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Doctors’ Garments And Bacterial Contamination

This colorized 2005 scanning electron micrograph depicts numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, magnified 2,390 times. Content provided by CDC/Jeff Hageman, MHS, via the CDC's Public Health Image Library (PHIL)Bacterial contamination of physicians’ newly laundered uniforms occurs within three hours of putting them on, making them no more or less dirty than the traditional white coats, researchers reported.

Researchers sought to compare bacterial and methicillin-resistant Staphylococcus aureus contamination of physicians’ white coats to freshly laundered short-sleeved uniforms, and to determine the rate at which bacterial contamination happens. They reported results in the Journal of Hospital Medicine.

ACP Internist‘s blog recently took up the debate as well. The issue has cropped up over the years, assessing not only the cleanliness but the professionalism inherent in the white lab coat.

Researchers conducted a prospective, randomized, controlled trial among 100 residents and hospitalists on an internal medicine service at Denver Health, a university-affiliated public safety-net hospital. Subjects wore a white coat or a laundered, short-sleeved uniform.

At the end of an eight-hour workday, no significant differences were found between the extent of bacterial or MRSA contamination of infrequently-washed white coats compared to the laundered uniforms. Sleeve cuffs of white coats were slightly but significantly more contaminated than the pockets or the midsleeves, “but interestingly, we found no difference in colony count from cultures taken from the skin at the wrists of the subjects wearing either garment,” researchers wrote.

And, there was no association found between the extent of bacterial or MRSA contamination and the frequency with which white coats were washed or changed. Colony counts of newly laundered uniforms were essentially zero, but after three hours they were nearly 50 percent of those counted at eight hours.

*This blog post was originally published at ACP Internist*

“On Hold” With The Doctor’s Office: Is Pop Music Doc Music?

So I’m calling a referring physician’s office the other day when their telephone answering message puts me on hold. And wouldn’t you know it — Kelly Clarkson was blasting in my ears. When the doc came on the phone, I asked him if he was a Kelly Clarkson fan. He had no idea what I was talking about.

But it got me thinking. So I asked him how their office chose their telephone answering message. He said he didn’t know. He figured the music was being fed from a local radio station.

You may not realize it, but having a well-thought-out telephone answering message can be a vitally important part of a doctor’s business. It’s the first contact patients and colleagues have with an office. It sets the first impression.

I’m sure there are consultants out there who get paid a lot of money to teach this stuff. Should you have hip hop music? Big band music? Perhaps a little disco? Maybe some talk radio? How do you decide what type of telephone answering message to set up in your office?

*This blog post was originally published at The Happy Hospitalist*

In The News: Boosting Disease Prevention And Unethical TV Doctors

An article in the New York Times this week looks at a raft of new public health initiatives passed by Congress that are aimed at boosting disease prevention. Examples include requiring restaurants with at least 20 locations to include nutrition information on their menus and mandating employers with at least 50 employees to allow new mothers to express breast milk at work. In addition, Medicaid will now cover smoking cessation counseling for pregnant women and Medicare beneficiaries will be eligible for an annual physical. The initiatives are expected to eventually save money by decreasing the country’s chronic disease burden. (New York Times)

Researchers from Johns Hopkins University recently did a study applying physicians’ ethical codes to the conduct of the fictional doctors on “Grey’s Anatomy” and “House, M.D.” Perhaps to no one’s surprise, TV doctors are behaving very badly. As the abstract of the study states, both shows feature “egregious deviations from the norms of professionalism and contain exemplary depictions of professionalism to a much lesser degree.” (Philadelphia Inquirer, Journal of Medical Ethics)

*This blog post was originally published at ACP Internist*

Nursing Bloggers Dish About The State Of Their Profession

I was following an interesting conversation on Twitter between several nurses. They were expressing concern about how nursing stereotypes were damaging to their profession. I invited them to discuss the subject with me via podcast.I have summarized some key points below.

You can listen to the whole conversation here.

[audio:http://blog.getbetterhealth.com/wp-content/uploads/2008/11/nursing.mp3]

Participants:

Gina from Code Blog (6 year veteran blogger, and has spent 11 years as an ICU nurse)

Strong One from My Strong Medicine (an anonymous blogger, athletic trainer and nurse of 3 years)

Terri Polick from Nurse Ratched’s Place (has held various positions in nursing, including psychiatric nursing for 20 years)

Current Nursing Challenges:

1. Nursing Instructor Shortage – nursing instructors make about 25% of the salary of nurses who do clinical work. Therefore, there are long wait times to enter nursing school due to instructor shortages. Many students can’t afford to wait, and choose other careers.

2. Inequality of Respect – some nurses feel that they have to continually prove themselves despite their training and qualifications. Patients often express disappointment or annoyance when they see a nurse practitioner (rather than a physician) in a group practice. Some doctors still expect nurses to give up their chairs when they enter the room.

3. Nursing Stereotypes – the “naughty nurse” and “nurse Ratched” images are still very much in the forefront of peoples minds when they think of nursing as a specialty. Some people believe that nurses simply pass out pills and make coffee, when in reality they are active in complex technical procedures and saving lives. These stereotypes and misconceptions denigrate the education and technical expertise of nurses.

4. Primary Care Doesn’t Pay: nurse practitioners incur higher debt and have lower salaries than specialist nurses. Just as in the medical profession, there are no incentives for nurses to choose careers in primary care.

Strengths of Nursing:

1. Nurses Are Better And Brighter Than Ever – since getting into nursing school is so competitive, the quality of individuals who are entering nursing school has never been higher.

2. Job Flexibility – nurses can easily transition to part time work for maternity purposes. Nursing careers offer a wide variety of work experiences – from nursing home work, to cardiothoracic surgery. One license offers hundreds of various opportunities.

3. Job Satisfaction – saving lives and serving patients contribute to a sense of job satisfaction.

What can be done to improve and advance the US nursing profession?

1. Establish an Office of the National Nurse. The National Nursing Network organization is promoting this initiative. The National Nurse would act as a government spokesperson for nurses-  promoting preventive medicine, increasing awareness of nursing, and securing financial support for nurse education. He or she would be the chief nurse officer of the US public health service.

2. Do not be afraid to speak up. Nurses should feel comfortable defending their professional ideals, and discouraging stereotypes.

3. Blog to raise awareness of nursing challenges and successes.

**Listen to the podcast**

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