Hand hygiene in hospitals has gone too far

Hand hygiene in hospitals has gone too far

We’ve run amok with wearing gloves in the hospital.  And by “we” I mean every healthcare worker in sight.  I see people putting on gloves before they’ll give a patient a clean warm blanket.  This is not only ridiculous, it’s actually harmful.  Here’s why.

We learned the hard way in the 1980s, during the early days of the AIDS epidemic, that the HIV virus and other potentially lethal microorganisms are carried in blood and body fluids. The Centers for Disease Control and the World Health Organization developed the concept of “universal precautions”, which applies during all patient-care activities that may involve exposure to blood, body fluids, mucous membranes and non-intact skin.  Observing “universal precautions” means that you always wear gloves in those situations because you may not know ahead of time if a patient carries HIV, hepatitis, or any other infectious disease.  You don’t want to get infected yourself, or inadvertently infect another patient.

But when did “universal precautions” come to mean that you have to wear gloves before you touch your patient at all?

The downside of hand hygiene campaigns is that they discourage us from normal human contact with our patients.  If you’re worried that the hand hygiene police will detect a deviation from protocol and report you to your hospital’s infectious disease authorities, there’s an easy way to avoid the problem. Steer clear of the patient.  And with the advent of the ubiquitous electronic health record, doctors and nurses are under tremendous time pressure to complete all the required data entry fields and move patients through the system.  When you think about it, not touching the patient saves time that could be more efficiently spent at the computer keyboard.  There’s a win-win situation, you might think.  But is it really?

There’s an old adage most of us heard in medical school:  “When all else fails, examine the patient.”  What this means is that all the tests, scans, monitoring equipment, and every other marvelous technology at our disposal can’t replace a skilled and experienced physician taking a history and examining the patient.  If you can’t figure out what’s going wrong, go back and examine the patient again.  It’s still good advice.

In anesthesiology, we’re always under time pressure to see our patients as efficiently as possible and get surgery underway.  Years ago, patients came into the hospital the night before surgery, and we had time for a personal interview at the bedside.  Today, patients come in on the morning of surgery even for the most life-threatening operations, and we have only a brief interval to meet the patient, complete an examination, decide on a plan of care, explain it to the patient and family, and obtain consent.  Yet the preoperative assessment is a key component of anesthesia care, and it may be your only chance to learn critical information about your patient.

I’m in the old-fashioned (some might say quaint) habit of wearing a stethoscope around my neck.  I listen to every patient’s heart and lungs before surgery.  On a number of occasions, I’ve heard a heart murmur that caught my attention and sent me back to the patient’s old records for further information.  Heart conditions like aortic stenosis, which increases the risk of anesthesia tremendously, may not always be noted in an abbreviated history and physical done by the admitting orthopedic surgeon or gynecologist who is focusing on the patient’s other problems.

I think, though, that listening to the patient’s heart and lungs is important for another reason:  it’s a time-honored ritual and a moment of personal connection between physician and patient.  It creates a cocoon of silence, however brief, and reassures patients that I understand their physical condition and am fully focused on their problems.  I have only a few moments to convince them that they are in good hands and may safely put their lives in my care.

Do I put on gloves when I place my stethoscope on the patient’s chest?  Of course not, unless the patient has an infection such as methycillin-resistant staph or C. difficile.  There is no healthcare standard stating that gloves are indicated for contact with intact skin.  The downside of using gloves in a brief external physical examination is that it sends this message to the patient:  “You are unclean.  I don’t want to touch you, but if I must, I’m going to protect myself.”  This is not the way to create a patient-physician bond.

After you examine a patient, it’s common sense to wash your hands and wipe down the stethoscope bell before you move on to the next patient.  But what I see happening in the hospital today has gone way beyond common sense.  There is no need to put on gloves before you place a blood pressure cuff or EKG electrodes on a patient.  As the World Health Organization points out, “The use of gloves when not indicated represents a waste of resources and does not contribute to a reduction of cross-transmission.”  And it can’t be good for the environment to have billions of gloves unnecessarily used and discarded.

So here are a few thoughts I’d like to leave with young anesthesiologists-in-training.

Touch your patient.  Don’t wear gloves.

Shake hands when you meet, or take the hand of a frail old lady and just hold it for a moment.

Listen to the patient’s heart and lungs with a good quality stethoscope that’s your own, not a cheap plastic one you found hanging somewhere.

