An open letter to America’s patients


Imagine its 1846 and we’re in Vienna. You’ve just given birth and are waiting in your “child bed” to see the physician team, totally blind to the fact that you have a three times greater chance of dying (about 1 in 10) then the woman next to you being cared for by a midwife (about 1 in 33).

Fast-forward two years later. You survived your first pregnancy and have returned to the same maternity ward to deliver your second baby.  It’s now 1848, and after a stunning discovery by an obstetrician named Ignaz Semmelweis your chances of dying have dramatically fallen. Now, whether you are cared for by a physician or a midwife, you have a 99% chance of survival.


Because Semmelweis learned that to prevent the spread of “puerperal fever” – now known to be caused by an overwhelming bacterial infection – physicians just had to wash their hands. 

Said Semmelweis in his 1861 paper:

Even so, one cannot impute guilt… any more than to me or to all the others who undertook examinations with contaminated hands. None of us knew that we were causing the numerous deaths.

With such a dramatic change in outcomes after such a minor change in practice, one could reasonably expect that Semmelweis was celebrated the world over, unifying medicine around hand hygiene as fast as information could travel in the mid-1800s.

Reasonable… but wrong.

Semmelweis was fired and exiled from the medical community in Austria.  He died four years later having been committed to an asylum, while women around the world continued dying at an unconscionable rate from a now clearly preventable condition.

Medicine has come a long way in the last 150 years. If you’re giving birth in the U.S. today, you have a 99.98% chance of survival.  Childhood leukemia – a once uniformly fatal condition – is survivable in over 80% of cases, and neonatal intensive care units are saving infants born more than four months early who weigh under a pound at birth.

Despite incredible advances in care, the “Semmelweis reflex” – an out-of-hand rejection of new information – remains prevalent. Furthermore, we still can’t even do the most basic, 100% proven practices like washing our hands 100% of the time.

As a result, the Institute for Healthcare Improvement puts the number of preventable deaths conservatively between 200,000 and 400,000 per year.  Do the math – in just the time it’s taken you to read this post, well-meaning and well-trained clinicians somewhere in America have inadvertently killed at least 5 people.

That’s why we need patients to stand up and take action.

As a healthcare community we are getting better, but it’s nowhere near fast enough. Providers are more transparent than ever about errors and what we’re doing to prevent them, but we need even more transparency. Patients are more activated than at any time in history, but we need even more activation.

Every day patients make decisions about where to seek care based on the things that are important to other decisions they make as consumers – how far away they are from a clinic, what’s the hospital’s parking like, what’s the institution’s reputation, and so on.  But few other consumer decisions we make in life carry with them a measurable chance of death.

So ask your providers about quality, ask how its measured and how its practiced. Research your doctors, your hospitals, your skilled nursing facilities and your rehab centers and read about their publicly-reported outcomes at least as much as you’re reading their Yelp® reviews.

Learn what it takes to prevent the kinds of preventable harms you may experience when you’re getting the care you need, be it a surgery (e.g., surgical site infections, falls, and catheter associated urinary tract infections) or chemotherapy (central-line associated bloodstream infections), or just a routine check-up (medication errors).  Make sure your providers are doing all the evidence-based things you’ve read about and ask what you can do to participate in the process.

And for heaven’s sake, don’t let your doctor touch you without first washing her hands. She’s known better for 150 years.

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