How come some doctors don't wear BSI/PPE when they touch their patients?

[The Buff OP]

Hey y'all! (Did I get it right this time, @xffan624 ?)
So I was wondering why some doctors don't wear gloves and such when they touch their patients. This might just have a simple answer to it, but I want to know what the famous (infamous lol) people of SDN have to say about it.

Examples that have happen to me or I have seen:

• Doctor was seeing a patient with some sort of fungus in his chest and the doctor kept touching his skin and scratching the patient's chest to see if it flaked without gloves.
• My mom gets this vaccination every week that the side effects are that her immune system gets low, the doctor doesn't use gloves when he examines her.
• When people come in with a cold, fever, etc (Ebola alert jk) and the doctor still touches them with their bare hands.

So yee...that one of the doctor scratching the guy's chest was weird, like dude that's gonna stay under your nails even if you wash your hands.

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[Winged Scapula]

The use of gloves is recommended when the examination may involve exposure to blood and all other body fluids, mucous membranes, non-intact skin and during contact precautions or known outbreaks.

The wholesale use of gloves outside of the above has been shown to reduce hand washing behavior, does not reduce cross contamination, can increase transfer to other instruments/equipment in the room and increases waste of resources.

I wouldn't personally scrape a person's skin off with my fingernail especially if I were worried it was a fungus but otherwise examining intact skin without gloves in most cases is perfectly acceptable to WHO and the CDC.

 

[The Buff OP]

The use of gloves is recommended when the examination may involve exposure to blood and all other body fluids, mucous membranes, non-intact skin and during contact precautions or known outbreaks.

The wholesale use of gloves outside of the above has been shown to reduce hand washing behavior, does not reduce cross contamination, can increase transfer to other instruments/equipment in the room and increases waste of resources.

I wouldn't personally scrape a person's skin off with my fingernail especially if I were worried it was a fungus but otherwise examining intact skin without gloves in most cases is perfectly acceptable to WHO and the CDC.

Ah, thanks, WS. I guess since I'm an EMT at the moment I'm use to the whole gloves and goggles for everything.

I forgot to mentioned that some docs have done testicular exams on me without gloves.

 

[Mad Jack]

Ah, thanks, WS. I guess since I'm an EMT at the moment I'm use to the whole gloves and goggles for everything.

I forgot to mentioned that some docs have done testicular exams on me without gloves.

Please don't be serious please don't be serious please don't...

 

[jl lin]

So now if people would just wash their hands the right way. . .
And it's nice when the nurses and docs wash their hands before touching and after touching the patient. Good, clean lotions are needed as well, b/c this gets drying as all heck. Hate when nurses wear fake or long nails. Even though they have tried to eradicate this from the hospitals, there are still persistent and pesky nurses wearing these--and playing with kid's umbilical lines, etc.

 

[Mad Jack]

So now if people would just wash their hands the right way. . .
And it's nice when the nurses and docs wash their hands before touching and after touching the patient. Good, clean lotions are needed as well, b/c this gets drying as all heck. Hate when nurses wear fake or long nails. Even though they have tried to eradicate this from the hospitals, there are still persistent and pesky nurses wearing these--and playing with kid's umbilical lines, etc.

Ugh fake nails, how are those not banned at every hospital yet?

 

[jl lin]

Ugh fake nails, how are those not banned at every hospital yet?

They are supposed to be--and even in the clinics, etc. But you still see some stubborn soul ignoring the literature.

 

[Mad Jack]

They are supposed to be--and even in the clinics, etc. But you still see some stubborn soul ignoring the literature.

They would literally send a nurse home immediately if they saw her with fake nails at my last hospital. Zero tolerance for those bug catchers in these parts.

 

[KnuxNole]

There are girls who wear fake nails all across the board in the clinic and wards(nurses, docs, students, etc.)

 

[Winged Scapula]

Ah, thanks, WS. I guess since I'm an EMT at the moment I'm use to the whole gloves and goggles for everything.

That makes sense in a emergency situation where you may not be able to get a good history on a patient and there certainly may be fluids, open wounds, and the like which you would come in contact with.

I forgot to mentioned that some docs have done testicular exams on me without gloves.

Socially or professionally?

 

[Winged Scapula]

Please don't be serious please don't be serious please don't...

Why?