Don’t turn your back to the patient in order to type on the computer.

As you stand at your patient’s head and get ready to induce anesthesia, make sure the room is quiet.  Put a hand gently on the patient’s shoulder, cheek, or forehead before you apply the oxygen mask and start giving medications, to let the patient know you’re there.

Remember that your voice and your touch are the last thing the patient consciously experiences.  Make your words calm and reassuring, but don’t lie.  Never say, “You’re going to be fine,” because truthfully you don’t know that.  It’s better to say, “We’ll be right here with you,” because that’s a promise you can keep.

There was a time when touch and comfort were about all that a physician or nurse could provide for most patients, since effective medicines were few and technology nonexistent.  Thankfully, we don’t live in those times.  But some of the physician’s art can’t be replaced.  If we let gloves or anything else come between us and our patients, everybody loses.

Karen S. Sibert is an associate professor of anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

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  • Ron Smith

    Way to go, Karen. Great post.

    I’m a private solo Pediatrician for most of the last 30 years. I had a parent come to the office about 6 years ago who wanted me and the staff to wear gloves every time and always while carrying for their child.

    I said no. They left and I have never looked back.

    Touch is one of the real aspects of good, solid medicine. There is something and a sincere, solid pat on the back or handshake or a gentle rake of the hand on the shoulder that comforts a patient and is part of their healing.

    Touch is so significant to us as humans, that in some Soviet satellites where orphaned infants and newborns were not handled, that they simple stopped crying, stopped growing, and even died. It is critical to the nurturing of a healthy child.

    Warmest regards,

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

    • meyati

      This happened at Cook County Hospital before abortions were legal. The nurses just didn’t have enough time to physically handle babies beyond feeding and changing diapers-they died within the first 6 months. Many didn’t last for 3 months. It really wore down the nurses.

    • querywoman

      Wonder if that kid developed allergies from his parents’ penchant for being super clean?

      • Ron Smith

        There was a study in the last year or two that demonstrated that children who eat dirt (pica) have healthier immune systems. Clearly are immune systems are stronger when they are challenged.

        Ron Smith, MD
        www (dot) ronsmithmd (dot) com

        • GT

          Whenever my mother despaired of how dirty we boys got, my grandmother would always chime in, “Gotta eat dirt to beat dirt!”

  • wahyman

    Maybe there should be a mandatory warning sign in the offices of the glove adverse: WARNING: We limit our use of gloves. Then patients could make their choice. Maybe the sign could also list what other safety procedures the office does not adhere to.

    There is also an alternative perception to “I must be dirty because they are wearing gloves” among patients. That is “Thank you for not exposing me to what you have touched.”.

    • Guest

      Maybe you didn’t read the article. It advocates using gloves when indicated, and washing your hands and equipment otherwise. That is what the studies have supported. It’s not the job of the healthcare staff to feed your germaphobic paranoia. Would you honestly “take your business elsewhere” if someone touched you without wearing gloves? That is mind boggling.

      • wahyman

        Given that I have a choice of physicians I would certainly deselect a physician that I thought was not providing proper care. Just as I would deselect any other professional, or non-professional for that matter, who appeared to me to not be performing their duties with due diligence.

    • PoliticallyIncorrectMD

      Wearing gloves while touching intact skin has as much in common with “safety” or “proper care” as prohibiting nail clippers on board of a plane has to do with security of air travel. It accomplishes absolutely NOTHING except creating an APPEARANCE of public safety. If you want your provider to wear gloves while examining you, I don’t see why it should not be accommodated, but making it mandatory for “safety” reasons is not just ridiculous, but simply WRONG.

      • wahyman

        Is it better to err on the side of caution, or to err on the side of increased risk?

        • PoliticallyIncorrectMD

          Personally – the choice is yours. As far as public policy goes, It is better to make decisions based on data and common sense rather than fear and paranoia.

          • wahyman

            “Common sense” is remarkably uncommon.

          • PoliticallyIncorrectMD

            I agree with you there. Nevertheless, common sense dictates that if one is safe using public transportation, public restrooms, money, and shaking people’s hands without gloving, they are likely not to be adversely effected by their physician (who washed their hands) touching them without having gloves on.

          • wahyman

            If they did wash their hands, and if one is biologically safe in the situations you describe, and if the physician did not work imore biohazardous environments than than the average public place.

