After a horrific couple of weeks of incarceration, a friend of mine recently escaped from one of Manhattan’s largest, best known and respected hospitals.
He had successfully undergone a long and complicated operation, but immediately afterward my friend was left in a recovery room for six hours, attended to by people who did not speak any language he spoke. A neck brace ordered by his doctor was put on him upside down, leaving him contorted and in yet more pain. Those attending him failed to administer the prescribed antibiotics. Since infection was present, his temperature rose to something close to 106 degrees. For hours he tried to get somebody’s attention, and when he finally did, it was necessary to pack the man in ice to bring down his fever.
His temperature dropped, but the infection remained and was so serious that it was necessary to wheel him back into the operating room to clean the wound and put in a drain. But still it lingered. It might be lingering until this day had not somebody discovered that the various medications being given him were nullifying the effectiveness of the antibiotics. This last by no means completes his tale of woe, but it explains how a hospital stay of days turned into one of weeks.
The man’s unnecessary pain and raging frustration can’t be measured, but the extra costs can, and they run up into something like a quarter of a million dollars. But how do such things happen?
This guy had good health insurance and, when he wasn’t delirious, he was able to take care of his own interests. He is anything but an inarticulate mute. He bitched, moaned and ranted and threatened. He did summon the hospital’s “patient advocate,” only to discover that the woman was there to represent her employers, not the people in the beds.
My friend escaped alive and, although he is contemplating a lawsuit, his case is hardly one of those clear-cut ones in which the wrong leg or the wrong breast was lopped off. He didn’t die, he is recovering, so the sluggish, inattentive care meted out to him may not play well in a law court. The defense lawyers can argue with some validity that no better care is available in any other New York hospital, since hospitals in this city have won themselves a reputation for processing patients as a Nebraska meatpacking house processes pork. In both cases, the products are moved out the front door, but it’s not a pretty sight.
So are medical machines better at their work than the humans who tend the patients are at theirs? The best and most advanced apparatus can take us so far and no further, for care and healing also depend on good people, effective organization and relentless application of the best practice, beginning with the fundamentals.
Yet when it comes to certain things that humans must do and machines can’t, things like taking patient histories and using them, or even something as fundamental as asepsis, the numbers show that many American hospitals are not doing what they should be doing. They are not keeping killer germs away from the patients. Hence, they are not doing some of the simple things that are as important as advanced science and medical engineering.
The Centers for Disease Control estimate that every year 2.4 million patients in American hospitals contract an infection during their stay after being admitted for something else. It is believed that 100,000 of these people die as a result. It is also believed that half of those infections–that is, 1.2 million cases and 50,000 deaths–would not have occurred if hospital staff, doctors, nurses and other attendants had washed their hands before touching a patient. That’s right, if they had only washed their hands.
One hundred and fifty years ago, a Hungarian doctor named Ignaz Semmelweis proved that infections were carried from patient to patient by doctors who did not wash their hands. Nothing in microbiology has changed since then, although the popularization of latex gloves has misled health care workers and patients alike into thinking that hand-washing is no longer an unexceptional necessity. They erroneously assume that antibiotics will save the patient from his caretaker’s slovenliness. They will not get it through their heads that, if the workers’ hands are not washed, they contaminate the gloves by touching them in the act of putting them on.
In 1996, a microbiologist stationed observers in the toilets used by the staffs of five of Boston’s best and most famous hospitals: Massachusetts General, Children’s, Brigham and Women’s, Beth Israel and Boston City. They learned that more than 30 percent of those using the facilities didn’t wash their hands at all, that 62 percent washed using
This and other studies confirm that the non-hand-washing is not confined to low-level, poorly paid nonprofessional staff. To the contrary. Doctors are less likely to wash their hands than nurses, and nurses are less likely to wash their hands than nonprofessionals. When physicians have been questioned about their failure to observe this instance of the immemorially ancient injunction of primum non nocere , they have been known to answer that they know when they need to wash their hands and when they don’t. So be it, but 50,000 corpses a year say otherwise.
Hospitals do crank up hand-washing campaigns but, once the drive is over, the old sloppiness reasserts itself, and spreading infection begins again. Maryanne McGuckin, an infection control specialist at the University of Pennsylvania School of Medicine, has been working with the idea of using patients as the prod. She told The Washington Post , “If you can teach patients to ask the embarrassing question [Have you washed your hands?], the stimulus has the potential of being far more long lasting” than campaigns that peter out after a time.
Some people are too sick to ask the people taking care of them whether or not they’ve followed the basic rules of hygiene. Most don’t have any idea that, in the interests of their own survival, they ought to. We are a long way from reaching the millions with this message and further still from getting them to ask the question of the doctor advancing on them with a medical instrument in his or her hands. (It is reported that women physicians are more likely to wash their hands than men.) Most people who are alone and helpless in a bed in a strange place among strange people will not be inclined to court the wrath of the staff by posing irritating questions to them.
Hospitals have as their undeviating goal zero mistakes, but they are not as successful at doing it as certain other institutions. In air traffic control, any accident, regardless of how small, is treated as a near-calamitous event and the institution reacts accordingly. Hospitals are not indifferent to mess-ups, but they are prone to accepting more than they should. Contrast the absence of hand-washing to airline safety, where no whoopses are permitted. In the air control business, even almost-accidents, near-collisions and close calls are investigated and blame is assigned.
In Washington, they enact patients’ bills of rights, they lay down minimum hospital stays for pregnancies or mastectomies as each new hospital horror reveals itself. That makes for fatter rule books but not for renewal.
Maybe renewal is not for us right now. With the market the way it is, and things being so swell, forget what’s bad and enjoy the rest. It’s the best hospital system in the world, isn’t it? As for those 50,000 the germs got, what are you? A shill for the soap industry? Wash your own hands. A lot of those people were going to die, anyway.
