Monday, April 30, 2012

The Issue of Time and Professionalism

Gawande, like of the authors we've read from this semester, is also concerned with time and asserts how many doctors simply do not have the time in between patients to properly employ good hospital hygiene up to standards. In a particularly disturbing chapter on hand washing Gawande illuminates not the laissez-faire attitude of hospitals and hygiene but the issue of time in both remembering and having the almost commodity moment to sanitize before interacting with a patient. Gawande admits that he, like many, can be careless with this and forget to squirt some Purel on his hands before touching a patient (eek!) There is a crucial flaw, however, with Gawande's argument in this chapter. He mentions that sometimes "the patient puts his hand out in greeting and I think it too strange not to go ahead and take it (23). While this is an honest statement, and one most can empathize with, Gawande (and presumably many doctors) sometimes seem more attuned to the social interaction of medicine and less so with the technical aspect of it. I'm not trying to nitpick at this one sentence that seems more or less of little significance, but it got me thinking about earlier discussions about technical and personal aspects of medicine--is it social or scientific? And how many doctors are worried about appearing rude at the cost of the patients health (not to mention the crazy bills for extended hospital stays as a result of infection.) I understand that doctors and surgeon juggle a complex balancing act of likability and professionalism, but at what cost? Perhaps Gawande was just anecdotally adding to his theories and meant nothing by the statement but it seems it human nature to respond to social circumstances the way he describes. When should a doctor draw the line, look like kind of a douche bag, and ignore the patients hand? (So to speak...)


  1. I agree with the point you made about how this book, like others, discusses the issue of time among doctors. It seems so absurd that a doctor would forget to wash his hand before meeting a patient, but it happens. I don't think a doctor should completely deny shaking someone's, but simply should wash their hands before entering the room and meeting the patient. Along the lines of time, I thought the chapter on doctors in Afghanistan and Iraq was really interesting. He stated how the number of deaths has not necessarily decreased due to new medical technologies, but to changes in how medical aide is provided. For instance, the use of Kevlar vests are strongly enforced, and a team of doctors now travel with the troops to provide aide right on the ground. However, in one part of the chapter he discusses the invasion of a particular city that led to a large number of wounded American soldiers. He states that the percent of deaths were rather low due to the diligence of the doctors. Yet, the doctors were awake for 48 hours, napped for a several and then returned to another 48-hour shift. While I understand they are working in a war zone and under extreme conditions to save lives, I don’t think this should serve as an example to other doctors. I believe doctors should be completely committed to saving the lives of their patients, and this might have been the point Gawande was trying to make. However, I believe other errors can occur when doctors don’t have sufficient sleep, which can cause problems.

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  2. I thought that this hand-washing anecdote from Gawande was interesting, particularly when stacked alongside the other aspects of healthcare he choses to introduce. Hearing the proficiency and no-nonsense attitude of the physicians working in the army, its hard not to wonder if physicians state-side have not grown cushy and lazy in their practice. The entire ruckus struck about sanitation truly gave my the impression that American doctors are frustrated in their profession to the point that hygiene is of secondary importance. Since contemporary physicians are by nature working in small margins, one would think that they would be extra cautious against miniscule slip-ups like these, no matter their specialty, character, or time-limitation. This is precisely the type of droning which Gawande is advocating against in his entire book. As soon as a physican becomes stuck in a rut in his practice, without the excitement of true patient relationship or passion for medicine, things start crumbling fast, as doctors simply go through the motions, bitch and moan about their jobs. I believe that the vigor and stamina of physicians in places such as Indian hospitals or Iraq result from the extremity of their situation, and the necessity to completely immerse oneself in the profession. This leads to remarkable health deliverance, rather than the factory-model encouraged by insurance companies, current healthcare system, and hospitals.