Hand Sanitizing?

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jesse120

Zanarkand Ruins
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I'm shadowing a PCP that NEVER washes his hands unless a patient like drools on him or something, and he doesn't wear gloves. Part of me wants to say something to him about it, but I don't feel it is my place to, being just a lowly premed shadow. I try to make it a habit of making sure he sees me using the Purell between patients so that he might think, "Hmm maybe I should, too," but clearly that hasn't worked. What do you guys think? Should I say something, or just ignore it?

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So wait... is he using the hand sanitizer? I'm pretty sure just using the hand santizer is acceptable so long as their isn't any visible soil on your hands, in which case you should use soap and water.
 
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So wait... is he using the hand sanitizer? I'm pretty sure just using the hand santizer is acceptable so long as their isn't any visible soil on your hands, in which case you should use soap and water.

No, he doesn't use anything on his hands in between patients. He only uses the sanitizer if there is visible soil on his hands. And yes, he touches all of his patients
 
No, he doesn't use anything on his hands in between patients. He only uses the sanitizer if there is visible soil on his hands. And yes, he touches all of his patients

he should be in jail for touching his patients....
 
I'm shadowing a PCP that NEVER washes his hands unless a patient like drools on him or something, and he doesn't wear gloves. Part of me wants to say something to him about it, but I don't feel it is my place to, being just a lowly premed shadow. I try to make it a habit of making sure he sees me using the Purell between patients so that he might think, "Hmm maybe I should, too," but clearly that hasn't worked. What do you guys think? Should I say something, or just ignore it?

I think you should definitely say something to him about it. Just make sure that I'm there with popcorn in hand to enjoy the ensuing show.
 
No, he doesn't use anything on his hands in between patients. He only uses the sanitizer if there is visible soil on his hands. And yes, he touches all of his patients

I think I would call the medical staff office and register a complaint as anonymously as possible. That's not cool
 
Is that gross? Yes. Should you pick up that habit? Absolutely not. Is he harming his patients? Probably not that much.

He is a PCP, which means most of the patients are not super-acutely ill. Since you mentioned he washes his hands when he gets fluids on them, his patients are getting the same stuff on their skin that they would get from sitting in the waiting room. As long as the patients don't have really nasty bugs or are otherwise immune suppressed, they probably won't get sick from something transferred. Washing your hands is like stopping at stop signs. It is a rule, and it is something you should do every time, not because of what happens that particular time, but will happen eventually by sheer probability. Do people always sanitize their stethoscopes? For the most part, only when they feel they have touched someone germy or are about to touch someone that is at risk of infection.

That said, if you really want to do something, think about talking to one of his nurses. They might feel a bit more comfortable saying something.
 
Is that gross? Yes. Should you pick up that habit? Absolutely not. Is he harming his patients? Probably not that much.

He is a PCP, which means most of the patients are not super-acutely ill. Since you mentioned he washes his hands when he gets fluids on them, his patients are getting the same stuff on their skin that they would get from sitting in the waiting room. As long as the patients don't have really nasty bugs or are otherwise immune suppressed, they probably won't get sick from something transferred. Washing your hands is like stopping at stop signs. It is a rule, and it is something you should do every time, not because of what happens that particular time, but will happen eventually by sheer probability. Do people always sanitize their stethoscopes? For the most part, only when they feel they have touched someone germy or are about to touch someone that is at risk of infection.

That said, if you really want to do something, think about talking to one of his nurses. They might feel a bit more comfortable saying something.


My snarky post aside, this is a very good response.
 
Why is this a tough situation????

And why are people suggesting crazy stuff like going behind someones back which is absolutely the best way to make someone hate you?

You just ask some random question like "It seems that hand sanitizer has gotten really popular in health care today, do you think there is any advantage to old-fashioned hand washing between patients?"

This non-confrontational question will prompt him to give his opinions related to washing/sanitizing hands after seeing a patient.
 
Can he tell that just by looking at them? As a scribe I got a called in to receive a heavy dose of antibiotics because a patient that my doctor had seen for a headache was later diagnosed with bacterial meningitis. You don't know what your patients are carrying, but I guarantee that he has spread at least one case of MRSA. Read Better by Atul Gawande and you'll use that gel every time.