Outside of obvious infection, open wounds and all the other reasons given above, there is no reason you have to wear gloves just because you're doing a testicular examination (although most would).

 

[jl lin]

There are girls who wear fake nails all across the board in the clinic and wards(nurses, docs, students, etc.)

Yea. It's always been a big pet peeve of mine. In the peds hospitals, there are usually more than enough microbes everywhere--and more than enough kids with one problem or another that inhibits their ability to fight the infection. Still, they are filled with nurses that are 21 and haven't seen parents despair over their kid dying in septic shock. Be cute on your own time, but knuckle down when caring for these kiddies--and anyone else for that matter.

 

[jl lin]

Why?

Outside of obvious infection, open wounds and all the other reasons given above, there is no reason you have to wear gloves just because you're doing a testicular examination (although most would).

OK, but probably be good to wear a pair of leather gloves, cuz my skinny hands are always freezing. LOL

 

[The Buff OP]

That makes sense in a emergency situation where you may not be able to get a good history on a patient and there certainly may be fluids, open wounds, and the like which you would come in contact with.



Socially or professionally?

A gentleman never speaks about his private life. Hahaha on physicals.

 

[The Buff OP]

Please don't be serious please don't be serious please don't...

Yeah...thanks for the bold and enlarged letters.
I don't usually troll on here, brah. Not all the times like twice.

 

[Mad Jack]

Yeah...thanks for the bold and enlarged letters.
I don't usually troll on here, brah. Not all the times like twice.

I would be saying nopenopenope before I let some doc get all acquainted with my junk. As a patient I just wouldn't be comfortable with it.

 

[deleted407021]

I would be saying nopenopenope before I let some doc get all acquainted with my junk. As a patient I just wouldn't be comfortable with it.

Yep, I've seen at least one doctor give testicular exams ungloved. He just washes thoroughly afterward, of course. Guys generally seem indifferent to whether or not the doctor is wearing gloves. Their going to be squicked that someone is touching their genitals, regardless.

 

[jb94mg]

I would be saying nopenopenope before I let some doc get all acquainted with my junk. As a patient I just wouldn't be comfortable with it.

You sure, brah?

 

[Mad Jack]

You sure, brah?

It ain't about how attractive the provider is, it's about how uncomfortable I am with the situation.

 

[masaraksh]

Ah, thanks, WS. I guess since I'm an EMT at the moment I'm use to the whole gloves and goggles for everything.

I forgot to mentioned that some docs have done testicular exams on me without gloves.

Interestingly, while we're on the topic of testicular exams, I had the same face when we found out during gross anatomy that there is a septum between the two testicles. Totally thought the two buddies shared a sac.

 

[deleted407021]

Interestingly, while we're on the topic of testicular exams, I had the same face when we found out during gross anatomy that there is a septum between the two testicles. Totally thought the two buddies shared a sac.

I didn't know that either. I wonder why it seems so surprising?

 

[The Buff OP]

I would be saying nopenopenope before I let some doc get all acquainted with my junk. As a patient I just wouldn't be comfortable with it.

I just close my eyes and think of Kate Upton.

Nah, that happen when I didn't know any better.

 

[The Buff OP]

Interestingly, while we're on the topic of testicular exams, I had the same face when we found out during gross anatomy that there is a septum between the two testicles. Totally thought the two buddies shared a sac.

Noooo!
I don't want to live in this world anymore.

Hahaha no ****.

 

[Deranged Medic]

Ah, thanks, WS. I guess since I'm an EMT at the moment I'm use to the whole gloves and goggles for everything.

I forgot to mentioned that some docs have done testicular exams on me without gloves.

I always wear gloves during my initial patient contact. However, there are times I need to take them off in the back of the medic, and if there is no risk of body fluid contamination, I often don't worry about putting them back on. Of course hand washing is important; I have watched several physicians (most of them have been in practice for a long time) touch multiple patients without ever washing their hands. My guess is this stems from the "good old days" when glove wearing and hand washing wasn't so important.

On a totally unrelated note, I know a medic who is rumored to have performed a testicular hernia exam on his patient. I wouldn't have the slightest idea what to even look for.

 

[Straw Hat]

I've seen plenty of doctors and nurses not wear appropriate precautions when we clearly have a sign and equipment on the door. And they want us to interrupt them and say hey can I help you find a mask, or whatever the appropriate gear is. I'm sure that would go well most of the time...

