Great Response from a Physician to my JAMA article

The other day I received this wonderful response from a physician to my JAMA article and thought people might like to see it.  Thank you so much Kirtikumar Shah for writing it and giving me permission to post it.


Ms. Suzanne C. Gordon,

I read your article in jama april 18,2012. I have been a practicing physician for last 38 yrs. in Houston Texas as internist and gastroenterologist.  I agree with many points raised in your article. Sometime ago one of my family members had surgery in one the major reputable hospitals  in Houston.  Every where there were signs — ” it is o.k. to ask if your caregiver has washed his/her hands “– this is nice — but I did wonder if any patient would have the courage to ask this question.

The solutions described in your article can go a long way to solve this problem.

In my clinic I have a routine that I always wash or sanitize my hands in front of the patient — while talking to patient I say, ” let me wash my hands and then I will examine you. This way I make sure that the patient knows that I am washing my hands before the exam.-  Not only that but I wipe my stethoscope with alcohol swab before  each exam.
I also teach my students who may be with me in exam  room that it is important to wash their hands in front of the patient so that there is no misunderstanding about whether we washed our hands or not.

I would like to forward your your article to local newspaper Houston chronicle and to the Harris County Medical Society medical newsletter.
Thanks for your article– it needs wider publicity in wall street journal and in new york times– also in american hospital asso. newsletter.”

Dr. Shah, thank you for writing this and I hope many other physicians and nurses will read it.

Susan Adams for Congress — A Nurse Role-Model

Nurse Adams Runs For Congress

I first met Susan Adams several weeks ago, at a Thai restaurant tucked into a shopping mall in sunny Marin County, California. An Adams-for-Congress supporter had contacted me, by email, about meeting her candidate.  My interest in nursing and progressive politics would mesh well, she assured me, with Susan’s impressive personal and political profile as a working RN, nursing professor, and Bay Area activist now serving on the Marin County Board of Supervisors. Before the pad thai even arrived, it was clear to me that Adams is a great role model for nurses in the Golden State (and any state), who want to make their voices heard in the public policy arena.

I had brought along a copy of From Silence to Voice: What Nurses Know and Must Communicate to the Public, a book that I co-authored with Bernice Buresh.  I handed Adams the book, over lunch, and the first thing she said (after “thank you”) was “how much do I owe you?”  “Nothing,” I replied, “It’s a gift.”  Without skipping a beat, Adams informed that that she was now “in politics and can’t accept anything.” Not a book, not a lunch.  “You start accepting books and lunches,” she said “and it’s a slippery slope.”  So my present turned into a book sale—not a bad deal for an author, but an unintended expense for a citizen politician who, without great personal wealth, has already had to raise more than $160,000 dollars to remain competitive in the crowded June 5 primary field in California’s 2nd Congressional District .

The constituency Adams seeks to represent runs north from the Golden Gate Bridge all the way to the Oregon border.  Before redistricting, many of these same north coast voters sent Lynn Woolsey, one of the most liberal members of Congress, to Washington, but Woolsey is stepping down next January. Adams is competing against seven other Democrats and two Republicans in a “jungle primary” that will be followed by a general election in November, pitting the two top vote getters against each other.

One of those opponents is State Assemblyman Jared Huffman. He’s also from Marin and the current front-runner (in fund-raising and the polls), who was just endorsed by The San Francisco Chronicle.  Another top tier contestant is Norman Solomon, a well-known progressive activist and writer who shares many of Adams’ views. The second biggest spender in the race so far is Stacey Lawson. She’s a newcomer to politics who is touting her business experience and making a bid for public office backed by her own hi-tech industry fortune in a manner reminiscent of  Meg Whitman’s run for governor last year.

Lawson’s wealthy friends have already endowed her with a campaign treasury five times bigger than Adams, whose bid to replace Woolsey was initially encouraged by the Washington, D.C. feminists at Emily’s List. Before Lawson left the business world and moved to Marin, she didn’t bother to vote much (a record of civic activism similar to Whitman’s in the GOP). But, now, Lawson’s fundraising prowess has led some Inside-the-Beltway queen-makers to shift their attention from Davis to her.

