Instead of seeing it as one more thing to cross off your to-do list, what if you considered it a vital means of communication? After all, isn’t that the original purpose of charting?

In this four-part series (scroll to the end for the rest of the articles!), Dr. Brady and Nurse Rebekah explain the secret of charting the right way: It’s called “conspiring.” And conspiring with your colleagues can improve patient care, make the doctors happy, and keep you out of court.

Dr. Brady: No, I’m not planning on writing a book called The ER Conspiracy. The books I write are actually all about doing your job better. In fact, by “conspire” I don’t mean the first definition in Merriam-Webster’s dictionary, which is to scheme or plot, but rather the second, which is more true to the verb’s etymology: from the Anglo-French conspirer, from the Latin conspirare, to be in harmony; conspire, from con = together + spirare = to breathe. The second definition is “To act in harmony toward a common end.” People, I just want us all to be in harmony and “breathe together.”

In medicine, we need to conspire or collaborate more. When different healthcare providers act together in harmony, patients will more likely be satisfied, rather than confused—and if something goes wrong and we all end up in court together, we’ll be less likely to have helped the plaintiff’s attorney.

Why will patients be more satisfied? The reason is simple. If everyone tells a patient something different, she doesn’t know whom to trust and gets confused.

Here’s an example. A patient comes in with cough and shortness of breath. The ER nurse does her assessment and tells the patient it’s probably a virus, but that she needs a chest x-ray to be sure. Then the ER doctor comes in, does her assessment and tells the patient it’s probably a virus and she doesn’t need a chest x-ray or any antibiotics.

Two days later, she’s not better and goes to her doctor, who tells her she has bronchitis but doesn’t need an x-ray, and writes her a prescription for antibiotics. If she’s in the top fifth percentile for IQ, she’ll probably realize that differences of opinion are not uncommon in certain conditions. If she’s like the other 95 percent of your patients, she’ll probably be confused and assume that two of the three people who gave her advice are incompetent. If only everyone had acted in harmony, the patient might have instead been satisfied and content while the virus ran its course and she recovered completely.

Nurse Rebekah: Most of us want to be the expert at something in our lives. Some people just pretend like they’re experts on everything—which we all know is totally implausible. (My hubby calls these people “Mr. SMITH,” which stands for Smartest Man In The Hemisphere. Try that on your next know-it-all…it’s hilarious.) But many people spend the majority of their lives honing their craft, knowledge and career. Whether you’re a working nurse or doctor, a Starbucks employee or an electrician, at some point you’ll probably know more than other people who may or may not be in your field, and your advice will be sought out. Therefore, because people are seeking your advice, you should make sure you know what you’re talking about—and if you DON’T know what you’re talking about, heed my mother’s advice to “keep your pie hole shut.”

I say this because patients look to us for guidance about their health. Sure, they may have had a prior appointment with Dr. Google, but they’re looking for your professional opinion. Stick to the facts. Using Dr. Brady’s example, I might say, “Mrs. Smith, because of your cough and fever, I’m going to order a chest x-ray per our protocol to expedite your care in the emergency room. The doctor will look at it and tell you what he thinks.” Leave it at that. Don’t claim virus or bacteria—because unless you brought your microscope with you, you won’t be able to defend that claim. And the physician should have the foresight to look in the chart and not say, “Oh, I don’t need a chest x-ray…why did that silly nurse order that?” Don’t staff-split. Leave that to the psych patients and four-year-olds.

Starting to get the idea? Only say—and write—exactly what you observe. Anything more is just speculation and can confuse and frustrate both patients and staff.

The Essentials of Nurse Charting

Part 1: The Secret of Successful Charting

Part 2: The One Thing Nurses Should Never Assume About Charting

Part 3: How to Avoid Lawsuits with Charting

Part 4: How to Choose the Right Words When Charting

Digital Vision | Thinkstock

What do doctors really want? Read the back and forth between Dr. Brady Pregerson, our favorite ER Doc, and Nurse Rebekah Child, our favorite sassy RN.

