Ebola as Shock Therapy for Doctors By Stella Fitzgibbons MD

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Okay, admit it–you DON’T always sanitize or wash your hands before you enter every single patient’s room, or even when you leave it. If a hospital patient is on contact isolation for C. difficile but you only want to ask him a couple of questions without examining him, you don’t always bother with the gown and gloves. And you’re still sneezing at random and refusing to wear those dorky short-sleeved white jackets, let alone bowties. Your Dad taught you to shake hands, and no fist-bumping infection control nurse is gonna change that.

But as of this writing, two American doctors who went to Africa to care for patients with Ebola have contracted the disease. Do you think they didn’t pack plenty of hand sanitizer before they left the States? Or that hand-washing is totally unknown, even in crude facilities?

We doctors ourselves may be a reason for concern about an Ebola epidemic here. Nurses have been too easy on us for too long, sighing resignedly instead of slapping our ungloved hands when we break isolation protocol. Hospital administrators can put up signs to remind us, but should we really need those? After all, we’re the ones who read the articles and texts about the latest viruses and are supposed to know how they’re spread.

The next patient you see with sore throat, fever and a rash probably doesn’t have Ebola. But it would do a lot of good, even to patients without it, if we would start taking infection-control precautions NOW instead of waiting for the headline that is probably coming. Practice may not make perfect, but this is a practice that saves lives.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Ebola as Shock Therapy for Doctors By Stella Fitzgibbons MD

  1. Pat
    September 11, 2014 at 2:57 pm

    Good column Stella, keep ’em coming.

  2. September 10, 2014 at 7:53 pm

    As a person who has gotten an HAI of antibiotic resistant bacterial infections twice out of the previous two times I was in a hospital – different hospitals, different conditions, different states – and ended up BACK in the (same or different) hospital for treatment of the infections, I feel I can comment.

    For one thing, the most recent time, hospital administration decided to put me in the obstetrics ward with MRSA as they’d put someone else in the isolation room I’d had reserved. That’s okay, because, as I’m sure you know, infants are born with such fantastic immune systems that they’d be sure to fight it off. Even at THAT, I had to remind all of the nurses and CNAs who came into the room to USE UNIVERSAL PRECAUTIONS. Many of them didn’t. One RN even argued with me, that when she came in that the patients involved were “Only sweet little babies”. Maybe, but I could catch something from that. I reminded her again when she left – did she really want to give MRSA to one of those “sweet little babies”? She huffed and went along with it. In defence of the doctor, he was aghast when he found out where I was and worked up the discharge. I was FAR better off at home!

    I also learned that in a large number of hospitals, with an airborne or partially-airborne pathogen, isolation or not does not matter anyway, since the entire hospital has its air mixed-together then redistributed by the HVAC system. They were designed this way in order to save money for the hospital corporation. Indeed, why should they work to prevent spread of these diseases? When people come back (or from another hospital) after having an HAI, they get more money, so long as it’s not proven they got it in the hospital.

    Yes, Moshe, Standard Precautions (formerly called Universal Precautions) have been proven to help prevent the spread of infectious disease. That was one reason that in the 19th century, doctors had a far worse record on infant and maternal deaths in obsterics than did midwives – the doctors didn’t wash their hands after handling cadavors or infected living people before delivering babies then. Now, there are worse things that are not treatable with antibiotics. See http://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm

    • Moshe
      September 12, 2014 at 3:03 am

      Beth, thanks for sharing your story. It is exactly why we need to focus on evidence based modes of decreasing infections in hospitals.

      As you note, standard precautions help decrease the spread of disease. Hand washing in particular (with an alcohol based sanitizer or soap and water) is effective in decreasing this spread.

      However, I don’t think that we should jump to all sorts of non-evidence based ideas. Fist bumping, for example, does not have a shred of evidence that it decreases spreadin disease in hospitals. Sure, it decreases bacterial load on hands, but who says that will decrease disease? Bacteria are everywhere – beds, doorknobs, clothing, computers, cell phones. We need to be vigilant in stopping the spread of these bacteria to the sick and elderly – by washing hands before and after examining them. If other modes will be shown to decrease hospital acquired infections – great! I’m not sure that taking unproven methods and implementing the is the way to go – far better to work on impementing the proven and studied methods (hand washing, standard precautions when needed, isolation rooms, etc) of decreasing infections.

  3. Moshe
    September 10, 2014 at 1:06 pm

    Do the interventions you propose have evidence to back up the contention that they decrease infections?
    The studies on these interventions are lacking in that they used surrogate endpoints, ie bacterial load as opposed to decreasing infections.
    I am all for hand washing, but fist bumping? Bowties?

    Show me the evidence.

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