Thread by @PeterJBeaver

1. A friend shared frustration and incredulity that Cardiologists investigating her father’s heart issue during a hospital stay were unmasked. During a SARS2 surge. Cardiologists. Don’t they know SARS2 causes vascular damage?

It occurred to me, this is about culture.

THREAD(11)

2. Culture is irrational. We follow culture even when it contradicts science. Medical professionals are no different. An interesting medical objection to Semmelweis’ infection control work almost 200 years ago was “a gentleman’s hands are clean.” What could that mean?

3. The resistance to Semmelweis was cultural. How so? Medical culture is complex. But fundamentally it’s about helping through diagnosis & medication/surgery. That work is active – it’s about doing, it’s about actively pursuing a goal.

4. But medical culture is also about status. Doctors are socially important. Most of us will sooner or later depend on them and their abilities, to help us, and those we care for. Life and death is everything to us. Sometimes, doctors become like gods.

5. Status within medicine has some association with patient risk. Brain surgery = high risk = high status. Dermatology = low risk = low status.

6. Infection control (IC) is a risk issue. But it can be difficult to know who caused an infection. Which may be some of the reason IC is low status. Also, no one became a great doctor by having no infected patients.

7. The problem with IC is that it’s negative. IC tries to make something not happen. Western culture is a decisive culture. We prefer actively achieving goals to cautiously avoiding pitfalls. If you don’t infect your patients but you don’t cure them either, what’s the point?

8. In Western culture go-getters and risk-takers are rewarded, and their failures are forgiven. They tried to achieve a great outcome. Failure is the sometimes unfortunate price of decisiveness. If doctors are decisive, occasional infections must be forgiven.

9. Having “unclean hands” implies dirtiness, which implies low status. Maybe masking is similar. It implies a doctor could be dirty. Thinking of themselves as possible disease vectors could threaten medical status. Hence, “a gentleman’s hands are clean.”

10. We are deep into irrationality. Doctors won’t mask because it devalues them. Never underestimate the role of ego and appearance in social life. Especially within intensely competitive groups where people must display conformity with group values.

11. CONCLUSION: Whatever the science shows (and the evidence base is quiet corrupt anyhow) for cultural reasons the medical profession are unlikely to voluntarily implement masking with respirators to prevent SARS2 infection. Mandates are necessary.