      • querywoman

        Yeah, gloves can transmit pathogens too!

  • Kay Dee

    “When you think about it, not touching the patient saves time that could be more efficiently spent at the computer keyboard.”
    Maybe docs should be gloving up before touching the keyboard, instead of the patient. When’s the last time that thing was cleaned?

    • SarahJ89

      I’ve been wondering about that ever since I saw an infectious disease specialist poke at my husband’s suppurating MRSA lesions, then turn to type on her keyboard without removing her gloves. We couldn’t get out of that office fast enough.

      • Trina

        And that also demonstrates why gloves aren’t the be-all end-all of hygiene. A germy glove will spread infection just as easily as a germy hand will.

  • querywoman

    Not exactly the same issue, but on the same thread: should human beings be afraid to touch either? I can’t believe how many people are afraid to shake hands in church during the flu season! I’ll take my chances and risks and act like a human!
    I asked my derm about the hand sanitizer epidemic, and he said it’s unnecessary. I can’t believe the hand sanitizer containers everywhere!
    Is it true that Katie Holmes used wipes on playground equipment before letting Suri play?

    • wahyman

      When did shaking hands become a necessary part of religious ritual?

      There must be a truism that for for every safety measure someone will tell you that you are a knuckle-headed wimp for complying with it.

      • querywoman

        Orthodox Jewish and Muslim men often won’t shake hands with a woman because she might be menstruating.
        Hand-shaking in church often causes me to shrink back! Very easy to explain! I have atopic eczema, and in various stages have scales flaking off. Sometimes I have very painful lesions on my hands and shaking hands is painful.
        It’s not contagious. Sometimes people do back off.
        I just took a picture of a very noticeable, nonpainful, scaling area on my foot.

  • EmilyAnon

    It’s interesting that the fruit and vegetable vendors at my local supermarket always wear gloves while stocking the produce displays. I wonder why such strict hygiene when you consider how many unseen workers, from field to store, have handled the items ungloved.

    I’m sure gloves in the hospital environment can also convey a false message of hygiene.

    • querywoman

      That’s nothing compared to the animal poop, insects, etc., that get all over them while growing!
      While I am it, we need to quit spraying whatever chemicals everywhere and resurrect our honeybees!

      • Tiredoc

        You can always wash fresh fruit and vegetables in a gallon or so of water with 2 capfuls of bleach. Kills off pretty much everything but spores. Can do the same with the iodine solution for camping. Pesticides have been ruled out as the source of the honeybee die off.

        • Dana

          I had strawberries and oatmeal for breakfast this morning. I can’t imagine soaking them in bleach – eeeeech! I’ll take a few germs, thanks, They’ll exercise my immune system.

          • Tiredoc

            The chemical formula for bleach is NaOCl. It breaks down into NaCl and O2. Salt and Oxygen. Soak it, take it out and let it air dry. Your strawberries will last 2-3 times longer in the fridge. It cleans off almost all the organic residues. Bleach works as well now as it did when it was first invented. No pathogens have developed resistance to it. Personally, my stomach doesn’t need the exercise that E. Coli, Shigella, Campylobacter, Giardiasis, and Salmonella give it. And by the way, if you travel outside the country and buy fresh vegetables and fruit, bleach will keep you out of the hospital. Ask the CDC if you don’t believe me.

          • querywoman

            Thanks for the tip if I ever travel.
            I’ve read that a bleach solution can revitalize produce. I try not to do buy too much at a time anyway.

          • querywoman

            I’ll eat an unwashed grocery store grape in honor of your breakfast!

        • querywoman

          I couldn’t resist eating my unwashed grapes today while waiting for the bus today after I left the grocery store.
          Did the same the other day!
          I could have gone into McDonald’s and got some of their chemical-laden food, but I wanted my grapes.
          Whatever is killing bees, we need a resurrection of them!
          They are multiplying quite well now in places like home attics!

          • Tiredoc

            I hate to be the bearer of bad news, but if you bought the grapes from a supermarket, they’ve already been washed in a bleach solution. This includes produce labeled organic. If you bought the produce from a farmer’s market, you’re supposed to wash it yourself before eating it.

            As for the honeybees, a few years back everyone was worried about all the frogs dying. Turned out to be a fungus spread by the researchers looking into why the frogs were dying off. Maybe the bees are just inbred.

