What a 19th Century Physician Can Teach Us About 21st Century Healthcare

While excitement and optimism largely define a trip to the hospital for the delivery of a new baby today, a different emotion accompanied a visit to an 1840’s maternity ward.

Fear.

At that time, one in ten mothers would die before she left the hospital. Meanwhile, women who received care from non-physician midwives experienced much lower mortality.

But why?

Dr. Semmelweis, a young physician deeply troubled by this phenomenon, proposed what was then a revolutionary idea—perhaps something small and deadly was being transferred to the mothers? And perhaps the physicians participating simultaneously in both child delivery and autopsies (you read that correctly) could improve patient care by washing their hands with a chlorine solution?

In the first three months after instituting this new handwashing policy, death rates dropped from 10% to 1% of mothers. Dr. Semmelweis was clearly on to something, even if the science of the day couldn’t exactly explain why.

And handwashing has been a standard of care ever…

Not quite.

Dr. Semmelweis’ contemporaries ridiculed this innovation. They were offended by the insinuation that they could have participated in the transfer of deadly material (what would come to be known as bacteria). They undercut his ideas. They rejected change.

Decades would pass before the benefits of handwashing became more accepted later in the 19th century. Mean time, the medical establishment of the day harmed an untold number of patients.

Back in present day, unfortunately, this story remains all too familiar. A 2001 study from the National Academy of Medicine reported it takes as long as 17 years for the findings of randomized controlled trials, the gold standard in science, to become integrated into practice.

This brings us to surgery, a particularly costly and consequential portion of any person’s health journey and of the healthcare system overall. Since its inception over a decade ago, Enhanced Recovery After Surgery (ERAS) has amassed hundreds of peer-reviewed articles supporting the benefits:

  • Fewer complications
  • Less pain
  • Higher patient (and provider) satisfaction
  • And faster return to normal activities, including work

Semmelweis may not recognize much about today’s approach to healthcare, but he would recognize the tremendous opportunity to follow the evidence and transform care.

There is too much at stake not to.

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