IN THE days before bacteria were discovered it was considered ungentlemanly for doctors to wash their hands. In the 1840s Ignaz Semmelweis, a Hungarian obstetrician working in Vienna, discovered that the high death rate among women after childbirth could be dramatically reduced if medical students washed their hands between conducting autopsies and delivering the babies.
This seems obvious now but poor Semmelweis was unable to explain the science behind his breakthrough and he was shunned by the medical establishment and committed to an asylum.
Nowadays, above every NHS sink is a sign reminding healthcare staff to wash their hands before and after contact with each patient. There are three bottles on the wall; the soap, some alcohol gel, and some moisturiser as hand washing can cause dry, cracked skin, which itself increases the risk of infection. The sign says that handwashing should take 20 to 30 seconds, so that's a minute of the ten-minute consultation used up and an average of 50 minutes of cleansing per day. That doesn't include the scenario where hands are washed and then the patient politely offers a hand to be shaken, meaning the whole process needs to be repeated once they have left the room so as not to cause offence.
To save time I opt for the alcohol gel but the volumes used make my consulting room reek and make my eyes water. I worry patients think that I have been drinking it rather than using it on my hands.
The hand-washing ritual is a little harder on a home visit. The etiquette here is complicated. Patients may be embarrassed that they have been too poorly to update their avocado suite or address the sub-standard toilet cleanliness. If shown to the kitchen sink does one remove the washing-up bowl or dunk the hands in with the teacups? Is it OK to use the tea towel to dry the hands? And, when the patient shouts from the bedroom, "get a clean towel for the doctor", should I reassure the terrified husband that it is fine and not to worry that after 43 years of marriage he has no idea where the clean towels live?