          • querywoman

            Tiredoc, why would that be bad news, that the grapes were already washed?
            I bought them at the grocery store, and they were in a special pre-fixed package, and assumed they had been washed.
            I’ve read of people getting sick off “organic” grapes that maybe had pesticide.
            If you wash your own fruits and veggies in a bleach solution at home, I assume you get exposed to quite a variety of germs at work to boost your immune system, no matter what precautions you take in your medical office!

    • SarahJ89

      It’s marketing, EmilyA.

      • Noni

        Imagine the environmental impact as well. All these discarded plastic gloves clogging up our landfills – yuck.

        • Dana

          That’s a good point. Plus, plastic gloves are a petroleum product. What a waste of a limited resource.

  • doc99

    Actually, you don gloves to protect the patient from you – the leading vector of nosocomial infection.

    • Karen Sibert MD

      Sorry, but that’s just not quite correct. Handwashing is the most important way to protect the patient from you. If you don’t wash your hands, and then put on nonsterile gloves, you might as well not have bothered to put the gloves on at all. In that situation, the gloves only protect you from the patient, not the other way around.

      Even sterile gloves won”t protect the patient every time–witness the recent case of the surgeon with an infected finger who infected several patients’ new heart valves through micro-perforations

      • querywoman

        Yup. And condoms are the best barrier against VD, but humans can still transmit stuff while using them.

  • Karen Sibert MD

    It only makes sense not to touch people, shake hands, or whatever if you’re never ever going to touch anything that they’ve touched. That’s unrealistic, whether it’s a hymnal in church or a dollar bill in your wallet. Germs are everywhere. In flu season, keep your hands away from your nose and mouth. Wash your hands after using the bathroom and before you eat. For medical professionals, wash your hands before and after each patient contact, and wear gloves in the setting of infection and when dealing with body fluids. The rest is silly. I don’t allow hand sanitizer or “antibacterial” cleaners in my house, with the exception of Chlorox wipes in the kitchen for use after preparation of meat or chicken. I want the normal flora to live happily in my house, and keep the really bad bacteria in check. And I have a dog and two cats, who do their part in keeping us all happy and healthy, germs and all.

    • May Wright

      You sound ridiculously sane, Dr. Sibert. Stop that at once! :)

      • GT

        Haw!

    • querywoman

      Yeah, some people are afraid of money! If I touch a tree, I don’t know who was touched it before me.

    • Mark S.B.

      Do you let your cats run along on your counter tops in your kitchen then later that day place your food on the same counter top. They do stand in their litter box, sorry if this is rude but.
      And yes I do wash my hands after handling paper money that looks like its been in a body crack of a human for 3 days. I’m also a hand washer and have not been sick in many years.

      • Trina

        Most sane people wipe off their benchtops before placing food on them.

        • Mark S.B.

          Most sane people don’t let their cats or dogs walk where you place your food. On the counter tops next to your sink, that’s so gross to let a animal walk in the kitchen on top of the counter tops.
          They belong on the ground.

          • disqus_z9d5lJX92l

            I don’t actually like cats very much anyway, the aunt I used to stay with after school till my mom got home from work had about 8 of them, and her house stunk. But! If you do have them, and you wipe down your benchtops well, I think you’d be okay. We have a Labradoodle and a Bouvier Des Flandres, they stay off the counters.

  • querywoman

    I’ve read descriptions of how medical charts (and that includes computers) are germ-infested. So?
    Both plastic and rubber are culturally new phenomena. Plastic is a byproduct of the petroleum processing industry. Rubber is a New World “discovery.” Wipes are a product made to suck the money out of fools.
    Humans have been using cloth, soap, vinegar, and alcohol as cleaners since way back when.
    We know that longevity has truly climbed in the modern urbanized world. We also know that handwashing vastly improved medical safety.
    My mother, a former heavy smoker, was a real clean freak. Her house was a black garbage paradise, with stuff stuck in garbage bags to keep them nice. I smelled the plastic everywhere. She kept her glucometer in its original packaging in a sack. Each use meant pulling it out and putting it back in. The packaging cluttered the house.
    The idea that plastic and rubber are magical shields to protect us from each other has gone way too far!
    Karen Sibert already posted about the germs everywhere. I’ve read that dust and manure actually contain some kind of anti-infective substance. The growth in asthma and allergies may be related to super-hygiene as well as antibiotic overuse.
    I’m a Christian who does yoga. I apply yogic balance in the way I view the world. In the past few decades, modern medicine has begun talking about the immune system more, how exposure to stuff strengthens it.
    Keep your wold in balance. Wash hands after you pick your nose or cough!
    I’m all for doctors and nurses washing hands between patients, but I’m with Karen Sibert on the extreme measures.
    I always forget to watch the staff examine me in the dermatologist’s office. I think they mostly examine me with their bare hands unless I have a really nasty lesion.

