How can we confront our pediatrician about not washing his hands?

Question

We recently changed medical insurance plans and switched to a new pediatrician. My wife is in nursing school and one of the things that's drilled into students is the importance of handwashing to avoid the spread of pathogens. Not surprisingly, she noticed that even though the examination room has a sink and hand-sanitizer dispensers, our new pediatrician doesn't use them.

I pointed out to my wife that the doctor might wash his hands before coming into the room for some reason. He also comes highly recommended from friends and we like just about everything else about his office. But we really can't afford to risk our children getting exposed to more diseases than they already are.

Is there some non-insulting way to ask a pediatrician to wash his hands just before examining our children?

Answer 1

First off, the doctor must wash his/her hands after entering the room, period. The doctor opened the door with his hand, right? That's a (major) point of contagion right there. Unless you're in some futuristic practice with automatic doors, I would never excuse the doctor from not washing post-entering the room.

Second, unfortunately, doctor handwashing is a major problem. Major studies have repeatedly found very low wash rates (This Study found a 40%-50% rate, for example), and the problem is very difficult to address from a management perspective.

From a parent's perspective, the odds are you can't really effect change here. That's not to say you shouldn't try; but I wouldn't presume it's likely to work. Doctors are creatures of habit, and if they're not in the habit of hand washing, they probably won't easily become in that habit - especially if only a few patients mention it.

What can you do? First, you should certainly mention it to the doctor the next time he comes in. "Hi, would you mind washing your hands before you examine my child?" Polite but matter of fact seems reasonable here. It's a reasonable request, given it's your child's health, and as long as you're not critical or condescending about it, the doctor shouldn't take it wrong. If that goes reasonably well (ie, the doctor doesn't object and does wash his hands), then continue that - each time. It may simply be that the doctor isn't in the habit and appreciates the reminder. If the doctor does take it badly, you may need to choose between a doctor with good hygiene and that doctor.

You also could wash your hands after the doctor comes in. That might serve as a subtle reminder, after all. If your child/children are old enough, you might encourage them to take an interest in this; doctors (particularly pediatricians) often are familiar with children who are a bit pushy about things around them (ie, most children) and could take it better from the child. This particularly works if you have a child like mine who enjoys washing and hates being dirty.

Finally, I would not address this with the practice administration or anyone other than the doctor. While it's possible some volume of complaints might initiate a change this way, it's more likely to irritate the doctor, and doesn't seem likely to be successful if the more direct method wasn't.

Answer 2

It's important that your doctor wash their hands, but less important than you might think. As a health care provider, I wash my hands before examining every patient, but it's out of respect for the patient's feelings, not because my hands are particularly dirty (I wash my hands after every patient encounter. I'm unlikely to bring you that patient's germs.)

Trust me, the germs are everywhere, not only on the provider's hands. They are on the chart, on the door handles, on the stethoscope, the chairs in the waiting rooms, the table with the flimsy paper, the instruments, all over the patient sign-out area, etc. They are, in effect, unavoidable. And your child is not the only person who suffers. Every time a doctor who sees children moves to a new area of the country, they are repeatedly sick for a couple of years. It's called "pedi-crud", and they get it from your kids.

That's my take as a health care provider. What can you do?

In every patient room with a sink, there are handwashing instructions posted on the wall. Before you get started into any conversation, notice the instructions and ask the doctor if they believe handwashing is critical to fighting the spread of disease. They will probably answer, "Yes, of course."

Well done, you've painted them into a corner.

Then answer their questions. If before the exam the doctor doesn't move to wash their hands, just say, "Um, would you be so kind as to wash your hands? You've convinced me of it's importance." They should be quite happy to, chuckle and do so. (Most doctors are happy to make their patients happy. It really is that simple.)

If they do not, you may have either a very pragmatic doctor or one without empathy, but it's hard to tell. I would bring the lack of respect for the handwashing request to the attention of the office manager in this case.

I have been brought up short by a patient or two (though not for hygiene); it's a humbling situation but not irreparable. Patients are often very good teachers as well. A wise doctor will listen to what they have to say. Both parties win.

Answer 3

I say, in a clear firm tone "please can you wash your hands before continuing?"

If I wanted to be delicate I would say "Sorry, but I didn't see you wash your hands. Would you mind doing so before you continue? Thanks."

In England it is always acceptable to remind clinicians about hand hygiene and patients are encouraged to do so. I would raise a complaint about anyone reacting negatively to my request for hand hygiene.

I have had to mention this to a few clinicians but they have always been fine with it.

Answer 4

I would ask in a curious, not attacking way something like : "Don't you need to use these?" (pointing at the sanitizer) "I always thought doctors offices were really picky about those..."

Answer 5

If doctors take issue with being asked to wash hands, patients are not to feel responsible for hurting their feelings as long as they ask in a respectful way. It's the patient's right. A little awkward discussion in the room is far less harmful than an infection. Most doctors will be happy to wash up. They know it's part of their job. If they are confrontational about your polite request, by all means, address the concern with administrative staff. It's your health and your right.

Answer 6

Doctors certainly feel dejected if they are being drawn attention for their hygiene. Being a healthcare provider, I know this. That's because advising something about their profession (how to examine a baby does include washing hands with sanitizer and that's what is taught to all child specialists) is nothing less than advising fish how to swim. It's overreacting but it's the truth.

Now, how you do that?

There is one good way which won't put anyone (a doc and you) in humiliation. There should be a feedback/suggestion box. Write it down (anonymously) and just drop your suggestion. If the management is active enough (I hope it is!), it'll be conveyed in a very straightforward way. You asking something to do and the management advising to do it makes a lot of difference. Alternatively, you can also put an anonymous mail to the organization with polite words (no offense at all) starting with In the interest of patients and organizations, we'd like to draw your attention to a trivial matter which could turn out to be a major health risk..." and so on...