Medical Culture

Every time I’m in a crowded hospital waiting room, I wonder how the idea of cramming the sick and vulnerable together in a small indoor space survived a century and a half of germ theory.

We could discuss the ​alternatives​, bottlenecks, and incentives that led to this, but here, I want to focus on the cultural aspect.

Are you familiar with Semmelweis' story? Ignaz Semmelweis, a Hungarian physician, showed in 1847 that doctors’ failure to wash their hands caused the high number of deaths in Vienna’s maternity wards. He not only proposed this idea but also collected data and proved it, reducing his hospital’s maternal mortality rate from 18% to less than 2%. Yet other doctors rejected his findings and, rather than acknowledging his discovery, had him committed to an asylum, where he died. It took decades for doctors to accept that they should wash their hands.

Is this the first time you’ve heard this story? It should be more widely taught. A century and a half later, we still repeat the same mistakes: we know that disease spreads through germs and that germs require proximity, yet hospital waiting rooms remain crowded. That’s because we learned only the superficial lesson from Semmelweis’s story, that doctors must wash their hands, and not the deeper one: that culture and the status quo can blind even knowledgeable professionals to obvious truths.

The second lesson is so important that it should be a core point of high school education.

(Related: my essay on ​teaching tacit knowledge​)