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MDs Behaving Badly

 



# 4816

 

 


The September issue of the Journal Influenza and Other Respiratory Viruses is now online, and while I’ve not had time to read all of it, one study in particular caught my eye.

 

 

May, L., Katz, R., Johnston, L., Sanza, M. and Petinaux, B. (2010), Original Article: Assessing physicians’ in training attitudes and behaviors during the 2009 H1N1 influenza season: a cross-sectional survey of medical students and residents in an urban academic setting. Influenza and Other Respiratory Viruses, 4: 267–275. doi: 10.1111/j.1750-2659.2010.00151.x

 

In this study, the authors anonymously surveyed medical students and residents at an urban institution during the peak of last year’s fall pandemic wave. 

 

The questionnaire asked about their attitudes towards the H1N1 virus, and their behaviors, during this time.  There is is a comprehensive review of the data in this article, but in brief the results and conclusions from the abstract read:

 

Results Forty-five percent of medical students and 53% of resident respondents perceived the risk of acquiring H1N1 at school or work as high, and although 43% of medical students and 66% of resident respondents had received the influenza vaccination and most reported increasing non-pharmaceutical preventive measures, 9% of medical students and 61% of residents with one or more episodes of ILI chose to continue to attend class or work when ill.

 

Conclusions Although students and residents report high risk of infection because of work- or school-related activities, many involved in patient care activities do not comply with recommended infection control precautions. Educational campaigns should be developed and infection control guidelines should be included in routine medical student and resident curricular activities.

 


More specifically (as depicted in the chart below), many of these residents and medical students indicated relatively low compliance with basic infection control methods, such as hand washing/sanitizing, the use of surgical masks and N95s, and cough etiquette.

 

image

 

The authors state that there are some limitations to this study (size, a single location, potential selection bias), but these results do suggest a need to instill a better culture of infection control among medical students.

 

Last year, in an essay called A Hospital Is No Place For A Sick Person, I wrote about the pressures that doctors and nurses are under to work, even when they are sick.

 

One of the more surprising things to come out of last year’s CIDRAP H1N1 summit in Minneapolis was the group polling that indicated that Hospitals were among the least likely to make it easy for employees to stay home if they were sick.

 

Of course, Hospitals will say they want sick employees to stay home . . . but their HR policies often run counter to that claim.

 

Many hospitals have `streamlined’ their operations to the point that they don’t have any `depth on the bench’.  There is also considerable peer pressure to work, even if you are sick, because if you don’t show up, someone else will have to do your job.

 

So some of the non-compliant actions described in this study, particularly working while ill, may have more to do with peer (or institutional) pressure than with personal attitudes and preferences.

 

Less understandable are the lapses in hand hygiene and cough etiquette.

 

The perceived mildness of the H1N1 virus undoubtedly contributed to some of this laxness.  Had this been another SARS, or some other highly virulent virus, I’m certain that many of these responses would have been different.

 

But even mild influenza can be deadly, particularly for those in high risk groups.  And so reducing the spread of the virus, particularly in health care facilities, needs to become a priority.

 

The entire study is illuminating and well worth reading.

Related Post:

H1N1
Infection Control
HCW

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