Okay, I admit it. I see his picture in the NY Times and I am immediately envious of his great shirt and tie, his blond good looks and as I read on, his MacArthur genius grant and the life which allows him to "travel the country, advising hospitals on innovative safety measures." (Italics mine.)
It gets worse--or better, depending on how green you are turning with envy-- when you look him up on Wiki and discover Atul Gawande has said his work "Has already saved more lives than that of any laboratory scientist in the past decade."
Now that got me thinking. What lab scientist has saved lives over the past decade? Let's see, there were the guys who identified the HIV virus, but that wasn't in the last decade. I'll have to think about this.
And there was that guy in Pakistan who did microlending and those people in Africa who brought cheap water pumps for clean water to African villages and there were those guys who came up with a new malaria drug...but why quibble over a statement like, "Has saved more lives than..."?
So, okay, what did this designated genius do?
Seems he came up with a checklist, similar to the ones used by airplane pilots, but for doctors and nurses, to be used in intensive care units which is:
1/ Wash hands with soap
2/ Clean the patient's skin with antiseptic
3/ Put sterile drapes over the entire patient
4/ Wear a sterile mask, hat, gown, gloves
5/ Put a sterile dressing over the catheter site
Check, washed my hands, got that. Check, wiped off the patient's skin. All these things, actually, I used to do with some part of my brain which hangs out way below the cerebral hemispheres, in those automatic part of the brain which gets you from your house to your office in the car and you cannot remember how.
Nothing new here. These are all things we were doing thirty years ago. But maybe people forgot, or forget.
Ah, yes, the doctor tells the Times, he discovered doctors don't always do these things when things get hairy in the ICU, so his big bright idea was putting all this stuff in a handy cart and making these carts available and close at hand. Voila, MacArthur foundation calling.
Meanwhile, he somehow measured outcomes. He showed, somehow, how many infections occurred because of lapses in sterile technique in the ICU and how many fewer infections occurred as a result of being more meticuluous by using the checklists. (Ergo, Dr. Gawande's assertion about how many lives his innovation of using handy sterile supply carts resulted.)
I guess there are some infections you can be pretty sure came from catheter sites, because of the nature of the bug (staph) which is a known skin (or nose) contaminant, but whether or not there was an actual lapse in technique would be harder to say, but if you see a reduction in local IV site infections and in bloodstream infections with skin contaminants, you could track that.
So maybe, if you get everyone's attention by doing a study, you can improve performance, at least for a brief time--the way worker's productivity improves every time you paint the factory walls a new color--the so called "Hawthorne effect." The problem is, how do you keep up the improvement, once it becomes routine?
It's not like this guy is Semmelweis, the Hungarian physician who had to convince his colleagues handwashing was a good idea, especially when you were going from the autopsy room to the delivery room and transmitting these invisible things, we now call bacteria, doctors did not believe in at the time. So in Semmelweis's time, childbed fever killed a lot of patients because doctors were obtuse and he was nearly hounded out of the profession because doctors don't like to be told they are doing something wrong.
I agree, doctors still do not like being told they are doing something wrong, but there are mechanisms in place to change behavior (vidre infra.)
And the good Dr. Pronovost is reviving that role of the crusading, courageous physician. He tells a story about the time he was the anesthesiologist and the surgeon was wearing latex gloves--at least he was wearing gloves, give the poor surgeon some credit--and Dr. Pronovost knew those latex gloves were killing the patient because somehow Dr. Pronovost knew the anaphylactic reaction he was seeing in the patient was caused by the latex and so he got the nurse to call the Dean of the medical school to make the surgeon take those gloves off. That's what a crusader Dr. Provonost is!
The surgeon cursed Dr. Provonost, which is to say, the crusader was doing what was right for the patient even though it was at a cost to the crusader, he will have you know.
But Dr. Provonost would do it again, You can bet on that.
That's the kind of guy he is.
