© Dr. Rajas Deshpande
Recently there was a study saying that Doctor’s Aprons may (not definitely) spread infections. This inference is quite established and proven many years ago, and solutions for this have been discussed at length. One must congratulate that this is proven again in India. However, the news headlines “Ban the Doctors from wearing aprons” appeared today. This is being projected as a “Long Neglected Mistake” of Indian Medical Profession. There are enough doctor’s bodies and other organisations to take a call about this, every hospital also has an infection control policy.
Let us see what all the doctors use all through the day:
Their own clothes. Usually clean and ironed. Apron. Shoes and socks. Stethoscope, Hammer, Torch, Ophthalmoscope or other scopes required for bedside examination. (This is why even the pockets are specifically designed in a doctor’s apron). Disinfected clothes in the OT / procedure room.
© Dr. Rajas Deshpande
The purpose of an apron is not only pride as wrongly projected. Most doctors see over 25 patients, some above a hundred every day. These patients have clothes which are wet / stained with blood, pus, snot, urine, faeces, and the doctor cannot examine patients from far away, without coming in contact with each patient. Many are brought in in an emergency, there is no time to clean the patient before examination. Then, sometimes a doctor has to rush from his OPD chamber to clean and dress a wound, to apply plasters, to start IV lines, all of these are known to cause stains very frequently, especially iodine. Imagine the OPD patient’s response to a doctor with his / her clothes all stained! In India, a consultant doctor also has to usually run through many hospitals every day.
So then, ideally a doctor should change his / her clothes after seeing every patient and wear a new pair of shoes. They should also shave their head as hair is a good storage for germs. After coming out of each ICU /CCU /NTU / PICU / SICU etc. units, every doctor should take a wash to prevent germs from being carried upon his / her person. A doctor visiting seven wards in a day should take a bath at least nine times, carry a wardrobe with those many pairs of clothes and shoes, and few extra sets for an emergency: because, seeing one patient and then seeing another with the same clothes on may spread germs!
Or they can wear plastic disposable aprons/ masks / gloves for each patient. In private sector, these accessories will be profit-billed to the patients (one set= @ 100 INR), as many times as they are used. So if four doctors will attend a patient in ICU, the patient will pay for four sets of plastic gowns. In a country like India where even basic medicines, equipment, wards, beds, lifesaving drugs are all short in almost all govt. hospitals, this will open up a whole new department of corruption, contracts for such disposable aprons, and waste upon pilferage .
Or, like most of us already do, doctors can wear aprons which are washed / sterilised every day, alternating pairs, changing / discarding whenever infectious exposure is strongly suspected.
© Dr. Rajas Deshpande
While most private hospitals maintain extensive cleanliness and disinfection protocols, these are usually neglected in most charity / govt. set-ups, where extremely old, dilapidated buildings, and old broken beds, furniture, storage systems, computers, fans, plumbing, electric wiring etc. carry all sorts of infections and do spread it. The current “Ban everything that spreads infection” policy must then close down everything that can spread infection, including all hospitals in old buildings to prevent spread of infection.
Then ideally doctor must also wash the stethoscope etc. instruments after every patient. Or why use them at all? Just do all the tests where there is no physical contact with the patients, so no germs will be spread! Also, after every patient, all equipment like MRI machines etc. must be thoroughly cleaned at the patient’s expense. Doctors must also be banned from using any phones, as all phones carry more germs than the aprons. Let the emergency messages be sent via so many pigeons adoring the windows of almost all govt. hospitals!
Then again, the relatives thronging to meet every patient, holding hands with them, wiping their tears, nose etc., and bringing in billions of germs into the hospital. Please ban them all.
Spitting, public urination, tobacco and alcohol, toxic colours and sweets, roadside food, drugs, street violence, poverty, hunger, Malaria, Dengue openly kill thousands in India every day. But some newspapers printed this news as if the doctor’s aprons were the main killers in this country.
Tomorrow same study will be applied to all nurses’ and wardboy’s and porter’s dresses too. These staff members have far more physical contact with the patient than the doctor. We are a country severely deficient in healthcare, every hospital is flooded with patients, there are not enough nurses and doctors to attend only a single patient all day long. Do they all change disposable gowns for every time that they touch different patients? Will there be enough time? Will the patient pay? Will the govt. provide for it?
Medical students wear aprons for all these purposes and also for the discipline. Patient must be able to identify the doctor, and the doctor must be able to reach the patient in time in case of an emergency. Or there are innumerable instances of people posing as doctors and taking advantage of the patient. In an illiterate country, name tags / nameplates are not always read. Even during the worst epidemics of swine flu and bird flu, the govt. was unable to provide masks to medical students or many doctors. Will they provide disposable gowns to medical students?
In India, shameless staring at a woman’s body is like a ritual among most classes, and female doctors face too much of this embarrassment everyday while being busy with patients. Sometimes the apron helps them deal better with such groping eyes.
Please don’t give the people one more reason to hate the doctor, to think that the medical profession does not have a brain of its own, that people have to demand banning doctor’s aprons. I won’t be surprised if there are new regulations and arrests of doctors for wearing aprons, and litigations for spreading infections by wearing aprons. Just because some countries and systems are paranoid and populist, everyone else does not have to blindly imitate.
I know what exaggeration is. It is also the only way to combat the ridiculous. Fashion doesn’t suit a good doctor, any which way.
© Dr. Rajas Deshpande
PS: The study was necessary and its publication an excellent achievement. This article is about misrepresentation of facts by some.