’ve had a medical injury, a close call with a wrong-site surgery and a close call with being mistaken for the wrong patient. I’m uptight and hyper-vigilant enough. I don’t need the added burden of having to nag the physicians and nurses to wash their hands, for crying out loud.
— Perrin J.