I would ask him whether you should wash your hands. That way he at least has to think about it and consciously decide not to wash his. If he decides to keep not washing his hands, you'll need to (gently) pass a message up the food chain. I like the recommendation of starting with a nurse, although be sure not to pick a nurse with an abrasive attitude who may inflame the situation.
That's a pretty strong guarantee to make and one that could open a physician to potential legal action. Unless you did the culture, gram stain, and antibiotic resistance testing I would cool the jets.

You may be right, but you don't have the authority to make such a claim.

Also, where were you scribing? ER? FP office? Clinic?
 
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I'm not saying people shouldn't sanitize after every patient. I'm just trying to put things in perspective.

If you ever get a chance, pat your hand on an agar plate and culture it. Then wash your hands and do another one. What you see will scare you.

Asking whether you should wash your hands is a nice tactic. Unless he says no...
 
I'm in an ER. At least 10% of the people we see have a MRSA infection in their medical history, and most of them caught it in a hospital. I think that because the results of their actions aren't visible to them, doctors severely underestimate the rate at which they spread these infections.

But lets play with some numbers. Say that there is a 0.01% chance that a patient has a communicable disease about which the doctor doesn't know. One in ten thousand patients is pretty conservative. In my ER, doctors typically see 20 patients per shift. Say 5 shifts per week, 50 weeks a year. That's 5000 patient encounters per year, each with a 99.99% chance that no infections are communicated. But 1-0.9999^5000 gives a 39% chance that they have passed on an infection in any given year. Over 5 years, that's up to 92%. 20 years and you are up to 99.995%

Of course you couldn't say that he caused a particular infection but the odds are that he has caused a few.
My biggest grievance here is the ED Doc vs. the FP Doc. Standard precautions should be observed regardless of setting but I find it hard to say a family doc, with recurring patients, has the same probability of transmission as an emergency department doc who doesn't know his patients or their histories.

I may be out on a limb, who knows.

As an aside, this FP should be washing his hands.
 
I can't believe how this problem (not washing hands) has been minimized by some of those who have posted here. And they are med students? :scared:

It doesn't matter what the setting is. The only difference is this physician doesn't have hospital administration breathing down his neck to enforce compliance. There is no taskforce to track trends of nosocomial infection.

How to approach someone about that sort of problem? I agree it is not an easy situation to confront someone who is allowing you to be a guest tagalong. You can be direct about a problem you see and still be polite. And what if it comes up as a topic in your interview? What are you going to say? You witnessed unsafe practices but did NOTHING? Now there is an asset to medicine. Going behind the doctor and bringing up the problem with his office assistants is an option, but the more respectful and respectable course of action is to be direct. Or here is an idea, go out to the Bath and Body Works store and get a bottle for each exam room and say something to the effect of, "I wanted to thank you for giving me this opportunity to learn about your practice, so I brought you a gift I thought you might like since I noticed sometimes you don't have time to scrub with soap and water."
 
I'm not saying people shouldn't sanitize after every patient. I'm just trying to put things in perspective.

If you ever get a chance, pat your hand on an agar plate and culture it. Then wash your hands and do another one. What you see will scare you.


Done that. It is a big difference. Of course washing your hands doesn't render them sterile. It does reduce the population of transient pathogenic bacteria.
 
Better wash your hands, you might catch their diabetes or HTN. He's a PCP.

Obviously it is preferable to wash your hands, but the advice to call him out on it is LOL.
 
Better wash your hands, you might catch their diabetes or HTN. He's a PCP.

Obviously it is preferable to wash your hands, but the advice to call him out on it is LOL.


Riiigghhht.... because MRSA and C.diff don't live in the community. The fact that you think handwashing is "preferable" is LOL.
 
No, he doesn't use anything on his hands in between patients. He only uses the sanitizer if there is visible soil on his hands. And yes, he touches all of his patients


That's awful.. as far as I know your supposed to wash your hands thoroughly between patients.
 
And what if it comes up as a topic in your interview? What are you going to say? You witnessed unsafe practices but did NOTHING? Now there is an asset to medicine.

:laugh::laugh:

Or here is an idea, go out to the Bath and Body Works store and get a bottle for each exam room and say something to the effect of, "I wanted to thank you for giving me this opportunity to learn about your practice, so I brought you a gift I thought you might like since I noticed sometimes you don't have time to scrub with soap and water."

:laugh::laugh::laugh::laugh::laugh::laugh::laugh:



^A fire ant could offer better advice.

OP: get over it. You're there to shadow, not save the world. Mind your own business. Ignore me at your peril.
 