    • SarahJ89

      I hate plastic. I have watched it proliferate in my 65 years to the point where it’s difficult to avoid. I store my food in glass and try to weed as much plastic out of my life as possible. Ha. Fat chance. I do my own canning, but guess what? The canning lid people line the lids with… plastic, the kind with that nasty stuff that’s released by tomatoes. I console myself with the thought that at least the jar is glass and the head space means the food isn’t touching the lid once it’s processed.

      • querywoman

        I’d rather store food in glass, too. I hate washing dishes, but I hate disposable plates, cups, silverware, etc.
        Sometimes I use vinegar to help sterilize food utensils.

  • EmilyAnon

    Dr. Sibert, patients are constantly being advised to ask their caregivers if they’ve washed their hands. But I could never bring myself to ask. Wouldn’t the surgeon, nurse, or anybody in our care be insulted that such an important task might have been forgotten? It seems the question could sour the relationship. Even if they didn’t wash their hands, would they admit it? I can’t imagine anyone saying, ‘thanks for reminding me, I forgot.’ Has any patient ever asked you if your hands were clean while administering anesthesia?

    • Karen Sibert MD

      We have hand sanitizer everywhere, including on the bedside tables. It’s easy to use on your hands while you’re saying hello, then proceed to shake hands with the patient, start the physical examination, or whatever. To me, that’s the easiest way to reassure a patient right up front that I’m doing the right thing without their having to ask. Hand sanitizer is also at the door of every room, and there are sinks everywhere as well. So no, I’ve never had a patient ask me about hand hygiene.

      • querywoman

        I consider a hospital room an appropriate place for hand sanitizer. Do they ever vary your cleaners? So many hospitals have superbugs! Vinegar is supposed to be really effective.

  • PoliticallyIncorrectMD

    Freedom is just a hallucination created by a pathological lack of paranoia.

  • Tiredoc

    You have provided an excellent example of observer bias. As an anesthesiologist, you have no way of measuring the amount of pathogens you transmit with your stethoscope. You instead remember the patient or two that you identified a heart murmur.

    Your true solution, don’t touch the patient unless you absolutely need to based on the history you already obtained from the patient, is the correct one. The actual yield of the supposed “comprehensive” physical examination is minimal. We need to get rid of the perfunctory patient grope, the nasty week-old “white” coat, the unwashed tie and long sleeved shirt. And yes, the stethoscope.

    When I was in medical school, I had a brilliant resident on my internal medicine rotation. He was organized, caring, with a prodigious memory. He also wore the same revolting coat the entire month, with the same dingy yellow tie almost black at the knot at his throat. On one occasion, he handed me his stethoscope to listen to someone’s chest. When I rotated the end, a small dab of orange came out of the hole at the center of the bell. Cerumen. Packed from the earpiece to the bell. Keep your stethoscope to yourself, please. I don’t want it near me unless you’ve run it through an autoclave.

    • Mark S.B.

      That’s so gross, dingy yellow tie almost black at the knot at his throat and a small dab of orange came out of the hole at the center of the bell.
      Some people are just gross and I’m not one of them.

  • Kaya5255

    Having been trained in “the good old days”, we were taught to wash our hands with soap and water when we entered and left the room. We were also taught to address the person by name; Mr. Jones, Mrs. Wilson, etc. NOT Hon or Dear, etc. We were also expected to look into the eyes of the person and touch them!!
    Common courtsey has gone the was of the DoDo in healthcare. Consumers are a disease, body part or worse…a number!! If I want to be a number, I’ll go to the Deli!!
    One final thing….healthcare workers…go home and change your out of your scrubs before you go shopping. That is a basic infection control requirement??!!!

    • wahyman

      At least in a good deli when your number is called you get good service.