MD said: The secret to most relationships—be they at home, at work or elsewhere—is the ability to predict what your “partner” wants as well as what he or she doesn’t want.

Ask yourself: What keeps your relationship going strong? What are major sources of aggravation? What makes your day run more smoothly and what causes things to slow down or grind to a halt?

So here’s my first tip for new nurses: Take a glimpse into the workings of an MD’s mind. Anticipate what doctors want and what they don’t, so as a team you’re collaborative and constructive. Hopefully the doctors you work with will be doing their part as well.

RN said: So here’s the thing: Each doctor in our ED is like a lover (without the sex and gifts on Valentine’s Day, of course!)—we have to know their pet peeves, their subtle signals that they’re in a bad mood, a good mood, a great mood…or to run in the other direction.

Many times, as soon as you say, “Dr. So and So,” you’ll get a look that will let you know what color the mood ring is. That said, if you speak to any doctor the way you would like to be spoken to, with respect and consideration and having done your homework, you’ll be golden. Oh, and don’t forget a small side of humor.

Do you have to be a mind reader at work?

And do you have any more tips on “What doctors want”?

Brady Pregerson, MD, and Rebekah Child, RN, may disagree about a lot of things, but they do agree about this: One way to lose your job is to violate patient privacy.

However tempting it was for hospital workers to sneak peeks at the Octomom’s charts, it was considered just as much a violation of privacy as sharing Farrah Fawcett’s cancer diagnosis with the tabloids or accessing the records of A-list stars. And all of those snoopers? Fired.

In part one of a two-part series on patient privacy, Dr. Pregerson and Nurse Child expound on HIPAA and what it means in your daily work life.

MD: We’ve all heard of HIPAA, the Health Insurance Portability & Accountability Act. This federal law, passed in 1996, became fully effective in 2003.

The portability part of the HIPAA moniker acknowledges the importance for relevant health information to be available to those with a “need to know” both for patient care and for billing purposes.

The accountability part of the title means that if you violate patient privacy without a legitimate reason or your patient’s consent, you’ll be in hot water with the federal government.

To stay on the straight and narrow path that HIPAA provides, ask yourself, “What patient health information can and should I share with others?” The golden rule here is that if it benefits the patient , then it should be okay. If you’re unsure, keep your mouth (and the patient’s chart) shut, or ask your supervisor.

RN: Everyone thinks this is “no duh” stuff, but remember, there was a time when an employer could refuse to hire you if you had a diagnosis of HIV, and your nosy mother-in-law could theoretically call up and get your latest pregnancy test results from your doctor’s office.

Disaster!

Keep in mind that the need for HIPAA (which sometimes can feel like a fiasco, I agree) was brought about by a couple of privacy-violating people who ruined it for everyone…just like those few drivers who got into accidents while talking on their cell phones.

So here’s what I recommend: Let’s say I get a phone call inquiry and I don’t know if information is “sensitive” or appropriate for sharing. My favorite cop-out is to say “The patient is still being evaluated. I could certainly have the patient or designated family member phone you back.”

No one (so far) has pinned me against the wall for anything more specific (maybe I should run for political office!). Let’s face it: If the patient is in the hospital or emergency department, he’s always still being evaluated until he’s discharged home. Until that point, his nosy family becomes someone else’s problem!

In Part I and Part II of our Pain Management series, ER doc Brady Pregerson and Nurse Rebekah Child examined the challenge of accurately assessing a patient’s pain, as well as the perils and pitfalls of simply dispensing the dope any time a patient asks. In this article, they point you to signs and symptoms that may indicate your patient has more than physical pain on his mind.