That’s a sad commentary on the affection that money can buy in Democratic politics today. Adams is neither new to elected office nor unfamiliar with the survival struggles of ordinary people, including being laid off and loaded up with night student debt.  A fourth generation Californian with family roots in rural Mendocino County, Adams got her nursing degree from San Francisco State in 1978. She earned both a masters and doctorate in nursing from the University of California at San Francisco (UCSF), where she specialized in women’s health and maternity.

A single mother of two, Adams put herself through school while working as an obstetrical and gynecological Nurse Practitioner at UCSF hospital. She has also served as a clinical professor, mentoring scores of undergraduate and graduate nurses, medical students, interns and residents.  Her nursing practice focused on the problems of chemically-dependent pregnant women, the subject of her doctoral research.
When UCSF hospital merged with Stanford in the1990s, Adams helped organize her facility for the California Nurses Association (CNA) and served on the union committee that negotiated the RNs’ first labor agreement.  Unfortunately, the marriage between Stanford and UCSF ended in divorce, leaving Adams among the casualties of its dissolution. Hundreds of staff positions were eliminated and she was one of those laid off (a management decision that, in her case, may have been motivated by her union activity).

Always politically active, Adams served as a campaign volunteer for now U.S. Senator Barbara Boxer, when Boxer, like Adams now, tried to move up from the Marin County Board of Supervisors to a seat in Congress.  Gradually, Adams gained experience lobbying on nursing issues in Sacramento and Washington.  In the 1999, she decided to run for the state Assembly because “our health care system was broken” and experienced caregivers were under-represented in policy-making circles.  “I threw my hat in the ring,” she explained, “so I could be part of the dialogue. After spending only  $1,000, I did better some of candidates that raised more than $100,000.”

Even though Adams didn’t win an Assembly seat, many of her friends and neighbors in Marin County encouraged her continuing involvement in electoral politics.  Arguing that Marin had a “fractured healthcare system, which wasn’t working for the county’s resident,” she campaigned to become a county supervisor in 2002.  “I wasn’t expected to win that race, because a very popular city council member, Paul Cohen, was also running and he had a lot of support and a whole lot of money,” she told me.

“But nurses have an 85% approval rating and people responded to my message that electing a health care provider could help us create a healthier community and a healthier planet for our families.”  Adams won the race, much to her surprise, and she has been re-elected to the board of supervisors twice since then.   In the decade Adams has served on the board, Marin County has built a health and wellness campus in San Rafael and Novato.  “We have clinics all over the county now.  We used tobacco settlement money for the San Rafael site and it provides comprehensive services in partnership with non-profit providers, including primary care, mental health services, and dental care.”  Patient visits have jumped from 10,000 annually to more than 100,000 a year now.  Says Adams: “This means we are definitely filling a need.”

Adams is particularly proud of a new county program that

“has diverted almost 200 non-violent, mentally ill offenders into treatment rather than jail and reduced recidivism by 85% and psychiatric emergency room visits by 50%.” Most of these former offenders are now gainfully employed and paying taxes again, she observes.  On the county board, Adams also cast the deciding vote that launched the Marin Clean Energy Program, which addresses climate change by encouraging green job creation. Working with other county supervisors, Adams helped obtain $25 million in federal funds for non-motorized transportation projects.

As a result, Marin is now one of only four counties in the country to receive federal demonstration project money for non-motorized pathways (i.e. walk-able and bike-able commuting routes). Another program she helped initiate and facilitate is the nationally recognized Marin Medical Reserve Corps. “In our county today,” she explains, “we have a few hundred healthcare professionals trained in incident command who are ready to jump into action in the event of disaster.  When we were faced with a flu pandemic, we had the whole county vaccinated within a week or two, receiving national recognition for this as well.”