I remember one patient was on airborne precautions which iirc is negative pressure and an n95 mask, doc just strolls right in like it's nothing. Sure you have a vent sucking in that air and the chance of transmission might be small but there's a reason for these protocols. I'd imagine the biggest constraint is time. You have tons of people to see and if a lot of them are on precautions who has the time to gown up, glove up, mask, wash, etc all the time. Speaking of gowning up I've only seen one doctor do that for contact precautions and it was an ID doc. It's silly not to follow proper protocols but yeah I think a lot of people just don't want to waste the time.

 

[The Buff OP]

I always wear gloves during my initial patient contact. However, there are times I need to take them off in the back of the medic, and if there is no risk of body fluid contamination, I often don't worry about putting them back on. Of course hand washing is important; I have watched several physicians (most of them have been in practice for a long time) touch multiple patients without ever washing their hands. My guess is this stems from the "good old days" when glove wearing and hand washing wasn't so important.

On a totally unrelated note, I know a medic who is rumored to have performed a testicular hernia exam on his patient. I wouldn't have the slightest idea what to even look for.

A lump? lol

Our protocols are that we must keep our goggles and gloves on until we clean off the truck, but most of us just take the goggles off when we arrive to the hospital.

 

[Deranged Medic]

A lump? lol

Our protocols are that we must keep our goggles and gloves on until we clean off the truck, but most of us just take the goggles off when we arrive to the hospital.

Wow! I have done this for over 7 years, and not once have I worn a pair of goggles.

 

[tima]

Some don't wear gloves so they can do a scratch and sniff test or a whiff test. It helps with the diagnosis.

 

[Deranged Medic]

I've seen plenty of doctors and nurses not wear appropriate precautions when we clearly have a sign and equipment on the door. And they want us to interrupt them and say hey can I help you find a mask, or whatever the appropriate gear is. I'm sure that would go well most of the time...

I remember one patient was on airborne precautions which iirc is negative pressure and an n95 mask, doc just strolls right in like it's nothing. Sure you have a vent sucking in that air and the chance of transmission might be small but there's a reason for these protocols. I'd imagine the biggest constraint is time. You have tons of people to see and if a lot of them are on precautions who has the time to gown up, glove up, mask, wash, etc all the time. Speaking of gowning up I've only seen one doctor do that for contact precautions and it was an ID doc. It's silly not to follow proper protocols but yeah I think a lot of people just don't want to waste the time.

I was a tech on a med/surg unit for a while. I only saw 1 physician put the proper N95 mask or hood on to see patients with droplet precautions. I'm pretty sure they didn't use the patient specific equipment or clean their personal equipment after seeing these patients either.

Some don't wear gloves so they can do a scratch and sniff test or a whiff test. It helps with the diagnosis.

They also used to taste their patient's urine to diagnose "the sugars."

 

[tima]

They also used to taste their patient's urine to diagnose "the sugars."

That's how Drs diagnosis diabetes on the spot. By the time the nurse arrives with the urine dipstick, the Dr already diagnosed the condition

 

[Deranged Medic]

That's how Drs diagnosis diabetes on the spot. By the time the nurse arrives with the urine dipstick, the Dr already diagnosed the condition

I can't wait to start medical school! It's going to enhance my palate.

 

[The Buff OP]

Wow! I have done this for over 7 years, and not once have I worn a pair of goggles.

Yeah, if you have prescribe glasses then you don't need to wear the goggles. Are you guys allowed to use the King tube as an EMT?

 

[The Buff OP]

Some don't wear gloves so they can do a scratch and sniff test or a whiff test. It helps with the diagnosis.

DO's?
*shots fired*

 

[The Buff OP]

You sure, brah?

It's being a while since I have seen a hot doctor chick.
Protip: Derm have the hottest girl docs.

 

[jb94mg]

It's being a while since I have seen a hot doctor chick.
Protip: Derm have the hottest girl docs.

There're probably more hot PAs, if I had to guess.

 

[cidem2065]

A lump? lol

Our protocols are that we must keep our goggles and gloves on until we clean off the truck, but most of us just take the goggles off when we arrive to the hospital.

Your service sounds like it sucks.