How to Recognize a Seeker

Dr. Brady: What do I do when I have a patient who I think is feigning illness in an effort to get narcotics? It depends. First and foremost, I do my best to make sure I’m not missing something. If you let your guard down, you will eventually get burned. I also find it useful and relatively simple to check and see how often the patient comes to the hospital. If she’s here less than five or six times a year, I worry less than if she’s here every month. But you have to be careful with this test, as some patients with real disease, such as sickle cell disease, really do need our services that frequently. Plus, in urban areas, some patients just visit different EDs every month; checking their home address may give a clue to this one. Another thing I like to do is call the patient’s doctor, if she has one, to get more information.

Nurse Rebekah:

Top Ten Signs Your Patient May Be Seeking Narcotics Inappropriately

1. He knows which ER docs have a proclivity for dispensing narcotics and schedules visits around their work hours.

2. She remembers your password for the Pyxis—and prompts you when you forget it.

3. He knows the exact dose of medication that will kill the pain: “4 mg of Dilaudid IVP usually works for me.”

4. She’s allergic to Toradol and morphine.

5. He went into a clinical depression when many emergency rooms stopped stocking Demerol.

6. She can relate to Nurse Jackie.

7. He’s been to the ER 15 times in the last year for pain management and yet can’t make it to the pain clinic for his appointment.

8. She balks at the idea of narcotics being given subcutaneously.

9. His holiday wish list looks like a Pyxis report.

10. Her primary physician not only knows her name, but so does the doctor’s wife, his three kids, the pharmacist and the pharm tech at the local drugstore.

Yes, this list is somewhat tongue in cheek, and sometimes the hints may be more subtle than directly depicted above. But all kidding aside, remember that these drug seekers get very good at their pasttime of hoarding meds. Don’t disregard any suspicion as an overreaction because it may lead to more than you realize. These people, for their own safety and the safety of your license, must be dealt with and their addiction must be treated. Do not be afraid to report them.

Image: Christine Balderas | iStock Exclusive | Getty Images & © iStockphoto.com

Vaccines inspire fear—almost as much fear as the diseases they’re meant to prevent. Dr. Brady and Nurse Rebekah discuss the cases they’ve seen.

Dr. Brady: If it weren’t for vaccines, I think I would have already died of measles, tetanus or rabies; suffered permanent damage from H. flu, rubella or polio; or been incredibly sick from typhoid, yellow fever or mumps. Infections are a major cause of death worldwide. According to the World Health Organization, they account for six of the top ten causes of death in low-income countries. In high-income countries, where vaccination tends to be widespread, infection accounts for only one of the top ten causes of death.

It’s not that I’m looking forward to any of the alternatives—heart disease, stroke and cancer topping the list—but I’m happy to avoid any and all ailments that I can. Measles—there’s a vac for that. Polio—there’s a vac for that. Swine flu? There’s a vac for that, too. I wish there were a vaccine for everything, but for now, I’ll take what they’re giving. I know that a vaccination, like everything else in medicine, and everything else in life, has a risk. There are no certainties. But there are calculable odds, and that’s a good enough strategy for me.

Nurse Rebekah: Poor Dr. Salk. All that work to invent the polio vaccine and people are walking around just snubbing their noses at vaccines in general. I don’t know about you, but I don’t think my iPhone would get great reception in an iron lung. Vaccinate away, please! Kids today don’t even have to suffer through the chicken pox. I kind of think that’s a little unfair, though…itchy pox never hurt anyone (ha ha); they built character and gave Calamine lotion a guaranteed demographic.

Imagine, though, if there were a vaccine for the common cold…think of all those companies that would be out of business! Wait a second, talk about a conspiracy! What if the cure for the common cold is out there, but scientists are holding out on us for financial reasons? Nah, what am I talking about? They would still make money from all the people who refuse to get vaccinated.

How do you handle a patient who refuses vaccination?

Image: Imagezoo / Images.com | Getty Images

Want to see a bunch of people get up in arms? Recommend a new vaccination. While vaccines were once accepted as a medical miracle (no more polio!), today’s parents closely examine the risk/benefit ratio of any and all recommended vaccinations.