Riiigghhht.... because MRSA and C.diff don't live in the community. The fact that you think handwashing is "preferable" is LOL.

They do live in the community and on you too. I hope you wash your hands everytime you shake someones hands or touch an object in a new room.
 
PCP > premed

He knows what he is doing. Tell him off, and you'll be gone.

I would NEVER question a physician. I might ask questions because I am curious, but not on anything like that.

Is it weird, yes. But he is in charge
 
PCP > premed

He knows what he is doing. Tell him off, and you'll be gone.

I would NEVER question a physician. I might ask questions because I am curious, but not on anything like that.

Is it weird, yes. But he is in charge
You would never question a physician's judgment? 🙄 They're not gods. Why worship them? It's always good to to get a second opinion on major things or even minor things if what they're doing isn't working.
 
Gotta love pre-meds spouting off about what is wrong with medicine and how they're not gonna be like everyone else cause they're smarter and better and less lazy =p Lol, at least it changes by the time they're in med school. Sure the PCP is wrong to not wash his hands. But he's not the one with the self-righteous attitude.

Oh whoops, wrong board! I hope he doesn't get admitted to med school because he'd make such a bad doctor! :laugh::laugh::laugh:
 
You would never question a physician's judgment? 🙄 They're not gods. Why worship them? It's always good to to get a second opinion on major things or even minor things if what they're doing isn't working.

+1. But to the OP, you're not really in a position to say anything or set an example as a shadower, regardless of how right you are. It's unfortunate.
 
ITT: Everything that is wrong with medicine

Be the change, Plasticup!

superman.jpg
 
My PCP never washes his hands either, nor did the family doctor I shadowed. Worst thing is my PCP works A LOT with HIV patients and he himself is sick a lot. I find that kinda disturbing.
 
If your own physician doesn't wash his hands, you can definitely say something.
 
Be happy you have the opportunity to shadow a doctor. It is not your place to worry about the problem. If you were a pt and noticed it then maybe you could say something. That would never go down where I volunteer because of the nurses that love to be abrasive towards docs.
 
I wasn't referring to the hand washing, but to the attitude that as a physician he is beyond reproach. Most of the doctor's that I've worked with wouldn't espouse such nonsense.

You'll have a fun time on the wards 🙂
 
Lolz nurse. Gloves for rectals and invasive stuff, wipe down your steth with alcohol wipes. It's primary clinic.
Is calling me "nurse" supposed to be disparaging? Are you that lame in your point of view that you need to call on "rank" (of which you have none) to justify yourself? Put on some big boy pants and be real. Hands carry pathogens. In the hospital and in the community/outpatient clinic. Washing hands significantly helps to disrupt the number one mode of transmission of pathogens. Well documented evidence. Go Pubmed yourself if you need to.

If you object to questioning the practices of a "superior". I get it, uncomfortable dilemma. But don't act like going from patient to patient, putting your hands on their body, and then moving on to the next one without washing your hands (unless you had your finger up their *sshole) is good medicine. Don't like hearing that from a nurse? Boo hoo. My heart is so broken. Try and sell your "not washing is not a big deal" theory to YOUR superiors, your PATIENTS, the QUALITY/RISK MANAGEMENT department of the hospitals they let you run around in. Tell me how well that goes for you.

:laugh::laugh:



:laugh::laugh::laugh::laugh::laugh::laugh::laugh:



^A fire ant could offer better advice.

OP: get over it. You're there to shadow, not save the world. Mind your own business. Ignore me at your peril.

What peril? The subpar doctor doesn't invite him back to shadow? Oh noez! Nobody likes a knowitall dipsh*t, but people respect someone that has a spine and stands up for the right thing.

They do live in the community and on you too. I hope you wash your hands everytime you shake someones hands or touch an object in a new room.
I wash my hands or use Purell everytime I enter a patient's room and every time I leave. Between when I touch the computer and the patient, after I go to the bathroom, before I eat, etc. I don't wash/Purell everytime I shake someone's hand no, but you can bet I'd be doing so if I did that right before examining someone's eyes, nose, mouth, etc. It is evidence based practice.

PCP > premed

He knows what he is doing. Tell him off, and you'll be gone.

I would NEVER question a physician. I might ask questions because I am curious, but not on anything like that.

Is it weird, yes. But he is in charge
Dude, you don't need to "tell someone off" to raise a concern. It doesn't need to be an accusation. Are YOUR social skills so poor that all you have is silent gutlessness or impertinence? There are respectful ways to raise a concern.

