Walking in the Valley A weekly column for those who live and walk in Silicon Valley by Barbara Dahlgren

Let's Not Shake On It Column for the week of August 8-14, 2004

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Starting this summer the National Board of Medical Examiners will require an exam to access whether or not aspiring doctors can relate to patients. This test has been mandatory for students coming from foreign medical universities wanting to continue medical training in the U.S. since 1998. Now it looks like U.S. doctors will have to improve their bedside manners too.

Shades of the 1991 movie The Doctor drift through my mind. Based somewhat on the autobiographical book A Taste of My Own Medicine by Dr. Ed Rosenbaum, The Doctor starred William Hurt as Dr. Jack McKee who knew it all and had it all. He looked at his patients more as numbers than names until low and behold he got cancer. All of sudden he was the patient and not the doctor. Gradually his views changed…dramatically.

Doctors have evolved into an aloof specialized species. The days of the country doctor who lived among the people are long gone. His neighbors were his patients. He knew them as friends as well as those in need of medical assistance. One of his strengths was the ability to communicate. He even made house calls. Remember the house call? I don’t. It was long before my time and I’m not that young. Was there a need for specialists in those country doctor days? Sure! If you had a heart ailment it was prudent to seek advice from a cardiologist (probably called a heart doctor in those days) if you could find one. But today it seems like every doctor is a specialist. I’m surprised they don’t have a splinterologist and a tummyachisist. All this specialization doesn’t really give doctor and patient time to bond per se.

Even if your doctor has a good bedside manner chances are he/she’ll be using it in a hospital. Hospitals are not really designed for sick people (or well people for that matter). These huge, unventilated structures are filled with every germ imaginable. People who enter are just an infection waiting to happen. Deaths caused by diseases caught from just visiting a hospital kill more people each year than car crashes and murders combined. These infections are so common they have their own name nosocomials meaning infections acquired in a hospital.

Doctors who are so intellectual they can’t communicate with the common man are nothing new. From the 1500s to 1800s officials were baffled why the death rate among women whose babies were delivered by doctors in a Vienna hospital was around 25% while those delivered by midwives was only around 2%. These mothers died from a disease known as childbed fever. All sorts of unusual theories were used to explain it from anatomical drawings of Da Vinci to eclipses to foul vapors. In 1846 Hungarian obstetrician Ignac Semmelweis discovered that these deaths could be stopped if doctors washed their hands in chloride of lime between patients. In 1848 when doctors were commanded to start doing this the death rate dropped to around 1%.

Unfortunately this finding was ignored by the medical profession of the day. Sherwin B. Nuland’s book The Doctors’ Plague explains why. It seems for years Semmelweis neglected to document his findings in medical journals. About a decade later when he finally did write a book it was over 500 pages long and “logorrheic, repetitious, hectoring, accusatory, self-glorifying…in sum, virtually unreadable.” It was probably like reading medical journals today. Eventually the medical community did accept this practice but if Semmelweis could have communicated with the common man or even his colleagues better thousands of lives could have been saved.

But guess what? According to a study in the Annals of Internal Medicine doctors of today only wash their hands before seeing patients 57% of the time. In addition over 30 separate studies by the American Medical News Service found that doctors do not wash their hands regularly between patients. The funny thing is the AMA encourages doctors to instruct their patients on how important it is to wash their hands. We even have a National Hand Washing Awareness Week (December 8-14 this year). This might be a case of what the Bible calls physician heal thyself. (Luke 4:23)

Be sure to visit this page every week to read the next edition of Walking in the Valley. You can write to the author at bdahlgren@wcgsouthbay.org.