And who can blame them? With a ton of scary stories linking vaccinations with autism (never mind the fact that numerous scientific studies have debunked the link), more and more Americans are refusing vaccines. In our “Great Vaccination Debate” series, Dr. Brady Pregerson and Nurse Rebekah Child share their thoughts on vaccination—and how to deal with patients who refuse immunization.

Dr. Brady: Have you had your flu shot? This year we have two: the regular seasonal influenza vaccine and the special H1N1 vaccine. I had both. The first one hurt my shoulder for more than a week; it was nothing very bad, just a mild occasional discomfort. That rarely happens to me. I don’t know if it was the ingredients or the needle placement, but I believe it was the latter because it felt painful even before the nurse started pushing the 0.5 milliliters of clear liquid through the needle.

Turns out that I probably didn’t need that one because the majority of the circulating influenza this year looks to be the novel H1N1, aka “swine flu.” A few weeks later, the swine flu vaccine became available and I took that one, too. I’m playing it safe—and it turns out that one didn’t hurt a bit. Not a side effect I could notice.

I’m a big vaccine proponent, but I have to admit I was a little scared of the H1N1 shot. I don’t know why. There was no reason to be. And the odds of a serious side effect are like a million to one. I’ll take those odds any day over a probably 25 to 30 percent chance of getting the swine flu and a 0.8 percent chance of death if you get it. But why did I ever worry? I guess it turns out no one is immune to vaccine scares, not even the choir used to hearing all the sermons of their benefit.

Nurse Rebekah: This is the first year that I’ve taken a flu shot. I personally think flu shots are a conspiracy. Every year the recommendations for who should get the flu shot gets broader and broader. I have a sneaking suspicion that those recommending the flu shot also own stock in the companies that produce those snappy little vials. But I have no proof of that, just my own theories getting the best of me.

Anyway, in eight years of nursing, I’ve never received a flu shot, and I’ve never had the flu. But never say never, right? Since I’m working full-time and attending school full-time, I felt like I really shouldn’t take any chances this year. So I buckled down and took my needle(s) like a champ.

I agree that needle placement is everything—it is a lost art. Honestly, I would rather have a first-semester nursing student give me an IM injection than a seasoned nurse. Most seasoned nurses don’t put it in the right place. My first injection was given subcutaneously and the second injection was given pretty much intra-articularly; the first by a nurse of more than 20 years and the second by a nurse of more than 40 years. Two fingers below the acromion process, people! Two fingers!!!

Yes, even healthcare professionals hesitate before agreeing to a new vaccination. But for the most part, they understand just how important vaccinations are. In part 2 of The Great Vaccination Debate, Dr. Brady and Nurse Rebekah explore some of the most common causes for vaccine refusal.

iStockphoto

You’re the nurse. Not the butler. Not the waitress. Not the servant. But when unhappy patients treat you like one, it may be time to put the stress of dealing with them into perspective.

We ask Dr. Brady Pregerson (“MD”) and Nurse Rebekah Child (“RN”) for their points of view.

MD: We’re all painfully aware of the challenges of meeting patient expectations, and fortunately many of our patients are, too. There are a multitude of reasons we can “let our patients down.”

• Sometimes we forget things when we’re juggling multiple tasks.
• Every part of our job takes time, which always seems to be a commodity in short supply
• When we’re in a hurry, doing the right thing usually takes precedence over explaining it.
• Maintaining patient privacy can be difficult when your patient is hard of hearing and only a thin curtain separates him from the bed in the adjacent treatment area.
• The inevitable delays that we can’t always predict: a hemolyzed blood specimen, a long wait for CT, a family doctor who takes two hours to return a phone call.

Each time I apologize to a patient for the wait and they answer, “I completely understand—everyone looks very busy and I know things take time,” I feel a weight has been lifted from my shoulders. The understanding patient is truly a blessing, and luckily there are many of them. But how should one handle the unhappy patient, the one who doesn’t seem to get it—get how busy we are—or doesn’t seem to care?

