The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
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An article in the New York Times made me shudder. No more white coats? According to a new study in the Journal of Infection Control and Hospital Epidemiology, there are now “guidance statements” about what health care providers should wear in the non-operating room hospital setting. The study discusses the available evidence regarding contamination of hospital attire with bacteria. Many studies show that there can be bacteria on a medical provider’s clothing – including scrubs, ties, and white coats. The authors then surveyed hospitals to determine policies related to the attire of health care providers. Out of 337 respondents, 65% believed that a health care provider’s attire was somewhat important or very important in the transmission of pathogens, yet only 11% of respondents enforced an attire policy. The authors didn’t state whether the survey respondents had any familiarity with the studies on clothing and transmission of pathogens, so the questions on the survey could very well have been leading in order to get the desired answers. The authors repeatedly note that there aren’t enough studies to make firm recommendations: “There is a paucity of data on the optimal approach to HCP attire in clinical, nonsurgical areas” “Appropriately designed studies are needed to better define the relationship between HCP attire and HAIs” “No clinical data yet exist to define the impact of HCP apparel on transmission” Yet despite this lack of evidence that clothing transmits infections to patients and despite a review of literature by Wilson et al. performed in 2007 showed that “the hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence”, the study authors then turn around and create a laundry list [no pun intended] of “guidance statements” designed to … prevent health care workers from transmitting infections to patients. “Studies” and the resulting unsupported recommendations such as this one are a huge problem in medicine right now. The Joint Commission manufactures similar junk science all the time – creating patient safety recommendations without one shred of evidence to support them. Their heads would implode if they had to substantiate the bases for all of their “patient safety goals.” Scientific evidence? Who needs scientific evidence? I just wrote about the same issue regarding “strong” recommendations for tPA use in stroke despite a collection of studies showing that tPA does more harm than good. Now a group of doctors representing prestigious universities all over the country is making “guidance statements” regarding hospital attire when they have NO scientific evidence for their “guidance.” Wash clothes? Fine. I don’t want bodily fluids on my white coat any more than patients want to see it there. Recommend further issues that need scientific studies? Good job. Let’s look into them to see if they make a difference in outcomes. But if you don’t have scientific evidence supporting your recommendations, then STOP MAKING THE RECOMMENDATIONS. Sorry, but I refuse to be called Dr. BareBelowTheElbows based on puffery and innuendo.Read More »