 

[Deranged Medic]

Yeah, if you have prescribe glasses then you don't need to wear the goggles. Are you guys allowed to use the King tube as an EMT?

That sucks. I can't imagine wearing googles every day at work. I'm a paramedic, so I usually move towards an ET tube. We carry the King Airway; I've just never used one.

 

[chizledfrmstone]

Interestingly, while we're on the topic of testicular exams, I had the same face when we found out during gross anatomy that there is a septum between the two testicles. Totally thought the two buddies shared a sac.

Whut? I never knew this and we just dissected the scrotum in our last block.

 

[Doctor Bob]

the chance of transmission might be small but there's a reason for these protocols

Ehh... some of the infection prevention protocols are nearly worthless and not grounded in good research.
As a medstudent/resident/medic/etc, you do what the protocol says, and ask your attending why.
As an attending you kvetch at the infection control person and ask why they have ridiculous protocols in place which are ineffective.

 

[Law2Doc]

. My guess is this stems from the "good old days" when glove wearing and hand washing wasn't so important...

Has nothing to do with not being "so important". Part of doctoring traditionally was laying hands on a patient because many patients already show up feeling diseased and a bit like an untouchable pariah as is, and you make them feel worse if you the doctor seem afraid to even want to touch them. On the other hand, if you aren't even afraid of catching what they've got, it makes their ailment that much less scary. So I think that's why the old timers worry less about gloves.

That being said I'm quick to glove up for anything more invasive than the initial handshake.

 

[masaraksh]

Whut? I never knew this and we just dissected the scrotum in our last block.

Lets review:
- midline raphe
- cremaster muscle --> retracts the balls
- dartos muscle --> shrivels the sac
- scrotal septum!

 

[NickNaylor]

Ehh... some of the infection prevention protocols are nearly worthless and not grounded in good research.
As a medstudent/resident/medic/etc, you do what the protocol says, and ask your attending why.
As an attending you kvetch at the infection control person and ask why they have ridiculous protocols in place which are ineffective.

Not to mention that some protocols are put in place based on little to no clinical information or because a nurse or someone else put something in the chart that set off the infection control alarms - regardless of whether such a thing is actually warranted.

 

[alpinism]

Not to mention that some protocols are put in place based on little to no clinical information or because a nurse or someone else put something in the chart that set off the infection control alarms - regardless of whether such a thing is actually warranted.

I can't tell you how many patients I've seen on rounds with contact precautions and everyone is like "I dunno why, it just says so on the door."

 

[Psai]

PPE is done inconsistently. The number of times I see people put on ppe and then their hair touches the patient's bed or they don't wipe off their stethoscope after using... What's the point of putting on a crappy cloth gown that takes time to put on and off when you're gonna put that stethoscope back on your neck and on the next patient? I'm very careful though when someone has something I don't want like pseudomonas or if they look like they're dying.

You sure, brah?

Analysis: Only one cheap pen in pocket. Coat is too white with no pen marks, coffee stains or unmentionable body fluids stains. No hospital or medical school logo on chest or arms. Hair not disheveled. Makeup done perfectly. Fisher price stethoscope securely around neck.

Final Determination: Not a doctor. Probability of nursing student: 80%.

 

[cidem2065]

PPE is done inconsistently. The number of times I see people put on ppe and then their hair touches the patient's bed or they don't wipe off their stethoscope after using... What's the point of putting on a crappy cloth gown that takes time to put on and off when you're gonna put that stethoscope back on your neck and on the next patient? I'm very careful though when someone has something I don't want like pseudomonas or if they look like they're dying.



Analysis: Only one cheap pen in pocket. Coat is too white with no pen marks, coffee stains or unmentionable body fluids stains. No hospital or medical school logo on chest or arms. Hair not disheveled. Makeup done perfectly. Fisher price stethoscope securely around neck.

Final Determination: Not a doctor. Probability of nursing student: 80%.

Sometimes I go with a glove around the stethoscope bell.

Also, the picture is 100% an actress for a stock photo company and not in medicine.

 

[Psai]

Sometimes I go with a glove around the stethoscope bell.

Also, the picture is 100% an actress for a stock photo company and not in medicine.

obviously

 

[The Buff OP]

Your service sounds like it sucks.

They are actually an award winning company in a large city.