RN: One way is to put ourselves in the patient’s shoes. Imagine you have a stomachache and you think it’s cancer (doesn’t everyone always think it’s cancer?), and no one explains anything to you, or the wait times. Or what if you’re in pain or you’re cold? The list goes on and on. I think we need to try to remember that this is our area of expertise and a very foreign land for many people. In certain situations, empathy is king.

It’s never a pleasant process dealing with someone who is rude or can’t be pleased, but that’s just one of the challenges we face on a daily basis. If you have a strategy, maybe you can win both the battle and the war.

Image: Sam Edwards | OJO Images | Getty Images

Nurse Rebekah Child and Brady Pregerson, MD, good-naturedly debate the claim that nurses are naturally more meticulous by dissecting the medical professional. How? Vis-à-vis an age-old nursery rhyme.

And don’t miss Nurse Rebekah’s homespun technique for ensuring bacteria-free hands (end of article). It’ll have you singing!

Nurse Rebekah: Wanna know my theory about why nurses keep their hands cleaner than doctors? If you do, read on; if you don’t, go and Google, Facebook or Twitter something.

It’s because men are the dominant presence in medicine. According to the AMA, in 2003, men made up 74 percent of the MD workforce, and we all know that the majority of men were once boys, and boys are gross. “Snips and snails and puppy dog tails” is what the famous poem says little boys are made of. Let’s just call a spade a spade here, people. Don’t think I’m male bashing, because I do love all of you guys and your manly ways. But I’m basing these opinions on both anecdotal evidence and hard data. Anecdotally, men spit and blow snot rockets. Scientifically, in a study based on the observations of 6,000 people in various cities, researchers found that one-third of men don’t bother to wash their hands after using the restroom, versus only 12 percent of women.

Dr. Brady: Yes, yes, I know the Mother Goose nursery rhyme: “Sugar and spice and all things nice, that’s what little girls are made of!” I don’t doubt it, and men may spend less time on personal hygiene, but I don’t think that’s the reason why nurses outperform doctors on hand washing. We need a study of male vs. female doctors and male vs. female nurses to figure out that one.

And another thing, perhaps that bathroom study was flawed. If they’re only urinating, many men wash their hands BEFORE rather than after. That’s because we use our hands to hold our urinating organ, and our hands are usually dirtier than our penises, so it makes sense to wash them first. Did your study take that into account?

Nurse Rebekah: Physicians may use bigger words and know more scientific stuff, but they still need to be guided in the ways of cleanliness—because 74 percent of them are male. Therefore, it’s up to us to publicly embarrass them, nag them and/or use brute hand-sanitizer force to get some better compliance. I hate when I see doctors typing at the keyboards with gloves on! TAKE THEM OFF AND WASH YOUR HANDS. Hello, I am NOT your maid and I am not your wife, so I will not pick up your dirty gloves. Throw them in the trash can.

Dr. Brady: We all sometimes need a little reminding; no one is perfect. Medicine—and emergency medicine, in particular—is definitely a team sport, and looking out for your teammates is part of the game. If we’re going to hold hands, let them be clean hands.

Nurse Rebekah: I hope all of us nurses (male and female) get really good at this—for our sake and our patients’ sake. I have a sneaking suspicion that if we don’t get really clear about hand hygiene, the tables may turn as the number of female physicians and male nurses increases. People, I want to live a long time and not catch a URI every four weeks, so let’s all wash our hands please! Plus, it’s a great opportunity to practice your singing (sing “Happy Birthday” twice and you’ve successfully met the mark for the recommended amount of time for sudsing up) or even longingly stare at the clock while you lather, daydreaming about clocking out at the end of your day!

We don’t trust Mother Goose to be the most scientific source, so we invite you to join in the banter by telling us where your workplace weighs in: Are nurses better at handwashing than doctors where you work?

Image: iStockphoto

Once again, the dynamic ER duo Dr. Brady Pregerson and Nurse Rebekah Child are back and ready to compare notes on the superbug MRSA. But first, they release some of the tension surrounding this very serious issue with a frank and open discussion on the experience of treating ‘abscess al Kahuna.’