As a nurse, do I raise concerns with the physicians (or nurses, or RTs, etc.) I work with? Yes. It's my responsibility. Am I respectful and professional about it? Of course.

My PCP never washes his hands either, nor did the family doctor I shadowed. Worst thing is my PCP works A LOT with HIV patients and he himself is sick a lot. I find that kinda disturbing.

And you trust your health with this person because?..... Really?... I don't know what to say. If my doctor or my kids' pediatrician did not wash their hands, that would be a deal breaker for me. It really blows my mind that some people are so cavalier about it. I can actually understand a nervous premed afraid to speak up, but to put yourself at risk for contracting pink eye at best..... just incredible....
 
What peril? The subpar doctor doesn't invite him back to shadow? Oh noez! Nobody likes a knowitall dipsh*t, but people respect someone that has a spine and stands up for the right thing.

If a pre-med was shadowing me and one day walked into my office with a bag of 8 Purell's from Bed, Bath, & Beyond spouting off some nonsense about I noticed you didn't have time to use soap and water . . . I would murder them.
 
If a pre-med was shadowing me and one day walked into my office with a bag of 8 Purell's from Bed, Bath, & Beyond spouting off some nonsense about I noticed you didn't have time to use soap and water . . . I would murder them.

That's you. And if you're not washing your hands, you deserve to be clowned (or at least respectfully reminded) by yes, even a premed.
 
Is calling me "nurse" supposed to be disparaging? Are you that lame in your point of view that you need to call on "rank" (of which you have none) to justify yourself? Put on some big boy pants and be real. Hands carry pathogens. In the hospital and in the community/outpatient clinic. Washing hands significantly helps to disrupt the number one mode of transmission of pathogens. Well documented evidence. Go Pubmed yourself if you need to.

If you object to questioning the practices of a "superior". I get it, uncomfortable dilemma. But don't act like going from patient to patient, putting your hands on their body, and then moving on to the next one without washing your hands (unless you had your finger up their *sshole) is good medicine. Don't like hearing that from a nurse? Boo hoo. My heart is so broken. Try and sell your "not washing is not a big deal" theory to YOUR superiors, your PATIENTS, the QUALITY/RISK MANAGEMENT department of the hospitals they let you run around in. Tell me how well that goes for you.

Do you work in infection control as part of the hand washing police? I think you should put in a transfer. I recently read a study that the unit keyboards had more pathogens than the patients.

The scenario you keep spouting is about superiors, hospitals etc. I'd like to see you tell the owner/operator of their private outpatinet practice to wash their hands as a shadowing student. Given my experience, they barely touch the patients. There is probably more bacteria on their necktie than hands.

We get it. Standard practices says that you should wash your hands. The guy should do it, but you don't need to become militant nurse on him.
 
That's you. And if you're not washing your hands, you deserve to be clowned (or at least respectfully reminded) by yes, even a premed.

You have a remarkably naive perception of how the world works.
 
She's probably protected by her nursing union.

She's actually sending a shiver through me. I haven't started clinicals yet, but she's giving me a glimpse into the potential mentality of some of the nurses I may run across. It's almost a robotic, quasi-religious, adherence to protocol. It's creepy, frankly.
 
She's probably protected by her nursing union.

Nice try. Don't belong to a nursing union, never have belonged to a nursing union. (Unusual, I know for California). I have been a nurse for 6 years, and worked as a medical assistant for 4 prior to that, so, yeah, you can be rest assured I know what it's like in the real world, particularly when it comes to working with other members of the health care system, including physicians.
 
She's actually sending a shiver through me. I haven't started clinicals yet, but she's giving me a glimpse into the potential mentality of some of the nurses I may run across. It's almost a robotic, quasi-religious, adherence to protocol. It's creepy, frankly.

Are you kidding me? What protocol? Washing your freaking hands? It's not karmic koolaid. Seriously, go around and advertise that you think that you don't necessarily need to wash your hands. That it's a trite custom, or somesuch. Tell your patients that it's all nurse propaganda.

Good luck with your knee-jerk reaction to discredit scientifically sound information just because it comes from a nurse.
 
And you trust your health with this person because?..... Really?... I don't know what to say. If my doctor or my kids' pediatrician did not wash their hands, that would be a deal breaker for me. It really blows my mind that some people are so cavalier about it. I can actually understand a nervous premed afraid to speak up, but to put yourself at risk for contracting pink eye at best..... just incredible....

