Are you worried about catching the horrifying MRSA super-bug when you go see the doctor? I’m embarrassed, as a physician, to say that there are legitimate reasons to be worried. Doctors actually do a bad job of washing their hands, with observed rates of hand-washing in the ICU as low as 28% (urg). On average, male doctors are worse, and, even more horrifying, as a group, surgeons are the worst.
The good news is that studies have also shown that under specific, carefully controlled circumstances, with numerous props and interventions, doctors are (sometimes) teachable.
However, it clearly takes a lot of persistent reminding.
So, to help you maneuver the socially awkward situation of asking your doctor to wash, here are ten physician-approved (by me) creative approaches you can try.
1) Bow like a French courtier while holding his fingers limply in yours. Straighten, wipe your hand on your thigh and say, “Dang. Just realized I forgot to wash after that bowel movement.” If he doesn’t make a beeline for the sink, bow again with a hand flourish toward the soap dispenser and say, “Would you like to go first, Your Eminence, or should I?”
2) When he walks toward you with hand outstretched to introduce himself, you say, “Ah, ahh, aahhh, CHOO,” and spray spit all over his palm.
3) Stand by the soap dispenser while you wait for the doctor to arrive. As he walks in, say, “Hey, this wall-box is pretty cool. How do you use this gadget, anyway?”
You might think it is unlikely that someone would believe you actually don’t know how to use a soap dispenser, but trust me. It will work. Years of training are devoted to convincing doctors that, given a choice, they must always assume their patients are idiots.
4) When he starts to ask you questions about why you’re there, say, “Sorry, but I don’t talk until the hands are washed.” If he smiles gently and tries to continue a discussion, put your fingers in your ears and repeat, “Nah, nah, nah, I can’t hear you…” until he caves. Remember, time is on your side.
5) Channel your inner Macy’s perfume-seller. Whip out a bottle of the standard, stinky hand sanitizer, and say, “You’ve got to try this. The smell, the feel, I’m telling you, this product is fabulous,” and then, without waiting for a reply, lean forward and squirt it all over his hands, even if he is holding your chart.
6) Bring a roll of blue tape to your appointment. Make a blue-line circle around yourself on the floor, at least five feet in diameter. This approach has the added benefit of giving you something to do besides reading a June 1997 Parents magazine during your hours of freezing semi-naked in the exam room. When the doctor finally arrives, say, while looking up over the top of your wrinkled magazine, “Hi. Just waiting for you here in my clean hands zone. If you’d like to join me, the sink is over there.”
7) Ask the nurse to tell him to wash his hands. If she rolls her eyes and says, “That guy? I wish,” then you know you’ve got your work cut out for you. A hard-core case like this calls for desperate measures. Bring in a gold star sticker. Tell him he only gets one if he washes his hands. Sure, it’s manipulative, but effective. Recovering pre-meds are suckers for extra credit.
Bring a beanie baby and a pair of scissors with you to your appointment. Stand in the far corner of the exam room. While you wait, muss your hair until it is wild, re-button your shirt so that you skip a few buttons, and practice having an eye twitch. When the door opens, hold the tip of the scissors to the soft furry neck and shriek, “Either wash your hands or the beanie baby gets it! We’re talking millions of tiny plastic beads spurting all over the floor! Don’t make me do it!”
9) Bring a clipboard and a pair of bifocals. As he comes into the room, and begins talking, say, “Hmmmm.” As the awkward silence descends, make checks on the clipboard while you mutter, “Introduces self, yes, neat attire, yes, waiting time, unacceptable.” Stare at him some more. When he gets flustered and says, “What is this, some kind of evaluation?” smile knowingly, airily wave your hand and say these important phrases, “new standards, Medicare, reimbursement criteria–it’s a pay-for-performance kind of thing.” He will blanch and possibly stagger into a chair. You ignore him, stare fixedly at the sink, pick up your pen and wait. If he can’t seem to pull himself together, or takes too long to recover consciousness, say sweetly, “Don’t make me take off more points,” and nod at the sink.
10) The last approach is radical. Not everyone will feel comfortable doing it. Warning: if you try this approach, there are likely to be side effects. Brace yourself for 1) a giddy sense of power that may last for days, and 2) persistent vertigo caused by a seismic tilt in the world order.
