Change. We are condemned to live in interesting times, as the Chinese Curse purportedly observed -although there seems to be no evidence that there ever was such a curse, nor does anyone appear to have any idea what it means… But I have always assumed that it had to do with change, and our sometime antipathy to it. Of course things have always been in flux but its only over the last hundred years or so that it has seemed exponential. We’ve had to accustom ourselves to a continuing and accelerating change and have come to expect that next year -if not tomorrow- may be significantly different from today. But although gradual change is readily assimilable, when the difference is abrupt or requires a significant adjustment we often rebel. Habits die hard. After all, an assumption of predictability and stability is what allows civilizations to function, groups to cohere.
It is under just such conditions that a fundamental dichotomy arises, however: knowledge is the enemy of stasis and progress requires modification, however incremental –a sea change into something rich and strange, as Shakespeare wrote. Change often comes upon us like contagion on the wind: pollution with an unknown virus. An unexperienced plague for which we have no defence. No immunity. And yet like the Siren’s song that lured ancient mariners onto rocks, it is seductive.
It’s hard to know what to make of Change. Not all of it is good; some of it is mere revision. As the poet Robert Frost once observed: ‘Most of the change we think we see in life is due to truths being in and out of favor’. Some of it, however, inevitably represents real advances, or even revolution -think of the concept of the paradigm shift popularized by Thomas Kuhn in his nineteen-sixties book The Structure of Scientific Revolutions. Something is conceived that is so new, so different from what we had come to believe, that it turns our belief system inside out. The change, to be adopted, has to offer distinct advantages over the old, of course; it has to be worth making the effort. Reinvesting. But it is not without a struggle from those with vested interest or careers dependent on the old knowledge…
There are many such changes occurring in Medicine. Some are lauded and universally appreciated: a new treatment for cancer, say, or a fresh insight into the cause of a disease. Others, seemingly trivial, go unremarked -or at least unflagged until pointed out. And yet they may represent paradigm shifts in their own right. For example, new ways of looking at the problem of hospital infections and the spread of resistant bacteria. Hand washing and alcohol-containing lotion dispensers situated outside each patient room along the corridor are being universally adopted and are an important component in the containment attempt.
But there is another approach that, now that I think about it, should have been equally obvious. I first read about it being mandated in some UK hospitals and filed it away somewhere as being a good idea. Now it is being considered here in North America, and none too soon:
It’s so obvious when you stop and think about it, isn’t it? What is worn from room to room, brushing against patients, rubbing on bedclothes, and stained by anything and everything that it touches? The white lab coat, of course! We see them so often in our hospitals, we’ve come to expect them. And we all know who wears them: lab techs shuffling along the halls, doctors hurrying from room to room, senior nurses… its a virtually ubiquitous sight in a hospital. An expectation. And yet, no matter how often and diligently the doctor -or whoever- washes his hands between patients, no matter how devoted to cleanliness, no matter how motivated, if he drags his lab coat -his uniform– from room to room, he’s like a germ duster. A fomite. A Johnny apple-seed for our times. And the admonishment of Bare-below-the-elbows, as the link suggests, makes sense too: it assumes the lab coat has been hung up outside the door. But it’s also one of those things that is clear in retrospect, but almost invisible unless pointed out.
Consider it pointed out.