Friday, August 30, 2013

Non-therapeutic touch

This post is puts it more eloquently than I ever could and to our credit (and to everybody elses discredit) is written by an anaesthesiologist.

Right on.  During the touchy-feelie parts of medical school I had to endure, they  talked about the importance of touching patients and how to do it in an appropriate fashion.  Aside from the touchy-feelie aspects, we learned in our physical exam sessions that you could actually get useful information like skin temperature, clamminess, edema and texture just by touching patients.  I haven't come across it yet but I suspect some people are now donning gloves just examine patients or take their blood pressure.

Nobody likes to be a vector for infection but our infectious disease department expects you to wash your hands before AND after wearing gloves so the gloves are mainly for your aesthetic protection. I wear them now for starting IVs and doing injections in the Pain Clinic but I know they don't protect against needle-sticks.

Patients in isolation are another matter and the odd time I have to assess a patient either as chronic pain consults or for anaesthetic purposes, I feel like my hands are metaphorically tied behind my back.  Trying to assess and counsel a patient while dressed up in a yellow gown, paper hat, mask and gloves sends the wrong type of message to the patient at what may be a stressful time for him plus it makes the examiner so uncomfortable that I at least just want to get things finished and get out of there as quickly as I can.  Hardly good medicine.

As the author points out there is a great deal of information that can be obtained with a good stethoscope and I must admit that in the holding area, I am often remiss in this.  Stethoscopes according to our infection control department are difficult to sterilize without damaging the plastic.  They haven't gone as far a banning stethoscopes which would really look bad, not that more than half of doctors even own one now, but are just ignoring this.
Laennec's stethoscope here is easily sterilized.  Maybe we should go to this one.

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