Is MRSA the most repulsive epidemic to find its way into the ER? Or is treating the nasty bump a perversely spectacular highlight of patient care?

Between our ER doc, Brady Pregerson, and our sassy nurse, Rebekah Child, they talk about the causes of MRSA, remind us of the seriousness and scope of the MRSA problem, and give some easy tips for nurses to help fight the spread of this nasty epidemic.

RN: So I was at the gym today (finally a day off!), and I was half watching the Oprah show and half watching this really sweaty guy because I thought he was going to fall off the treadmill and code. (Side note: Please, people, if you haven’t been to the gym since 2003, for the sake of us medical personnel, don’t go full blast on your first time out. You’re just giving all of us angina.). The topic of Oprah’s discussion was MRSA, and the more I thought about the perils of MRSA and the more I watched Mr. I’m-Gonna-Lose-70-Pounds-Today, who was sweating his own saltwater pool, the more I was reminded of my first encounter with an MRSA patient a number of years ago.

She was a young girl who was an avid spinner, and couldn’t attend her favorite gym class of late due to this ever-growing, ever-painful red lump on her right buttock. So she came to the ED, and lo and behold, it was a pretty good-size abscess. When the doc injected the lidocaine, it was just enough to release some much pent-up pressure. There, from this young girl’s haunches, sprung forth a fountain of blood and pus similar to the fountains at The Bellagio, but without the obvious beauty and background vocals of Celine Dion and Andrea Bocelli. An obsession was born.

MD: Ew, I hate this stuff. I guess some people like to watch the stuff drain, but honestly, the stuff is stinky and awful. What’s more, I hate to have to drain an abscess, because even though I know I’m helping the patient, I have to be cruel to be kind. I always give some morphine or dilaudid first unless they have to drive home, but that injection still hurts. You nurses are lucky here. You don’t have to inject the lidocaine (it burns) and you can stand a few feet back from the bubbling pus.

RN: Yes, the lido burns, but put a little neut in it! I still don’t understand why this isn’t done all the time. I have since become what I like to call an abscess aficionado. I can usually tell by the amount of pus and the smell whether it is MRSA or not. I have a hard and fast rule: No doc is allowed to I&D my patients without my presence because it’s like missing the opening act of the Academy Awards—the best part!

MD: When I treat a patient for an abscess, it’s definitely a teachable moment. They never want to have to come back for another I&D. So I tell them how they can avoid this in the future: Keep clean, shower often and never pick or squeeze anything unless you wash your hands immediately beforehand and immediately afterward. People just don’t understand how dirty their hands and fingernails are. Even with no visible dirt, per se, Staph aureus is lurking around every corner.

RN: Over the years, we’ve seen MRSA grow from a hospital problem into a community problem. This nasty mutant bug can very easily be picked up from the gym (sweaty bottom + tiny, dirty seat + open pores = trip to the ED for serious antibiotics). Average, ordinary people are contracting this insolent bacteria and just can’t shake it.

MD: Although Staph aureus infections have been around since before the dark ages, and even yours truly had to go to the emergency department as a teenager for the type of cure only a gleaming 11-blade can offer, we’re definitely in the midst of an MRSA epidemic. And unlike some of the other current epidemics such as HIV and hepatitis C, which primarily target those who share needles or don’t protect themselves during sex, MRSA targets everyone.

Athletes are definitely at risk, but so are we.

In fact, as healthcare workers, we’re probably at higher risk than most. A friend of mine who’s a nurse developed an MRSA infection after a minor hand surgery. We’re around it every day. So if we don’t take the proper precautions, it means trouble.

I’m almost tired of all the articles on the subject. I get it. I should wash my hands frequently at work, and when I get home, wash everything else. And of course, taking precautionary measures during patient care, including using the correct barriers when dealing with open lesions and putting patients with a history of MRSA infection on isolation to protect patients and staff.

