Full Table of Contents
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Abbreviated
Table of Contents
Home Page
Patient Safety
Silence vs
Safety
Silenced
White wall
of Silence
Silencing
Conflict Of
Interest
Psychology of
Providers
Subjectivity
Blacklisting
Nurse survey
Loyalty
Mobbing and
bullying
Trust Us
Defensive
documenting
Report Rate
Risk
managemnt
SOAP
Management
Hospitals
Crime in
medicine
Sexual Abuse
Liability
Limitations
Free Speech
for Patients
Exploitation
OSMB Medical
Boards
Mammography
solutions
Medical errors
Medical
Complaints
One number
Links
Injured patients who want to help and be heard, click here.
Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.
In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.
Ignaz Semmelweis
People keep pressing for mandatory reporting. They press for laws that will force health care professionals to report what patients need to know to survive. When they don't press for that, they press for restoring empathy and compassion. People who press for these things are people who don't know history. It is a conversation we have been having for at least 160 years.
Most people have heard of MRSA by now. It stands for Methicillin-resistant Staphylococcus aureus, a bacterial infection that, by using so many antibiotics, we have bred to be resistant to antibiotics. Overusing antibiotics robs future generations of the ability to benefit from them - just one of the reasons why it is important for the patient community not to be infected in the first place, especially by caregivers.
Ignaz Semmelweis is the man who first figured out that something could be done to prevent patients from being infected by their caregivers. He is so renowned for the discovery that asking someone in medicine who Semmelweis is would be like asking someone born and raised in the United States who George Washington is - with the difference that they don't know two of the most important lessons to be learned from him.
Semmelweis practiced medicine during the mid 1800s. When he first graduated from medical school he was unable to get a position as an internist, so he became an obstetrician. He was put in charge of two government-supported maternity wards. Among his duties were examining every patient everyday in preparation for the professor making his rounds, and he was in charge of all the records.
The fact that then, as now, almost no adverse events get reported accurately (see Medical Reporting) was a problem he could overcome because he saw every patient everyday himself and he saw all the records made by others. What was going on in the institutions was hard to hide from him.
Here is one of the things he saw. The first maternity clinic had a mortality rate that varied from month to month from 10% to 30%. The second had a mortality rate closer to 4%.
Young pregnant women are very interested in learning how to survive the new world they are about to enter. Among other things, they pay attention to other pregnant women. When they see 1 in 3 of their friends die in one clinic one month, but not in the other, they care. The public knew the first maternity clinic was a death trap. The caregivers knew it too, but they still sent patients there. This is one of the most important things that patients should understand. Then, as now, caregivers send patients into death traps. After all, most patients didn't die.
The chief difference between then and now is that back they at least they knew which clinic was a death trap. Today, they don't know. Adverse events are erased in medicine whenever possible. Today no one has an accurate grasp of where safety is.
Semmelweis knew. And all of his patients were young pregnant women. There are few things on earth more compelling than a young pregnant woman. Semmelweis wrote about facing women who, when told they were being sent to the first clinic, got on their knees pleading not to be sent there. One of the unfortunate aspects of being a patient is having to find ways to motivate caregivers to care. Enough young pregnant women pleading with him finally got Semmelweis to care.
And that is why he is
so important in the history of medicine.
He began analyzing what was known. He searched for differences between the two clinics, even baring some religious practices to see if that made any difference. He could find nothing wrong.
Then a friend of his who worked in the first clinic was helping students with an autopsy when the scalpel of one of the students slipped and cut his friend. The fever killing so many young mothers in the delivery room was the same fever his friend died of in the autopsy room This was before bacteria had been discovered. So Semmelweis speculated that perhaps some cadaverous material, as he called it, was traveling on the hands of the students from the autopsy rooms to the delivery rooms.
The first clinic was a teaching clinic. The workers were students. In the second clinic the workers were midwives. Throughout history, until recently, the chief tool for teaching medicine was cadavers. The students would be doing an autopsy in one room when suddenly a woman went into labor and they would rush to deliver her baby. Then they would return to doing the autopsy.
Semmelweis tried an experiment. He ordered the students to wash their hands before going from doing autopsies to delivering babies. In three months the death rate dropped to zero.
Semmelweis reported this amazing discovery, that washing hands saves lives, but did other physicians start doing that? No. And for the 160 years since we have continued to have the same conversation about how to get caregivers to give care in the ways that would avoid infecting patients and avoid the many other problems resulting from caregivers not behaving the way patients need them to behave.
Today we know how to reduce infection rates in hospitals to zero, but they don't do it. They cannot be persuaded to do it. They say it would take too much time.
Semmelweis was able to get the students in the dangerous clinic to do it because they were students. They had to do what he said. Doctors don't have to do what anybody says. And the well being of doctors is improved by letting patients get infected because other patients cannot not find out about it and avoid physicians and facilities who kill patients habitually. The number of patients who come to them is not effected by whether or not they take the time to keep patients safe. So there is no advantage in it for providers to prevent those infections. In fact, there is an advantage in letting patients get infected. It saves providers time and it generates additional treatments for which they can charge when patients become infected. They make more money by infecting patients.
So Super Bugs Evolve
One new bacterium now resistant to many antibiotics is Clostridium difficile, a germ that causes deadly intestinal infections in hospital patients. It recently has been discovered that it can spread through the air. It sends out a spore that lands on surfaces where it is picked up by hands. Those hands spread it.
Normally other bacteria that live in our intestines keep it from being a problem, but the broad spectrum antibiotics given to hospital patients wipe out those beneficial bacteria already in the intestines of patients and allow Clostridium difficile to flourish and broadcast more spores into the air. The spores are resistant to disinfectants and can survive in open areas for months.
Anyone with diarrhea could be spreading it. Catching it can produce fever, nausea, abdominal pain, severe diarrhea and sometimes colitis. The best way to prevent its spread? Washing hands. Because hospital personnel do not disinfect their hands enough, antibiotics have had to be used so many times to save patients from it that it has become resistant to those antibiotics.
If the patient community could learn where the biggest problems with this infection were, they could avoid those places. If patients avoided those places, providers would find the time to clean up the problem because their own well being would depend on it.
Passing another rule requiring better behavior has not increased hand washing enough in 160 years. Appointing another watchdog or implementing another best practices policy has not either. Patients really need to be able to see the facts of what and where such problems are in order to make intelligent cost-benefit analyses. An informed patient community can make its well being important enough to the well being of care givers to cause them to clean up their acts.
Care givers don't care where the death traps are as much as
they care about protecting their own well being. If they did, they would know.
And they don't. The only reason Semmelweis cared is that his patients knew
because they were in a unique situation that enabled them to figure it out for
themselves. That's the position patients need to be in again today. Otherwise it
will continue to be in the interest of medicine to infect patients.
According to the Centers for Disease Control, of the patients that our caregivers infect, 99,000 die each year. That means a number many times larger than that are disabled, but do not die from it. And not one of those deaths is the result of an error. The means to prevent each of those infections is known and available, but it is calculated that it would take too much time. That is why the symbol for patient safety should be a chalk outline.
If the symbol is not a chalk outline, it should be a graphic representation of concerned people having the same conversation for 160 years without figuring out that it is the wrong conversation.