      • Kaya5255

        Yeah, hopefully!! LOL!!!!!

  • Susan Perry

    Beautiful, beautiful blog for so many different reasons. Dr. Silbert reminds us to pause and remember that we are, after all is said and not said, humans with the need to reach out to each other.

    • wahyman

      False compassion over bio-safety. Excellent idea.

      • Trina

        You obviously prefer hygiene theatre, which is what this glove obsession version simple hand-washing is.

        • wahyman

          I certainly prefer it over lack of hygiene theater.

          • Trina

            It’s like the TSA and their security theatre, though. You may FEEL safer knowing that no-one on board your airplane is armed with nail-clippers or more than 60ml of hand lotion, but……..

          • wahyman

            But…would you feel better if they were playing games on their phones and not screening anyone?

          • EmilyAnon

            http://tinyurl(DOT)com/yzlvlpc

            sorry,don’t know why so many pics posted

      • Susan Perry

        Why do you assume that it is “false compassion” on the part of Dr. Silbert or are you talking about me? I sincerely hope you aren’t a healthcare professional. Read the whole blog. She doesn’t deny the need for good hygiene.

        • wahyman

          Even real compassion is not a substitute for not following established protocols. What other safety protocols are to be considered optional? And how many of those does the patient even get to see?

  • querywoman

    Good, Karen. I see you are getting a few more comments.. We don’t need health care workers in space suits!

  • Mark S.B.

    Wouldn’t it just be easier to wear gloves and not care if the patient may think you think their not clean. Its more safe for both the doctor and the patient to just wear gloves then trash them. It puts a layer of safety in between you and the patient, or the patient and you it does not matter.
    But safety and cleanliness should come first, if patients get annoyed that’s just life.

    • FFP

      Next time you shake your friend’s/family member’s hand, wear a glove! You never know where that hand has been. It’s just safety and cleanliness, after all. :p

  • Alan Byron

    I am simultaneously irritated and confused by ‘House’ where nobody seems to examine patients but make brilliant diagnoses by inspired debate.

  • katerinahurd

    If you think as you state in your article that gloves worn by physicians signify that disease is equivalent to dirt. Why then do you not consider that a stethoscope imposes an imbalance in the relationship between a physician and his patient? What do you think as an Anesthesiologist about the surgeon, Atul Gawande, who demonstrated that one in three Americans undergo surgery in the last week of their life?

    • FFP

      Atul Gawande is just another fame-seeking physician like Sanjay Gupta, Mehmet Oz etc. Don’t treat as Gospel everything they say or “demonstrate”. Quite the opposite.

      • EmilyAnon

        It’s easy to vet a person who uses their real name, not some phantom who hides behind initials. Why should anybody take your ‘insight’ seriously.

        • FFP

          Then don’t. This is not a society where free speech from doctors (and not only) is appreciated. People have careers destroyed over thought offenses all the time; freedom refers only to freedom from criminal prosecution.

          And they are not my initials. They are Dr. Plasma’s.

      • querywoman

        I get so much spam with “Dr Oz,” and I promptly delete it all.

  • FFP

    The hand hygiene police reminds me of the Sovietic commissar system, where uneducated blue-collar workers with “healthy origin” were dictating highly-educating intellectuals what (not) to do.

    It’s about the same nowadays in our hospitals, where everybody feels righteous enough to “educate” a medical doctor about almost anything, including hygiene and patient contact, not to speak about being reported for not respecting the hygiene police, and thus becoming a “disruptive” physician. Just like in Stalin’s Soviet Union. But, hey, we the doctors are the “oppressors”, and the nurses are the “people”, or at least that’s the way the media likes to picture us.

    • querywoman

      We Americans don’t know the real human smell is anymore.
      The French are supposed to be really stinky. We bathe too much in America, but that’s a habit most of us like.

  • Richard Willner

    There are cameras pointing at the hand washing stations at some hospitals. We have seen some surgeons nailed because of the hand washing police.

    Richard Willner
    The Center for Peer Review Justice.
    info@PeerReview.org

  • querywoman

    I paid attention in my dermatologist’s office today. I have atopic eczema, mostly a noncontagious flaky dry disease with scabs coming off. Today I had one possible infectious lesion on either foot.
    Neither the resident derm nor the senior derm gloved up to examine me!
    I suppose they might for a real nasty moist lesion!