RN: I can’t help but wonder what part we played in this growing problem. I always try to emphasize to my patients on discharge that they MUST TAKE ALL OF THEIR ANTIBIOTICS. Don’t stop taking them when you feel better, don’t save them for another sick day, don’t give up if you miss a dose. Keep going until the bottle is empty! I try to explain to them about these mutant bugs and how serious they are. I also wonder what doctors have done, or haven’t done, to prevent this. Sometimes, people just demand an antibiotic even when everyone from the ED volunteers to the cafeteria staff knows that this person has a virus and, thus, antibiotics are useless. But some docs give in, most likely to win the battle, even though in the long run they may lose the war.

MD: Not me! I know the data. Ninety-five percent of respiratory infections are caused by viruses, and 75 percent of the inappropriate antibiotics in this country are written for URIs. I find that most patients will trust me that they don’t need antibiotics if I take the time to explain why. It takes a few extra minutes of my time, something that is precious at work, but I think it’s worth it. I have a whole shpiel I give, which I won’t reproduce here, and it usually works. I want to win both the battle and the war. I want to be part of the solution and the cure. Of course, it doesn’t always work, but I’m batting around 900 these days. For abscesses, there’s a bit more controversy. According to most experts, simple abscesses actually don’t require antibiotics after an I&D. However, there is data to suggest that antibiotics may help eradicate the carrier state that exists between acute infections. Sounds worth it to me.

RN: One thing nurses and doctors can always do better is wash their hands. I’m going to go out on an anecdotal limb here and say that nurses are better at being hygienic than doctors are. Actually, that’s not really a limb—it has been shown in quite a few studies—but we’ll have to save that for a future installment of MD/RN! Have a great day, people, and remember: Stay safe, stay sanitized.

Image: Somos/Veer | Getty Images

We all want to look good at work, but we want to stay healthy as well. In Part II of The Perils of Beauty, Dr. Brady and Nurse Rebekah talked about white lab coats as carriers of germs. Here, they tackle your hair, hands and face.

Nurse Rebekah: Our last stop on this adventure through hospital wardrobe is hair. I have a decent amount of hair, it’s long and if I’m motivated enough, I can make it look real puuuurrrrty. But not at work!!! Tie it back, ladies! This goes for physicians, too! I’ve seen both sexes guilty of hair sins: long, beautiful hair flowing down over their shoulders and right into a sterile field, foley catheter or a seeping-oozing-disgusting wound.

Think of that old high school cheer…tie it back, tie it back, waaaaaaaaaaaaaay back. I’m just waiting for a mutant MRSA strain that makes your hair fall out in giant abscesses. People tie their hair back when patients have lice. Why? Because you can see lice. You can’t see the smarmy microbes, but they are there, right? We learned that in microbiology. Remember the door handle swabs?

Dr. Brady: Personally, I’m more interested in the touching-your-face issue. Most communicable diseases are transferred by touching your eyes, mouth or nose with unclean hands and fingers. I’m paranoid about touching my face unless I’ve just washed my hands. I consider my hands to be a disease-ridden zone, except for immediately after sanitization. The last place I want those hands to be is anywhere near my face or my food. Yet I see people all day long rubbing their eyes, picking their nose and touching their lips. I want to yell, “Don’t! Do you know where those hands have been?”

Fortunately, there is a balancing force: the secretaries who wipe down everything in a 10-foot radius with sanitizing surface wipes as soon as they get to work. I love to watch that. Fortunately, my ED is pretty clean. I even see the cleaning crew regularly spray the curtains with disinfectant. I don’t think they do that everywhere, but they should. Can you imagine what would grow if we plated those on bacterial culture?

In part IV of The Perils of Beauty, Dr. Brady and Nurse Rebekah discuss the ways our clothing enhances—or undermines—our professional image. Read Parts I through III here.

We’d love to hear your advice about avoiding germs at work. Do you wear a ponytail? Cover yourself in a coating of Purell? Wash your hands both before and after using the restroom?