I was originally scheduled today to do a couple of spine cases at one of our hospitals where I normally spend very little time, though it’s technically within my call “pod” region here. I got a text at 11 pm last night that re-shuffled today’s OR personnel in order to cover a specialized case that was added. So I was pulled back to the OB suite I usually cover, at a different hospital, to free up someone for the add-on. This was a relief for several reasons.

First, the substitute place is much closer to home. The nursing staff and obstetricians I work with are really chill and pleasant people, and I like the work itself. I know where everything is, so every case doesn’t seem like a burglary, with me rifling through drawers to find drugs and supplies.

But mainly it’s because, at the other place, I’m pretty sure I’d have been getting my balls broken by the nursing staff over something or other from the moment I set foot on the OR floor. It’s just how they seem to roll there.

Under pressure from government and 3rd-party payers, hospitals are focusing intensely on trying to further reduce the incidence of perioperative infections, which stubbornly persist in the single digits despite everything we’ve tried. Infections are costly, both in dollars and in lives, and reducing them is a worthy goal. But it’s become a point of contention between nursing, administration, and medical staff. A cynic or paranoid would suspect there are elements of a power struggle involved. But I’m Polly-Effing-Anna, so I’d never think such a thing.

Here’s a for-instance. They don’t like cloth scrub caps, because they’ve convinced themselves (based upon no evidence, and contrary to the little good evidence that does exist) that cloth surgical caps are more likely to be associated with infections. Never mind that a recent, well-conducted study debunked this notion pretty thoroughly. I can be assured that if I wear my favorite LSU cloth scrub cap, I’m going to get grief for grief’s sake from some functionary.

They also insist that we wear long-sleeved scrub “jackets” over our scrubs to cover our arms while in the OR, because they’re convinced themselves and the administration that all of the skin flakes cascading off of everyone’s bare arms are the cause of infections – again, an evidence-light assertion, but a convenient cudgel to wield against the medical staff. Nonetheless, because I’m perhaps the consummate Team Player, I told them I’d be happy to wear a jacket, but not to bring me one that’s two sizes too small. I also suggested, perhaps bitingly, that before implementing such a policy, they might have made sure to provide the means for compliance – like, say, stocking an adequate supply of jackets sized for those of us who aren’t wraiths.

Sadly, there’s a lot of this kind of low-grade aggravation besetting the practice of medicine, like a cloud of mosquitoes constantly biting the tender flesh around one’s ankles. It strikes many of us docs as pointless gamesmanship and dominance-seeking behavior, especially galling because there’s generally no scientific basis for any of it. I suppose every job has similar annoyances. Sucking it up and trying to keep my tongue in check is all I guess I can do.

Michael Sebastian @mikeseb