I trust my health with that person because I am a transsexual and he is the only doctor in the STATE that will accept transsexual patients. So either I don't get medical treatment at all and nearly die of pneumonia because I don't have access to a doctor (which is what nearly happened before I had him), or I deal with his lack of hand washing. Luckily, I am always the first patient of the day.
 
Are you kidding me? What protocol? Washing your freaking hands? It's not karmic koolaid. Seriously, go around and advertise that you think that you don't necessarily need to wash your hands. That it's a trite custom, or somesuch. Tell your patients that it's all nurse propaganda.

Good luck with your knee-jerk reaction to discredit scientifically sound information just because it comes from a nurse.

What in the HELL does this have to do with some douche shadowing a doctor? Why stop at hand-washing? Perhaps he should counsel the doctor on his relationship with his wife for the sake of the doctor's children?

"You know doc, I overheard you on the phone with your wife, and I noticed a bit of a tone of your part. Now I know relationships can be demanding, but please, for the sake of your children, you need to learn how to cope with these stressors. Here's my cell phone number if you need any further counseling. Now let's go see some patients! Right after you wash your hands."
 
Do you work in infection control as part of the hand washing police? I think you should put in a transfer. I recently read a study that the unit keyboards had more pathogens than the patients.

The scenario you keep spouting is about superiors, hospitals etc. I'd like to see you tell the owner/operator of their private outpatinet practice to wash their hands as a shadowing student. Given my experience, they barely touch the patients. There is probably more bacteria on their necktie than hands.

We get it. Standard practices says that you should wash your hands. The guy should do it, but you don't need to become militant nurse on him.

Actually, I'm not on the "handwashing police". Oddly enough, I think many of their campaign tactics are foolish and a waste of time. You know what I'm talking about, the cutsey posters, etc. That doesn't mean that I don't agree with the basic premise of washing hands. And hey, if you find a study that shows there is a higher concentration of bacteria on keyboards, than patients, than that further demonstrates you should wash your hands after touching the keyboard before you "barely touch your patients."

And hey, not trying to be militant, but I'm not going to sit quiet while a super basic tenet of good medicine is dismissed or even called "preferable". It's as bad as saying antibiotics are okay to prescribe for the common cold because it makes your patients happy.

And it really is an important issue, which you should already know if you actually do keep up with the literature.
 
I trust my health with that person because I am a transsexual and he is the only doctor in the STATE that will accept transsexual patients. So either I don't get medical treatment at all and nearly die of pneumonia because I don't have access to a doctor (which is what nearly happened before I had him), or I deal with his lack of hand washing. Luckily, I am always the first patient of the day.
Off topic but I doubt that this is true. Only PCP? or is he a specialist?
 
Off topic but I doubt that this is true. Only PCP? or is he a specialist?

He is a PCP and he writes for our hormones. Technically, I should have said he is the only PCP who will see trans patients. There are two plastic surgeons that will see us (one of which stopped a few months ago because dealing with trans patients is increasing his malpractice) and one obgyn. I have a neurologist who I am the first trans patient for and I am not entirely sure he would willingly accept another.

I've lived here for 11 years and been active in the trans community here for 8. We all know the doctors who do and don't see us, when they started seeing us, if they are still active, and where they moved to. Over half of my PCP's patients are from out of state because trans patients can't find a doctor who will treat them. Other doctors who say they help the LGBT community, usually do not help T. This is one of the major reasons that I want to go into medicine. By the time I get into medical school and am done with residency, my PCP will be not too far from retirement. He is the type who would not retire until he is sure that his patients are with someone he trusts. Our main difference would be that I use hand cleaner after seeing each patient. 😉
 
I'm shocked that medical students have invaded this thread to laugh at the posters who think hand-washing is a must. Regardless of the specialty, doctors should always wash their hands and if they don't, they should be called on it. I don't care if it's a patient, a supervisor, a med student, a nurse, or a pre-med. What's the worst he can do? Refuse to let you shadow again? Big freaking deal! There are other "doctors" in the sea, hopefully some who know a little something about hygiene at this stage of the game.

And sideways, instead of acting like the thread clown and berating a pre-med, maybe you should wait until you've actually been on the wards to claim expert status on this issue. Simply being in medical school doesn't make you an expert on what happens in clerkship. Your posts are as laughable as they are ignorant.
 
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