Do I really have to remind you to wash your hands before surgery?
In the course of my own religious studies, I came across a remarkable number of Jewish commandments that had the side effect of improving hygiene and keeping Jews healthier, even thousands of years ago. For example, according to Jewish law, one cannot make a blessing if they smell human waste. In a time before flush toilets, this meant that sewage areas had to be at the outskirts of a Jewish village. This would be the only way to prevent such smells from becoming a constant presence. As it turns out, proper waste disposal has the benefit of reducing the spread of a variety of illnesses.
In general, Jewish homes tended to be far cleaner, also for religious reasons. In the time of the holy temples, it was necessary to keep a home free of rodents and other pests [that carry disease] in order to retain the ritual purity of certain items that would eventually be brought to the temple. It is known that during the plagues that swept through Europe, carried by fleas on the backs of rats, Jews were relatively spared due to their religious and cultural focus on cleanliness. Many Jews still died during this period of time, because the lack of disease amongst the Jews was seen as an act of witchcraft by the non-Jewish neighbors. Many Jews died in pogroms, due to claims that the Jews had fallen in with the devil.
Basically, adherence to Jewish law maximizes the benefit from public health measures. Another example is that Jews would always wash their hands before touching food, and it was regular practice to bathe, especially before the weekly Sabbath.
In the following article, that recently appeared in the New York Times, the author, Mr. David Bornstein, speaks of preventable harm that continues to cause suffering and death across the hospitals of the United States. It is estimated that somewhere between 80 to 450,000 deaths occur each year due to preventable errors in hospitals These numbers are of course ludicrously high.
Imagine what the public’s response would be if 400,000 people died every year, just in the United States, due to plane crashes. Imagine improper food preparation that led to thousands of children dying every year. It is needless to say that a government could fall over such numbers. Nevertheless, the bubble that surrounds medical practitioners protects physicians from any significant repercussions. Admittedly, some doctors do get sued for malpractice when they operate in an error-prone manner. But the number of such cases is tiny relative to the number of people who are hurt for no justifiable reason.
Patients continue to die every year because physicians, despite their years of training, fail to wash their hands appropriately. It is mind-boggling that in this day and age, a doctor fails to wash his or her hands when dealing with patients. It is disgusting that patients are still frightened to ask the doctor if he or she has washed their hands before touching them. Whereas doctors have no qualms about overprescribing high-end antibiotics that have contributed to a world crisis in resistant bacteria, the same doctors cannot be bothered to do the most basic action that could spare the lives of hundreds of thousands of people.
I remember, three years ago, being at a conference in Israel on quality of care. One of the presenters discussed the importance of hand washing and noted that it was necessary to be imaginative in order to find ways to encourage doctors to partake in this standard practice. The idea that doctors have to be cajoled into practicing the most basic hygiene, really made me nauseated. And yet, a room full of physicians nodded their heads as if to say that something as basic as handwashing is not necessarily within their purview.
I have expressed my opinion on issues like this in multiple blog posts. I personally believe, from my own experience with hundreds of physicians over 2 1/2 decades, that human doctors simply cannot be relied upon to do their jobs properly. In the article I referred to above, there is a description of how multiple different hospitals are working with their medical staff to reduce preventable errors. There is a very evident sense of the privilege that doctors still enjoy, such that simply threatening to fire them for not following basic protocols is considered unreasonable.
Someone will always say that if we fire doctors for every “little thing”, we would quickly run out of staff to care for all of the patients. For doctors to take advantage of such a situation, so as to avoid personal responsibility in the performance of basic tasks that save lives, is in my opinion, nothing short of immoral.
I have also spoken multiple times about the need to reduce or even eliminate the human component in medical care. As technology advances, every effort should be made to replace physicians with artificially intelligent computers and robots. Until this time when human physicians have been marginalized, doctors’ egos should be bruised as often as possible.
Properly designed electronic medical record systems should limit the ability of physicians to act inappropriately. When physicians claim that such computer oversight would reduce doctors to nothing more than technicians, I personally smile. When intelligent robots will be able to take blood, replace all forms of tubes and catheters, continuously clean patient rooms and bathrooms, and physically block a physician from touching a patient if protocol has not been followed, then we will experience a huge drop in preventable errors.
By the way, none of this eliminates the human component in medical care. This approach simply stops doctors from making ridiculous, unjustifiable, unprofessional, and deadly mistakes. Any physician who feels that this is too limiting and interferes with the famed doctor-patient relationship, will hopefully leave medicine and look for gainful employment in whatever field that robots have still not taken over.
The designers of electronic health records could do far more to advance this cause. In my own EMR, there are many points at which a physician must justify his or her actions in order to record documentation or discharge a patient. One of the major innovations I instituted was a program that allowed for real-time continuous oversight of patient management via a concise webpage. On many an occasion, far too many an occasion, I personally was able to identify clinical practice that was inappropriate. And all of this is without the coming age of “sensors everywhere”. When the time comes that software is able to know if the doctor did in fact wash his hands before examining a patient, we will definitely be on our way to dramatically improving quality of care, despite human physicians.
I should point out that I personally experienced two physicians who felt that such oversight was exaggerated. They threatened to leave the workplace if they were not excluded from such tracking. All I can say is that I was happy to receive their resignations. They found work elsewhere, but I pity the patients who they treat.
EMRs can dramatically contribute to better care. But someone within the multibillion-dollar EMR industry will need to make it a priority to have computerized medical oversight. Once such systems are in place, there will be many physicians arguing that they are being blocked from doing their work “their way”. The point they are missing is that most of medicine is not meant to be innovative.
In most cases today, there are very clear and strict protocols for handling a wide variety of patient conditions. EMRs that enforce these protocols, by definition, would not be interfering with any physician’s work. Quite the contrary, they would be [for the first time] forcing doctors to work properly. Since the fear of litigation or just basic professionalism and morality is not enough to get doctors to do their jobs properly, computer oversight is the only hope for people who needlessly suffer in the hands of individuals who should have their MDs rescinded.
I am very passionate about this issue, as I’ve seen for myself too many patients suffer for the stupidity of human health care providers. I’ve seen patients die because of doctor laziness and/or disinterest in the patient’s welfare. In a desire to save money and to increase profits, I’ve seen medical institutions tolerate totally substandard health care. Once, however, EMRs make poor delivery of care impossible, all of this insanity will hopefully stop. I say “hopefully”, because in cases where ego and money are involved, human beings can be very imaginative in finding ways to bypass critical safety measures.
I truly hope that I will live long enough to see self-important physicians being cast aside by AI systems and robots. Perhaps the technological deflation of doctors’ egos will finally weed out those practitioners who more appropriately belong in a slaughterhouse. For the individuals who stay in the practice of medicine, they will be the kind of people who welcome any and all help that advances the welfare of the patient. When this day comes, I know that I will feel a heavy weight lifted from my heart.
Thanks for listening.