Friday, October 26, 2007

"Professionalism and the Psychopathology of Everyday Life"

This is an email sent to the Department of Medicine at Columbia by Donald Landry, Acting Chair of Medicine (and one of my mentors).

I've reproduced it here because it's one of the strongest and best arguments for handwashing that I've read.


Re: Professionalism and the Psychopathology of Everyday Life

Consider the spectacle of surgeons who argue with JCAHO
inspectors rather than mark an extremity prior to lateralized
surgery, or pediatricians who object rather than wash their hands
prior to examining a child. How can we understand such behavior
described by witnesses as “bizarre”, “inverted”, and “strange”?
How can we understand hyperintelligent internists who, as
a group, adhere to elementary hand washing protocols only 50-60% of
the time, despite constant reminders?

A potential explanation: some physicians perceive in the new
required practices an almost mortal threat. But why? Imagine a
physician whose entire life is devoted to providing the highest
quality of care, a prideful physician admired by patients,
respected of peers – imagine such a physician who now hears that
his or her sterling practices of the last few years or decades are
flawed, dangerous, substandard, unprofessional. To accept this
pronouncement is to see the edifice of a lifetime's work leveled in
a moment. How could such a physician react, except with denial and
defensiveness? And from this wellspring comes the contradictions
that we witness with wonder.

I see only one productive course. We must surrender. We must
surrender in terms of our conduct and our disposition. Only from
the most open posture can we rapidly assimilate and incorporate the
best practices to which we all aspire in moments of quiet

The care of our patients must transcend every other concern.
Failure to commit radically to this principle breaks faith with our
patients and invites sanctions from external observers...

Full disclosure: I can recall a time when I failed to wash my
hands 100% of the time. My practice consisted solely of ICU
patients and I was wearing new gloves for each patient, so why wash
hands? But I was wrong and admitting this was the necessary first
step to change. And so if you are fully compliant, wonderful. But
if not I strongly advocate unconditional surrender...

Many thanks for your help and for your commitment to our

Don Landry

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