Here it is: you say, “Hey, I want to see you wash your hands.”
Interpret any excuses, evasion, or refusal as a clear sign that it’s time to find a new doctor. As far as I’m concerned, even a frown of annoyance justifies giving a doctor the boot.
No matter which approach you use, make sure you ask your doctor to wash up, even if it feels awkward or embarrassing. If we all ask, one day the hand-washing question, heard in doctor’s offices all across America, will be as normal and expected as the doctor’s question to you, “take a deep breath, please?”
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Doc Gurley is a Board-certified Internist physician and the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing. 
[...] a review of the issue of doctors and handwashing (or lack thereof). Read the Doc Gurley November 16 post if you want a quirky take on what you can do about the [...]
[...] 3) Ask people to wash their hands, especially that person with the big needle. If you’re feeling socially awkward about doing this – see the post on Ten Creative Ways To Get Your Doctor To Wash His Hands. [...]
Very funny, and very good. It’s not the doctors I worry about as it is the person coming into my hospital room to take blood.
Usually she enters the room with gloves already one. How do I know how many patients those gloves have “seen”?
Put new ones on in front of me please.
Sometimes, Death Is Good- For A Vicious Unicellular Microorganism
There are a variety of different types of foreign bacterial infections one can get from many different sources, yet some are more common than others. If they are not beneficial for your physiology, they all should die in order to restore your health.
Bacteria are a simple life form, yet are incredibly productive and efficient. As with other life forms, it exists to reproduce. To do this, it fully utilizes all available resources and energy to develop the protein that is essential for its survival, and bacteria have the ability to adapt as needed to assure this happens.
It needs exactly 7 genes to produce the essential ribosomes for this to occur. Any more or less genes than 7, the bacteria is not maximizing its efficiency to survive and reproduce. Amazing.
Strept infections are caused by what are called gram positive bacteria, and are unique that these bacteria grow in pairs. Staph bacterial invasions are gram positive as well, yet it is the MRSA, Methicillin Resistant Staff Aureous microbes of this type often are very difficult to treat normally when a patient suffers from their damage from being invaded by these bacteria. Another difficult situation is when a patient is infected by VRE, Vancomycin Resistant Enterococci, as well.
These MRSA and VRE pathogenic or disease causing bacteria are the ones that are the most clinically concerning for the health care provider.
Group A strep infections can cause diseases such as strep throat and pneumonia. Since there are several types of bacteria, a diagnostic test called a culture and sensitivity is usually performed to assure the correct antibiotic is selected for treatment, as the bacteria are identified with this method.
Typically, fluid from the area suspected of being infected is obtained from the patient suspected to have an infection and smeared on what is called a petrie dish. And then these dishes are incubated for 2 to 3 days. Gram positive bacteria stain during this process a dark violet or blue. Gram negative bacteria would be pink in color, and are capable of harm as well to a human being.
When the culture is complete, technology offers recommendations on the appropriate class or brand of antibiotic for this bacteria present in another person- presuming the bacteria will not be resistant to the antibiotic recommended, as this happens on occasion.
Usually, classes of antibiotics that are used to treat gram positive strep infections that are not VRE or MRSA are cephalosporins, macrolides, or general penicillins. If the microbe that is causing the infection is resistant to the antibiotic from such classes that are administered to the infected patient, particularly with methicillin and vancomycin, which is the case with VRE and MRSA bacteria, then there are other more aggressive antibiotics that will be chosen for this patient.
Such brands and types of antibiotics for MRSA and VRE bacteria include Zyvox, which has both IV and oral dosage options. There are also other antibiotics, such as Cubicin. However these antibiotics for antibiotic resistant bacteria are given usually due to infections that have progressed to a more serious nature within a patient infected in such a way.
Progressive medical conditions include sepsis, or blood infection, osteomyelitis, or bone infection, or Pneumonia, which is a serious lung infection. A hospital stay is normally required with such patients, as the last antibiotics mentioned for MRSA and VRE bacterial infections are given by IV administration initially for several days, if not several weeks.
There are numerous classes and types of antibiotics available, yet bacterial resistance to most of these antibiotics constantly remains serious concern for the health care provider, and the infected patient, with MRSA at the top of the list of concerns for the health care providers.
Dan Abshear
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_spotlight_2006.html