Isolation: Fighting Infection but Alienating Patients?

I encourage you to read and ponder a recent essay in The New York Times written by Abigail Zuger, MD, an infectious disease physician in Manhattan. In "Isolation, an Ancient and Lonely Practice, Endures," Zuger describes the ordeal that contact isolation has become in today's hospitals, as well as the social stigma it creates for patients. Acknowledging the need for isolation to help prevent transmission of pathogenic organisms, Zuger still makes a case for contemplating a medical hold-over from the Middle Ages.

She turns poetic in her description of the contamination in a typical hospital patient room: "A microscopic version of Google Earth, scanning them in and out, would show a small, malevolent universe consisting of a human being surrounded by a shimmering, human-shaped cloud of bacteria. When patients turn in bed, giant waves of bacteria rise and travel on air currents all over the room, landing on bedside tables, on adjacent beds and on the people in those beds. The palms of people who touch these patients turn gritty with bacteria, and every time those caring hands touch another patient, the bacteria stick fast."

Zuger explains the tedious ritual of donning and doffing personal protective equipment upon every visit to an isolation room and notes, "Isolation is an immense nuisance for everyone," and adds, "For a nurse rushing in and out of patients’ rooms dozens of times a day, all that dressing and undressing is just not possible. Nurses learn to change their routines to get everything done in fewer visits. Meanwhile, patients with diarrhea need a lot of nursing care. They may begin to complain they are getting very short shrift in that department and, come to think of it, are not seeing the doctors much either. These patients feel terrible anyway, and they feel even worse feeling terrible all alone. Any intimation that isolated patients are at risk of substandard medical care will elicit passionate denials from all individuals and institutions involved. But some data argue otherwise."

Your heart might just break when you read Zuger's description of one patient's experience in isolation, about which she notes, "Increasingly, modern medicine forces us to specialize in the invisible. Here we had invisible germs with an inviolable mandate, and an all too visible patient pleading with us to ignore it. It was quite a struggle to try to see the one, to try not to see the other."

To access the essay, CLICK HERE.