In 1846, Ignaz Semmelweis became the assistant director of the first obstetrical clinic of the Vienna General Hospital where his duties included instructing medical students who attended at births. The hospital had a second clinic where midwives attended births. Semmelweis examined data on the number of mothers who died in his clinic compared to the other, and compared to mothers who gave birth outside the hospital. Mortality was uniquely higher, and much higher, in his clinic. Semmelweis was outraged by the indifference of his medical colleagues to what were clearly avoidable deaths. By careful assessment and statistical analysis, Semmelweis was able to pinpoint the cause—the mothers were killed by something the medical students carried on their hands from the autopsy rooms. This was of course before germs were identified and understood. But he instituted a policy of hand washing and the high mortality in his clinic disappeared.
Happy ending? Sadly, no. The physicians took exception to Semmelweis’ demonstration that they had been the cause of the unnecessary deaths and scoffed at the hand washing. They refused to believe something they couldn't see could be harmful. Semmelweis was forced out of his position and full vindication and recognition did not come until after his death.
What moral does this story have for us? In my opinion, it’s this:
First, decisions that affect patients are made based on authority and expediency, not evidence. Just as in Semmelweis’ hospital, carefully gathered data are not properly used to make decisions. The most important decisions are mostly based on the intuition of those in authority. When data are addressed, it is often to justify a decision already made on intuition, authority, or expediency.
Second, decisions are defended as necessary based on myths or irrelevancies about whether better clinical service is feasible. There is a vast body of evidence about the value of many clinical services that many patients are never offered. This vast body of evidence has been compiled and analyzed just in the ways that Semmelwies analyzed his.
In one sense, we don’t have to offer these services here—we’ll probably keep our accreditation and paycheques anyway. But to truly live up to our many lofty vision, values and mission statements, we must take on the much harder job of delivering what we say we do. Our choice here and now is whether we stand with Semmelweis.