He told the nurses at the hospital, "They could page me day or night, and I'd support them," if they saw any of those arrogant doctors failing to wash hands or step out of line. "Well, in four year's time we've gotten infection rates down to almost zero in the I.C.U."
And so he's save more lives than any lab rat, test tube rattler in any lab in this country.
Or so they say. Or so Dr. Gawande says.
Dr. Pronovost says he got the infection rate at Johns Hopkins Hospital from being among the worst 10 percent of the country to among the best. Of course, this assumes the other hospitals really know what their infection rate actually is--not always so simple a proposition.
There are certain numbers which get floated around, like there are "Over 90,000 deaths in American hospitals every year from medical errors." That particular bogus number which was supposedly extracted from a review of hospital charts (as if you can tell anything like that from a hospital chart) has been the only number out there. And any time you see a number that large about what happens with patients the only thing you can be sure of is it's a fantasy and pretty surely bogus.
Dr. Pronovost says his biggest opponents are the doctors who form a hierarchy and will not admit their mistakes. So he has written a book, Safe Patients, Smart Hospitals: How One Doctor's Checklist can Help Us Change Healthcare from the Inside Out.
Apparently, Dr. Gawande has a copy.
An appearance on Ophra cannot be far behind.
Who am I to denigrate antisepsis or Dr. Pronovost?
I do not have a PhD in "hospital safety" from the Johns Hopkins School of Public Health. As far as I know, they were not giving out PhD's for stuff like that back in the days of the dinosaurs. And a doctoral thesis with the core tenet being a five item checklist every medical and nursing student learns the first day on clinical service--well, who woulda thunk?
Do I pick up the very strong aroma of a self promoter?
I mean, doing what we were all taught to do in medical school, reminding others to do this, and parlaying that into a genius grant and a professorship and such a great looking shirt with a white collar and stripes, just gets all my olfactory senses in an uproar.
I remember, now admittedly this is long ago, when I was a medical student in the OR and I was standing there holding retractors for some very intimidating surgeon, an eminence grise who had invented the procedure we were doing, who wrote the textbooks, who could turn a medical student's blood into ice by simply looking over this scrub mask at you, and the scrub nurse or some circulating nurse tells that surgeon, "Uh-uh. Broke field, Re glove."
And this titan of surgery sqwaked like some ten year old caught with his finger up his own nose, and the nurse shook her head and everything stopped while the surgeon regloved. I had not noticed what he had done, but the nurse had caught it.
And the surgeon laughed , once he got back, shook his head and said, "She's a tough cookie, that one. But that's why we keep her around."
So, I'm asking, since when does the nursing profession need a champion who nurses can call day and night, as if there is only one doctor who has ever empowered nurses?
Nurses, good nurses, have been invested with certain policing powers for decades. It was the thing which struck me most vividly when I was a mere third year student, the power of the OR nurse. They didn't use the power to show how important they were. They knew they were extending anesthesia time for the patient. But everyone knew the OR and its rules were organized to protect the patient.
Primum non nocere. First do no harm.
Actually, for most medical students, the phrase they heard most often, ad nauseaum, from every nurse, from every resident, from everybody right down to the unit cleark, was "Put the patient first." You want to go to the bathroom before you help that patient out of his wheel chair? You want to go eat lunch before you get that unit of blood for the patient? You want to go to sleep before you look at that patient's X Ray. Fine, but it's the patient who'll suffer. You have to put the patient first. It's the patient who'll suffer. I got really sick of that phrase. Out and out appeal to your guilty conscience. But doctors used to be selected for a well developed guilty conscience. I guess that's why we had so many kids from Holy Cross at my medical school and the ones who didn't go to Holy Cross would have felt right at home in any Catholic school. We all had the internal nun, not far below the surface.
But maybe things have changed.
Apparently, if you cleave to all that now, you are a media star, and get to wear shirts with white collars and stripes.
Damn, isn't the modern world something?
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