I felt awful about it. It wasn't a bad scratch. And when I apologized profusely, the patient just laughed. It didn't even leave a mark, at least not one that I could see. But I definitely felt my fingernail make facial contact.
My fingernails are not the long scary kind that start curling over on themselves. I could describe them, but a picture is worth a thousand words so this is the current state of my fingernails:
I don't paint them, but I keep them clean. I can't imagine cutting them really short, just because I feel like I use fingernails as a tool of sorts. I trim them maybe one a week or every other week.
But is it appropriate to have longish fingernails as a doctor? Am I obligated to cut them shorter?
I was told it's inappropriate... because of the hygiene issue.
ReplyDeleteI keep mine a bit shorter.
Agreed with Blondie. Take a culture of underneath your nails. I bet you'd trim them then.
ReplyDeleteThose look exactly like my nails.
ReplyDeleteI really need to trim mine in order to percuss, but I keep putting it off. Then I end up in a situation where I need to percuss a patient and I end up with terrible scratches on my knuckles and no good percussion for my effort. Sigh.
I hadn't even thought about the hygiene or scratching issues.
I keep mine a lot shorter than that. I can't stand the way typing feels when they get long at all. I think we're required to keep them short at the hospital.
ReplyDeleteAmanda: But you can probably say the same thing about white coats, for those who wear them. And ties, for sure. And stethoscopes, I bet. At least I wash my hands or use alcohol after every single patient.
ReplyDeleteWhile nails do have a crevice for germs to get caught, my daughter proves that even with very short nails, there's still huge potential to get visible dirt in those crevices. I am not convinced longer nails have much greater potential for germs than shorter nails. Unless the nails are cut down to nubs, which I doubt most people do.
Why not culture them while long and then cut them shorter and culture again?
ReplyDeleteMight be interesting to see if there's a difference.
Of course, this does nothing for the scratch issue, but it sounds like it's uncommon anyway.
Also, kids put their hands in things we won't and they get dirt places we don't as a result. So I don't buy the kid argument. Not unless you're digging in dirt with your kid. (Mine makes mud pies.)
M
OK, so, um, WHERE does everything think I'm getting my nails cultured (twice)?? Is this a feature of CVS that I'm not aware of?
ReplyDeleteHey, design a methodology, get a grant - you could probably get a couple of articles out of it.
ReplyDeleteBut yes, I'm sorry to agree that I think your pretty fingernails are too long for a doctor.
Most docs I've worked with have shorter nails...probably due to both hygiene and risk of scratching patients.
ReplyDeleteI did a quick seach in CINAHL and found a handful of articles suggesting that anything over 2 mm increases risk for infection. But so does wearing a ring and a wrist watch. Unless you're doing a surgical scrub, in which case your nail length doesn't matter but wearing nail polish does increase risk for infection.
ReplyDelete/tada
Uh oh... so between my nails, my ring, and my watch, I'm practically a petri dish :P
ReplyDeleteHannah: When you say risk for infection, what do you mean? Risk of getting an infection myself? Risk of colonization? Risk of infecting other patients?
lol, sorry. I guess you could probably be at risk for infecting yourself? The 4-5 studies I found all talked about increased colonization. Longer nails like staph, for instance. I'm assuming that doing a study to see if longer nails (or rings or wrist watches or nail polish) cause increased infections in the patient population would be almost impossible because you'd have to control for soooo many variables.
ReplyDeleteI foresee a time in the far away future when doctors will all practice bald and nude :)
ReplyDeleteWe DO usually desinfect our stethoscopes after every use? That said, my fingernails are much shorter, but they've always been. As long as you don't regularly scratch people, can work (somebody mentioned percussion) fine with then and pay attention to keeping them clean (maybe even getting desinfectant under there a bit) then I wouldn't have a problem purely because of lenghth. (From here the ring also looks like if you take care it can get desinfected from all sides.)
ReplyDeleteI do think it's inappropriate to have long fingernails but I'm a GP who does a lot of obstetrics and womens' health. My nails are usually trimmed so that you can't see the whites (a habit from when I used to play piano regularly). I've gotten in the habit of wiping my stethoscope with cavi wipes after each use as well.
ReplyDeleteI just did 3 months in London, and we were not allowed to wear white coats, watches, rings or long sleeves and the men were not allowed to wear ties.
Don't your fingernails cause problems with gloves? I saw a student nurse try to wear gloves over long nails, and she promptly stuck a hole right through one of the fingers.
ReplyDelete(And then the instructor caught a look at her hands, threw a fit, and sent her to find nail clippers immediately. But that's a different story and has to do with the school uniform policy.)
Scrub: I think I'd have to have much longer and/or sharper nails to poke holes in something. Never even came close to something like that.
ReplyDeleteWhen I was a med student a resident told me I really had to cut my nails because i kept on scratching him while we were positioning the patient on the OR table. Between that and the iodine scrub solution that makes my nails flake off, I've had short nails ever since. That being said, I have non-surgeon friends who have nice long painted nails and they seem to do fine in life. So I think it's probably a combination of personal preference and how much hands-on stuff you do over the course of hte day.
ReplyDelete@apotential - Kudos to you for still using the time-honored art of percussion. I thought all younger physicians just ordered CT scans and Echocardiograms instead of auscultating and percussing.
ReplyDeleteI miss wearing nail polish so much. And my hands used to be pretty, now they are a horror show. In fact, to go off on a tangent, I have developed a delightful little stress-related dermatitis on my dorsal MCP of my right hand that has been refractory to everything. I am now on oral steroids so I'm feeling no pain. But I'll say that all that hand sanitizer has not done wonders for my hands and I've decided to never use it again. I just hit the sinks.
ReplyDeleteIn summary: being a doctor is not compatible with being a hand model.