Although several of Adams’ opponents in the 2nd Congressional share her progressive views about single-payer health care, she believes that her hands-on experience in hospitals and leadership role in public health makes her the real expert in the race. After all, how many other 2nd district candidates can boast of “delivering hundreds of babies as a nurse”—a track record that, according to Adams, insures that she’ll “deliver for us in Congress.”

“You’ll be my boss,” she tells the voters of the north coast,” not Wall Street, millionaires, or corporate donors.”  With women holding less than 17% of the seats in Congress, she also hopes “to bring more common sense and collaboration to the table” in Washington. At the very least, at a time when right-wing Republicans are targeting feminist gains on many fronts, it certainly wouldn’t hurt to have an outspoken RN and grandmother of four fighting to protect women’s reproductive rights and access to health care, including contraception.

Win or lose, Susan Adams is the kind of nurse that many patients have been glad to have at their bedside and in the delivery room. She’s a credit to her profession—a living, breathing affirmation of the RN’s duty to be a “patient advocate,” in the broadest and best sense of that term.

(For more information on the Adams campaign, see


Ask Me If I Cleaned My Hands

I just wanted to alert people to a new article I did for JAMA, which appeared on April 18, 2012 in the journal.  It’s entitled Ask Me If I Cleaned My Hands and recounts my experiences with hand hygiene when I was a patient getting surgery several years ago.  I can’t print the entire article here but you can find it by linking to the url above.  I can quote from it a bit.  So here is a bit from the beginning.  I hope you will read it and think about some of the ideas in it.  I was pleased that it was cited as one of JAMA’s 50 top viewed articles in April.

So here is an excerpt:

cator in a residency program at a medical school,
told me a tale. She was accompanying an intern as
they trailed alongside an attending physician who was
seeing patients in an out patient clinic. He
examined three patients in a row and did not clean his
hands before or after examining any of them….

This is about all I can show you, but article makes some suggestions about how to really make patients a part of the hand-hygience process.  And believe me, the solution is not to expect patients to ask their doctors and nurses if they have washed their hands.  We just won’t do it.  It’s too scarry.

In fact, I wonder how many physicians and nurses have ever had patients ask them if they have cleaned their hands?  I would love to know if that ever happens.

I hope people find the JAMA article of interest.

Is Healthcare Information Technology Really a Silver Bullet?

This morning, when I woke up, I called a good friend and colleague to find out about a project we are working on.  Before I could even broach the subject, she told me she’d just had a terrible morning.  Why, I asked.  She’d just gone to see her gynecologist and went in an hour early for her appointment to get some blood work done.  The secretary told her to come in at 8 am to do the blood draw.  She dutifully arrived only to be told that, in fact, the person who does the blood draws only comes in at nine.  Glitch number one.

But that was okay, she was told, because the health care system was updating its computers and introducing all sorts of electronic wizardry (healthcare information technology (HIT) — the kind the Patient Protection and Affordable Care Act (PPACA) has supported and which promises to protect patients from all manner of frightening medical errors and injuries.  Because she was early for her appointment with the doctor, she could take the time to fill out a bunch of forms that would provide critical information that would be entered into the computer and would help physicians and nurses etc make better judgments.  (Obviously, I added the nurses here because no one in health care would ever talk about anyone on the team other than physicians).  Fine, my colleague thought, I’ll be glad to fill out all your forms. Continue reading

Repeat After Me: A Suggestion to Help Reduce Medical Errors

There’s a lot of talk today about including patients as members of the healthcare team.This is supposed to help avoid medical errors and injuries and make patient care more about the health of the patient rather than the convenience of their caregivers or the financial well-being of the institutions which care for them.

There’s a lot of talk about including patients in their own care but what about action?In my experience as both patient and observer, there’s not enough in this regard.Take the issue of medication errors.In my experience, doctors and nurses don’t take enough time to thoroughly go over details about the medications they are giving and how they should be taken. Here are just two examples – one from my own experience.

Continue reading