Gloves---a Touching Story

Gloves---a Touching Story

I have become dedicated to bedside teaching, and by that I mean at the bedside—not outside the patient’s room or at the nursing station or in a room with a white board.  At the bedside, next to patient, hearing the patient’s story and examining him or her often open undiscovered and unexpected insights.

Faith Fitzgerald, professor of medicine at University of California at Davis, wrote of such a bedside experience.  Planning for attending rounds she was told by her house staff that they had “no interesting patients”.  Mildly protesting,  I am sure, the team departed for the bedside breaking through the usual centripetal forces.  They went to the room of an “uninteresting woman” who they discovered was a survivor of the sinking of the Titanic!  The following narrative is not as dramatic but is lovingly instructive.

I am now retired and have the privilege of making teaching rounds each Tuesday morning with an inpatient team:  a teaching hospitalist, a senior resident, a first-year resident, and two medical students.  This Tuesday the group was mobilized reluctantly, as they had “no interesting patients”, and we went to beside of a frail elderly woman recently admitted from a long-term care facility.  She was said to be demented she was immobile, sitting upright in her bed she reeked from the stool in her incontinence pad, her head lolled to the side and her toothless mouth was agape.  Her eyes followed but she did not respond to questions or commands.

We discussed the metabolic derangements and the resulting delirium that had brought her to us.  We examined her head, neck, chest, legs and fingernails.  We discovered nothing unknown.  We returned the bed to a low position and dimmed the overhead lights, and as we moved toward the door, she called us back.  She lifted her head, she opened her eyes, and with her dry tongue spoke “no gloves—no gloves”.  I returned to her side and without gloves I touched her arm, and she said, “No gloves, yes I want to be touched”.

Appropriate touching is important to humans, and even more so for the vulnerable and needy.  It appears that it has become standard to put on thin purple gloves to examine all patients at the bedside.  This seems to have been progressively ongoing for the last thirty years, prompted by the HIV/AIDS epidemic and now MRSA and C. difficle.  Before the mid 1980’s we had gloved on occasion for syphilis, viral hepatitis, various skin infections, and of course the rectal exam.  Now clinicians routinely glove with any expectation of touching the patient, including the physical examination.

Human touch is important.  The literature, old and new, medical and non-medical, has encouraged appropriate touching.  As an example, the late Lewis Thomas, widely read essayist, physician and investigator, wrote in 1983 “…the oldest and most effective act of doctors, the touching.  Some people don’t like being handled by others, but not, almost never, sick people.  They need being touched...”.  This is the lesson relearned from this “uninteresting woman”.



2/6/2017